目的探讨超声引导经皮热消融治疗肝内胆管细胞癌(intrahepatic cholangiocarcinoo—ma,ICC)的临床价值。方法1998年10月至2009年8月,14例经病理确诊的ICC患者(19个结节)于我院接受了超声引导下经皮热消融(微波或射频消融)治疗。本文对14例消融治疗的并发症及长期生存进行了回顾性分析。结果18个结节完全消融(18/19,94.7%),1个(1/19,5.3%)消融不全。14例无一发生与消融相关的死亡,仅出现1例(1/14,7.1%)门静脉血栓。随访时间1.3~72.9个月(平均19.0个月士15.1个月,中位7.3个月)。生存1年以下、1~5年、5年以上的患者分别为10例(10/14,71.4%)、2例(2/14,14.3%)、2例(2/14,14.3%)。随访期间死亡9例(9/14,64.3%),存活5例(5/14,35.7%),肿瘤复发9例(9/14,64.3%)。治疗后无瘤生存期1.1~72.9个月(平均16.6个月±26.3个月,中位4.1个月)。结论超声引导经皮热消融治疗ICC安全、有效,具有临床应用价值。
Objective To evaluate the clinical value of percutaneous ultrasound (US)-guided thermal ablation of intrahepatic cholangiocarcinoma. Methods 14 patients (19 nodules) with histolog- ically proven intrahepatic cholangiocarcinoma (ICC) were treated with percutaneous US-guided ther- mal ablation from Oct. 1998 to Aug. 2009 in our hospital. The local treatment response, complication and survival were retrospectively analyzed. Results 18 (18/19, 94.7%) nodules had complete necro- sis, and 1 (1/19, 5.3 ~) nodule had residual tumor after ablation. There was no mortality associated with thermal ablation. Only 1 (1/14, 7.1 ~) patient developed portal vein thrombosis. The follow-up ranged from 1.3 to 72.9 months (mean, 19.0__. 15. 1 months; median, 7.25 months), 10 (10/14, 71.4~) patients survived less than 1 year, 2 (2/14, 14.3~) survived 1-5 years, and 2 (2/14, 14.3%) survived more than 5 years. Of the 14 patients, 9 (9/14, 64.3~) had died and 5 (5/14, 35.7~/oo) were alive. The causes of death included tumor progression (8/9, 88.90//oo) and liver failure (1/9, 11.1~). 9 (9/14,64.30//oo) patients developed recurrence on follow-up. The disease-free sur- vival ranged from 1.1 to 72.9 months (mean 16.6+26.3 months; median 4.1 months). Conclusion Percutaneous US-guided thermal ablation therapy using microwave ablation (MWA) or radiofrequency ablation (RFA) is a safe and effective therapy for intrahepatic cholangiocarcinoma.