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目的评估经肝动脉化疗栓塞(TACE)联合同步射频消融(RFA)治疗单个大肝癌(肿瘤最大直径≥5 cm)的安全性和疗效。方法对2010年1月至2012年6月间18例原发性肝细胞癌患者单个病灶(平均最大直径7.5 cm,5.1~15.5 cm)进行了联合TACE和同步RFA治疗。评估联合技术成功率、技术相关并发症、局部肿瘤治疗反应、无疾病复发时间、随访患者存活率。结果技术成功率100%,介入治疗后1个月复查,局部病灶以凝固性坏死为主,病灶完全缓解17例,部分缓解1例,完全缓解率94.44%(17/18)。随访过程中(2~29个月),17例病灶完全缓解患者平均无疾病复发时间为(16.8±4.0)个月。18例患者6、12、18个月生存率均为100%。所有患者均未发生严重并发症,17例患者术后ALT和AST出现一过性升高。3例患者需经吗啡和芬太尼加强止疼后,疼痛明显缓解。结论联合TACE和即时同步RFA治疗单个大肝癌安全、有效。疼痛是同步联合治疗主要不良反应,经持续镇痛后可耐受。
Objective To evaluate the safety and efficacy of transcatheter arterial chemoembolization (TACE) combined with simultaneous radiofrequency ablation (RFA) in the treatment of single large hepatocellular carcinoma (maximal tumor diameter ≥5 cm). Methods A total of 18 patients with primary hepatocellular carcinoma from January 2010 to June 2012 were treated with TACE combined with simultaneous RFA for single lesions (mean maximum diameter 7.5 cm, 5.1-15.5 cm). Assess joint technology success rate, technology-related complications, local tumor response, time to disease-free relapse, and follow-up of patient survival. Results The technical success rate was 100%. One month after interventional treatment, the local lesion was mainly coagulation necrosis. The complete remission was achieved in 17 cases and partial remission in 1 case. The complete remission rate was 94.44% (17/18). During the follow-up period (range 2 to 29 months), the average time to disease-free relapse in 17 patients with complete remission was (16.8 ± 4.0) months. The 18-month survival rates of all patients at 6, 12 and 18 months were 100%. No serious complications occurred in all patients, and postoperative ALT and AST in 17 patients were transiently elevated. 3 patients required morphine and fentanyl to enhance pain relief, the pain was relieved. Conclusion The combination of TACE and real-time synchronized RFA for the treatment of single large hepatocellular carcinoma is safe and effective. Pain is the main side effect of concurrent treatment, tolerable after sustained analgesia.