World J Gastroenterol. 2013 Jul 14;19(26):4192-9. doi: 10.3748/wjg.v19.i26.4192.
Transcatheter arterial chemoembolization followed by immediate radiofrequency
ablation for large solitary hepatocellular carcinomas.
Wang ZJ, Wang MQ, Duan F, Song P, Liu FY, Chang ZF, Wang Y, Yan JY, Li K.
Department of Interventional Radiology, PLA General Hospital, Beijing 100853,
AIM: To assess the technical safety and efficacy of transcatheter arterial
chemoembolization (TACE) combined with immediate radiofrequency ablation (RFA)
for large hepatocellular carcinomas (HCC) (maximum diameter ≥ 5 cm).
METHODS: Individual lesions in 18 patients with HCCs (mean maximum diameter: 7.5
cm; range: 5.1-15.5 cm) were treated by TACE combined with percutaneous RFA
between January 2010 and June 2012. All of the patients had previously undergone
one to four cycles of TACE treatment. Regular imaging and laboratory tests were
performed to evaluate the rate of technical success, technique-related
complications, local-regional tumor responses, recurrence-free survival time and
survival rate after treatment.
RESULTS: Technical success was achieved for all 18 visible HCCs. Complete
response (CR) was observed in 17 cases, and partial response was observed in 1
case 1 mo after intervention. The CR rate was 94.4%. Local tumors were mainly
characterized by coagulative necrosis. During follow-up (2-29 mo), the mean
recurrence-free survival time was 16.8 ± 4.0 mo in 17 cases of CR. The estimated
overall survival rate at 6, 12, and 18 mo was 100%. No major complications were
observed. Levels of alanine aminotransferase (ALT) and aspartate aminotransferase
(AST) in the blood of 17 patients transiently increased on the third day after
treatment (ALT 200.4 ± 63.4 U/L vs 24.7 ± 9.3 U/L, P < 0.05; AST 228.1 ± 25.4 U/L
vs 32.7 ± 6.8 U/L, P < 0.05). Severe pain occurred in three patients, which was
controlled with morphine and fentanyl.
CONCLUSION: TACE combined with immediate RFA is a safe and effective treatment
for large solitary HCCs. Severe pain is a major side effect, but can be
controlled by morphine.
2011卫生部 原发性肝癌诊疗规范 肝癌的鉴别诊断
肝癌检查 首选B超 经济实惠