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目的:探讨经皮微波固化(PMCT)治疗门静脉(肝动脉)、肝静脉及肝后下腔静脉旁复发性肝癌的安全性及疗效。方法:对2006年8月—2012年10月收治的不能手术切除的肝内大血管(门静脉或肝动脉、肝静脉及肝后下腔静脉)旁复发性肝癌患者采用微波固化治疗,77例患者共105个肿瘤结节,肿瘤直径1.5～7cm[(2.9±1.4)cm]。微波治疗172次。治疗前后检查AFP、B超,观察患者的术后并发症。结果:全组均未发生与PMCT治疗相关的死亡,并发症以肝区疼痛、发热、转氨酶及总胆红素一过性升高为主,经对症处理后均好转。无肝破裂大出血、胆瘘等严重并发症。66例术前AFP明显增高患者,治疗1个月后AFP转阴或明显下降56例(72.7%)。术后3个月B超提示32个(30.5%)肿瘤结节外径缩小,60个(57.1%)肿瘤结节停止生长。随访1年存活72例(93.5%)。结论:PMCT治疗门静脉(肝动脉)、肝静脉及肝后腔静脉旁复发性肝癌安全有效,可用于肝内大血管旁的复发性肝癌患者。
Objective: To investigate the percutaneous microwave curing (PMCT) treatment of portal vein (hepatic artery), hepatic vein and retrohepatic inferior vena cava recurrent liver cancer safety and efficacy. Methods: The patients with unresectable intrahepatic major blood vessels (portal vein or hepatic artery, hepatic vein and retrohepatic inferior vena cava) who underwent resection of the liver cancer were treated with microwave radiation from August 2006 to October 2012. Totally 77 patients A total of 105 tumor nodules, tumor diameter 1.5 ~ 7cm [(2.9 ± 1.4) cm]. Microwave treatment 172 times. Before and after treatment check AFP, B ultrasound, observation of patients with postoperative complications. Results: No death related to PMCT was found in all groups. The complications were mainly liver pain, fever, transaminase and total bilirubin. The symptoms were all improved after symptomatic treatment. Hepatic bleeding without rupture, biliary fistula and other serious complications. Sixty-six cases (72.7%) of AFP were found to be negative or significantly decreased after 1 month of treatment. At 3 months after operation, 32 (30.5%) tumors showed smaller diameter of the tumor nodules and 60 (57.1%) of the tumor nodules stopped growing. One year follow-up survival 72 cases (93.5%). Conclusion: PMCT is safe and effective for the treatment of recurrent hepatocellular carcinoma in the portal vein (hepatic artery), hepatic vein and posterior hepatic vena cava. It can be used in patients with recurrent hepatocellular carcinoma beside the large intrahepatic vessels.