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原发性肝癌射频消融术后针道转移再消融治疗效果分析
Clinical effect of ablation in treatment of needle tract implantation after radiofrequency ablation for primary liver cancer
文章发布日期:2019年03月07日  来源:  作者:鹿宁宁,王海燕,张英华,等  点击次数:337次  下载次数:70次

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【摘要】:目的研究原发性肝癌射频消融术后针道转移危险因素及消融术治疗效果。方法回顾性分析2017年1月-2018年10月4例原发性肝癌射频消融术后发生针道转移在首都医科大学附属北京佑安医院肝病与肿瘤介入治疗中心行消融术再治疗的患者临床资料,评价危险因素、消融治疗效果及术后并发症发生情况。结果4例患者肝内肿瘤病灶均临近肝包膜,低分化肝细胞癌2例,中分化肝细胞癌1例,高分化肝细胞癌1例。消融术后发生针道转移时间间隔为3.6~14.3个月,针道转移病灶数目均为单发,3例位于前腹壁,1例位于右侧侧腹壁。后行氩氦刀冷冻消融术治疗3例,射频消融术治疗1例。术后2例患者出现发热及暂时性疼痛加重,给予对症治疗后症状缓解,无严重并发症发生。术后1个月复查增强CT显示3例患者转移灶完全消融,随访2~19个月无复发。1例患者局部病灶残余,但疼痛症状较前明显缓解,随访3个月残余灶无明显增大。所有患者术后1个月血清AFP及异常凝血酶原值均明显下降。结论消融治疗尤其是氩氦刀消融术治疗腹壁针道转移灶具有疗效确切、并发症少、耐受性好的优势,对于无法耐受外科手术或不愿意行外科手术的患者是一种较好的治疗选择。
【Abstract】:ObjectiveTo investigate the risk factors for needle tract implantation after radiofrequency ablation for primary liver cancer and the clinical effect of ablation. MethodsA retrospective analysis was performed for the clinical data of 4 patients with needle tract implantation after radiofrequency ablation for primary liver cancer who underwent ablation therapy in Center of Interventional Oncology and Liver Diseases, Beijing YouAn Hospital, from January 2017 to October 2018. Risk factors, the clinical effect of ablation, and complications were analyzed. ResultsAll four patients had intrahepatic tumor lesions located near the Glisson′s capsule, and among these patients, two had poorly differentiated hepatocellular carcinoma (HCC), one had moderately differentiated HCC, and one had well-differentiated HCC. The time from radiofrequency ablation to needle tract implantation ranged from 3.6 to 14.3 months, and all four patients had a single lesion of needle tract implantation, which was located at the anterior abdominal wall in three patients and at the right abdominal wall in one patient. Of all patients, three underwent argon-helium cryoablation, and one underwent radiofrequency ablation. Two patients experienced pyrexia and transient aggravation of pain after surgery, and the symptoms were relieved after symptomatic treatment. No serious complication was observed. Contrast-enhanced computed tomography performed at one month after surgery showed complete ablation of metastatic lesion in three patients, with no recurrence after follow-up for 2-19 months. One patient was found to have local residual lesion, with marked relief of pain, and no enlargement of the residual lesion was observed after follow-up for 3 months. All patients had significant reductions in serum alpha-fetoprotein and abnormal prothrombin at one month after surgery. ConclusionAblation therapy, especially argon-helium cryoablation, has a good clinical effect in the treatment of needle tract implantation at the abdominal wall, with the advantages of few complications and good tolerability. Therefore, it is a good choice for patients who cannot tolerate surgical operation or are unwilling to undergo surgical operation.
【关键字】:癌, 肝细胞; 消融术; 治疗结果
【Key words】:carcinoma, hepatocellular; ablation; treatment outcome
【引证本文】:LU NN, WANG HY, ZHANG YH, et al. Clinical effect of ablation in treatment of needle tract implantation after radiofrequency ablation for primary liver cancer[J]. J Clin Hepatol, 2019, 35(4): 813-817. (in Chinese)
鹿宁宁, 王海燕, 张英华, 等. 原发性肝癌射频消融术后针道转移再消融治疗效果分析[J]. 临床肝胆病杂志, 2019, 35(4): 813-817.

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