摘要目的 总结肝癌射频消融(RFA)的临床经验并探讨评价RFA疗效的方法 .方法 对49例肝癌病人进行了统一方案的RFA治疗,其中男43例,女6例;年龄39～72岁,平均(56.4±9.3)岁.肿瘤直径1.5～10 cm,其中≤3 cm 16例,3.1～5 cm 15例,>5 cm 18例.按肝功能Child-Pugh分级,A级41例,B级8例.病理诊断为肝细胞癌44例,胆管细胞性肝癌5例.采用RITA射频消融肿瘤治疗系统(RF-1500)行RFA.在RFA后3～4周常规行CT及TACE,以评价肝癌RFA的效果及巩固疗效.结果 全部病例RFA术后恢复顺利,总体1、2、3年生存率为77.5%、56.5%和44.0%,肝癌RFA后3～4周,AFP阳性(≥25μg/L)者转阴率62.9%(22/35).改进的肝癌RFA方法 可对直径5 cm以下的肿瘤进行比较彻底的消融,≤5 cm者1、2、3年生存率为100%、79.6%和61.9%.将肝癌消融近期疗效分为3个级别,RFA术后获得根治性消融(19例)、亚根治消融(9例)、姑息性消融(21例)者2年生存率分别为85.7%、60.0%和24.3%.结论 肝癌RFA相当于从机能上切除了肿瘤,肝癌消融近期疗效三级分类法可以比较客观地评价RFA的效果,以指导辅助治疗的选择.

abstractsObjective To summarize the experience in treatment of unresectable primary liver cancer (PLC) with radiofrequency ablation (RFA) and evaluate the outcome. Methods Over a 3-year period, 49 consecutive patients with solitary or muhinodular PLC (Child-Pugh class A or B) under-went RFA. Histopathologic types were of hepatocellular carcinoma in 43 cases and of cholangio-carci-noma in 6. The tumor size was 1.5-- 10. 0 cm. RFA was performed by a RITA expandable electrode device(RF-1500) followed by TACE administration 3-4 weeks later. Local efficacy was evaluated with computed tomography (CT) performed at an average of 4 weeks after RFA treatment and then during follow-up. Results There were no severe complications after RFA in all the patients. The total 1, 2 and 3-year survival rates were 77.5%, 56.5% and 44.0%, respectively. Tumors no more than 5cm in diameter could be ablated inside out. The 1, 2 and 3-year survival rates were 100%, 79.6%, 61.9%, respectively. The treatment response of RFA was assessed as curative ablation (complete tumor ablation with 0.5-1 cm ablative margin) in 19 cases, sub-curative ablation (complete tumor ablation with less than 0.5 cm ablative margin) in 9 cases,non-curative (noncomplete) ablation in 21 cases. The 2-year survival rate was 85.7 %, 60.0% and 24.3%, respectively, in patients with differ-ent types of response. Conelusion RFA has similar effect as resection of PLC on small tumors. The classification method for the evaluation of RFA display the results in 3 grades, and it is useful for the selection of adjuvant therapy.