经皮冷消融联合酒精注射治疗不能切除的肝细胞癌/Percutaneous cryoablation combined with ethanol injection for unresectable hepatocellular carcinoma
Xu Kecheng , Niu Lizhi, Hu Yigang et al.
[Abstract]
Objective To evaluate the effectiveness and safety of percutaneous hepatic cryoablation combined with percutaneous ethanol injection( PEI) for patients with hepatocellular carcinoma ( HCC) unsuitable for surgical resection.
Methods One hundred and five masses in 65 HCC patients underwent percutaneous hepatic cryoablation. The cryoablation was performed using Argon gas as a cryogen in the Cryocare System. Two freeze thaw cycles were performed, each reaching a temperature of-180 C at the tip of the probe. PEI was g iven 1 or 2 w eeks after cr yoablation and then once a week for 4-6 weeks in 36 patients with
tumor mass larger than 6 cm in diameter. Absolute alcohol( 100%) was slowly injected into periphery zone of cancerous tissues in liver . Results During average 16 months follow-up duration ( ranging 5 to 21 months), 32 patients( 49. 2%) were alive without tumors, and 22 patients (33. 8%) were alive with tumor recurrence two had bone metastases, three lung metastases and the remaining 17 tumor recurrences in the liver, of whom only 3 developed at a cryoalbation site. Among 41 patients who had been followed up more than one year, there were 32( 78%) patients who were alive with or without tumor recurrence. Eight patients (12. 3%) died of tumor recurrence. Three patients( 4. 6%) died of noncancer related causes. Among 43 patients who had under gone CT scan, 38 ( 88. 4%) had a shrinkage of tumor mass. Among 22 patients who had received biopsies of cryoablated tumor mass, all but one biopsy showed necrotic or scar tissues. Serum AFP in 91. 3% of the patients whose serum AFP had increased before cryoablation returned to normal or nearly normal levels during postoperative 3-6 months. Complications of cryoablation included liver capsular cracking in one patient, transient thrombocytopenia in 4 patients and asymptomatic right sided pleural effusions in 2 patients. Two patients developed liver abscess at the previous cryoablation sites after postoperative 2 and 4 months respectively and recovered after the treatment with antibiotics and drainage.
Conclusions Percutaneous cryoablation may offer a safe and effective option for patients with HCC that cannot be surgically removed.
[Key words] Hepatocellular carcinoma; Cryoablation; Percutaneous ethano l injection; Treatment
