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  【摘要】 目的 探讨肝动脉化疗栓塞术(TACE)联合微波凝固(PMCT)治疗小肝癌的疗效。方法 25例原发性肝癌患者,共28个病灶,直径均≤3 cm。先予行TACE,2～4周后在CT引导下行PMCT。结果 治疗后予穿刺活检及CT扫描,显示28个病灶完全性坏死,其中25个病灶周边正常肝实质有约3～5 mm完整环状坏死,3个病灶周边正常肝实质环状坏死不完整。20例AFP升高者,治疗后4周内AFP降至正常水平。随访6～24个月,均未见复发。随访期内患者均存活。结论 TACE联合PMCT治疗小肝癌,疗效确切、安全、无严重并发症,是治疗小肝癌较理想的综合治疗方法。

 【关键词】 肝细胞癌;肝动脉化疗栓塞术;微波凝固治疗

 【Abstract】 Objective To explore the therapeutic efficacy of transcatheter arterial chemoembolization(TACE)in combination with percutaneous microwave coagulation therapy(PMCT)in the treatment of small hepatocellular carcinoma.Methods 25 patients with 28 hepatocellular carcinoma nodules which were less than 3 cm in diameter were treated with TACE and continued to perform CT-guided PMCT within 2～4 weeks.Results By biopsies and enhanced CT scans,complete necrosis of the tumor and the noncancerous area about 3～5 mm surrounding was obtained in 25 nodules,incomplete necrosis of the parenchyma surrounding in 3 nodules.Serum AFP level returned to normal level after treatment 4 weeks in 20 patients who originally had a high serum AFP level.The follow-up period was 6～24 months and all patients remained alive.NO patient had a recurrence.Conclusion Therapy of TACE in combination with PMCT for small HCC is a safe,effective and perfect treatment without severe complications.

 【Key words】 Hepatocellular carcinoma;Transcatheter arterial chemoembolization;Percutaneous microwave coagulation therapy

 原发性肝癌是临床上常见的恶性肿瘤之一,手术切除仍是目前肝癌治疗的首选方法。但各种非手术疗法的作用日趋重要,其中肝动脉化疗栓塞术(TACE)是肝癌非手术治疗中的首选方法;经皮穿刺微波凝固治疗(percutaneous microwave coagulation therapy,PMCT)因热效率高、凝固范围可靠、创伤小、并发症少等优点已在临床上得到了广泛应用,其对小肝癌的治疗可达到根治的效果。本文总结了采用TACE联合PMCT治疗小肝癌的资料,报告如下。

 1材料与方法

 1.1病例资料25例患者为我院2007-05—2009-11期间住院病人,其中男性21例,女性4例;年龄22～78岁,平均(62.21±10.48)岁。病灶数目共28个,肝内单个病灶者22例,2个病灶者3例;AFP升高者20例;HBsAg阳性者23例。病例入选标准:原发性肝癌患者,单个肿瘤直径≤3 cm,总数不超过2个;无肝外病灶;无门静脉癌栓。所有患者按原发性肝癌诊断标准[1](21例)或经肝穿刺病理活检证实(4例)。按Child-Pugh分级,所有病例肝功能均为A级。治疗过程中均未接受其他方式的抗癌治疗。

 1.2仪器设备TACE治疗所用仪器为GE公司生产的ADVANTX LCV+/DLX数字减影血管造影机,Medrad Mark V Provis高压注射器。微波仪器:南京庆海微波电子研究所研发的FORSEA MTC-3型组织间肿瘤微波凝固治疗仪,微波发射频率2 450 MHz,功率5～100 W,时间1～99 min连续可调,配置的电极针杆为14 G,采用冷水循环系统冷却。

 1.3治疗方法所有病例首先选择TACE治疗。采用Seldinger技术经股动脉穿刺插管,先行腹腔动脉和肠系膜上动脉造影,了解肝肿瘤位置、数目、大小及血供情况 ......