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目的评估经皮热消融治疗可再手术切除复发性肝细胞癌(RHCC)的临床疗效。方法 37例肝切除后 RHCC,肿瘤直径1.2～7.0 cm,平均(2.8±1.3)cm,临床评估可再切除但由于病人不愿意接受手术,采用超声引导经皮微波消融(MWA)或射频消融(RFA)治疗,观察局部疗效、治疗并发症和远期生存情况。结果肿瘤完全消融率(完全灭活率)91.9%(34/37),其中直径≤3 cm结节为95.8%、3 cm 以上者84.6%。并发症发生率5.4%(2/37),无治疗死亡。平均随访(20.5±14.4)个月,肿瘤局部复发与肝内远处复发率分别为21.2%、72.2%。消融后1、3年无瘤生存率分别为35.9%、17.4%,中位无瘤生存期为6.7个月;消融后1、3及5年累积生存率分别为70.0%、35.3%和35.3%,中位生存期为32.6个月;初次肝切除后1、3、5及10年生存率分别为85.1%、63.4%、41.0%和37.6%,中位生存期47.0个月。结论经皮热消融技术是可再手术切除 RHCC 的有效治疗手段。
Objective To evaluate the clinical efficacy of percutaneous thermal ablation for the reoperation of recurrent hepatocellular carcinoma (RHCC). Methods 37 cases of RHCC after hepatectomy, tumor diameter 1.2 ~ 7.0 cm, average (2.8 ± 1.3) cm, clinical assessment of re-excision but because the patient is not willing to accept surgery, using ultrasound guided percutaneous microwave ablation (MWA) or radiofrequency ablation ( RFA) treatment, observed local efficacy, treatment complications and long-term survival. Results The rate of complete tumor ablation (completely inactivated rate) was 91.9% (34/37), of which 95.8% were nodules with diameter ≤ 3 cm and 84.6% were above 3 cm. The incidence of complications was 5.4% (2/37) and no treatment death. After a mean follow-up of (20.5±14.4) months, local recurrence of tumor and distant recurrence in liver were 21.2% and 72.2%, respectively. The tumor-free survival rates were 35.9% and 17.4% in the 1 and 3 years after ablation, and the median disease-free survival time was 6.7 months. The cumulative survival rates at 1, 3, and 5 years after ablation were 70.0%, 35.3%, and 35.3%, respectively. The median survival time was 32.6 months; the 1-, 3-, 5-, and 10-year survival rates after primary hepatectomy were 85.1%, 63.4%, 41.0%, and 37.6%, respectively, and the median survival time was 47.0 months. Conclusion Percutaneous thermal ablation is an effective treatment for re-surgical removal of RHCC.