Abstract
目的 探讨超声引导下肝癌射频消融局部疗效的影响因素.方法超声引导下经皮射频消融治疗72例肝癌118个结节,肿瘤直径1.0～8.8 cm.对≤2.0 cm结节单点消融,2.0 cm以上者采用多点消融,能量输出每次10 min,电极先端温度达到95℃持续至少6 min.结果结节完全消融(CA)率89.0%(105/118).≤3 cm结节CA率97.6%(82/84),＞3 cm者为67.6%(23/34)(P<0.001).接近胆囊、胆管、胃肠、大血管等重要结构的肿瘤CA率60.0%(15/25),非接近者96.8%(90/93),P＜0.01.术后经2～26个月随访,局部复发11例(9.7%).≤3 cm结节局部复发率6.0%(5/84),＞3 cm结节20.0% (6/30)(P<0.05).接近重要结构的肿瘤局部复发率38.1%(8/21),非接近者3.2%(3/93),P＜0.01.结论肿瘤的大小和位置是影响射频消融治疗肝癌局部效果的重要因素.改进穿刺导向和布针技术,对特殊部位的肿瘤采取特殊的处理措施,有可能在一定程度上提高局部疗效。
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