中文摘要：

目的 探讨超声引导经皮微波治疗肝转移癌的疗效和影响生存率的因素。方法 1995年7月至2005年6月北京解放军总医院超声科行微波局部消融治疗肝转移癌128例患者282个肿瘤，原发灶分别为食道、胃肿瘤26例，结肠、直肠肿瘤44例，乳腺癌19例，肺癌15例，其他部位恶性肿瘤24例。肿瘤最大直径0．7～8．6cm（平均3．5cm±1．6cm）。根据肿瘤的大小分组：直径≤3．0cm64例140个结节；直径〉3．0cm64例142个结节。根据肿瘤的个数分组：单发47例，2个44例，3个或3个以上37例。根据肿瘤的分化程度分组：低分化57例、中分化53例和高分化18例。生存率的单因素分析采用Kaplan-Meier方法；显著性检验采用Log rank方法；生存率的多因素分析采用Cox逐步回归方法。结果 平均随访时间30个月±20个月（1～103个月）。1、2、3、4、5年的累计生存率分别为90．88％、73．84％、51．09％、36．14％、31．89％。单因素分析肿瘤的大小（P=0．028）、分化程度（P=0．026）和病灶有无复发或转移（P〈0．001）对生存率的影响有显著性差异；多因素分析病灶大小（P=0．035）、有无复发或转移（P=0．001）及肿瘤的分化程度（P=0．038）对生存的影响有显著性差异。结论 超声引导下微波消融治疗肝转移癌对肿瘤直径小于3．0cm、分化较好且无复发或无肝内外转移的肝转移癌有较好的远期疗效。

英文摘要：

Objective To explore therapeutic results of local microwave ablation for hepatic metastasis and the factors influencing the survival after pereutaneous microwave ablation therapy. Methods From July 1995 to June 2005 128 patients with 282 hepatic metastases nodules with the primary diseases of upper gastrointestinal tumor （n =26）, colorectal tumor （ n =44） , breast carcinoma （ n = 19）, pulmonary carcinoma （ n = 15 ） , and malignant tumor in other part of the body （ n = 24 ） , underwent pereutaneous microwave ablation therapy and were followed up for 29.7 ± 19.9 months （ 1 ～ 103 months）. The largest diameter of the metastatic nodules was 3.5 ± 1.6 cm （0.7 ～ 8.6 cm）. Sixty-four cases had 140 nodules ≤ 3.0 cm in diameter, and 164 cases had 142 nodules 〉3.0 cm in diameter. Forty-seven patients had single nodule, 44 patients had 2 nodules, and 93 patients had 3 or more nodules. Fifty-seven patients had tumor of low differentiation, 53 had tumor of middle differentiation, and 18 had highly differentiated tumors. Kaplan- Meier method was used to calculate the cumulative survival rate. Statistical comparison of the effects of potential predictive factors on survival rate was performed using log-rank analysis. Multivariate analysis of the survival rates was performed by using Cox＇s proportional hazard model. Results The 1, 2, 3, 4, and 5- year cumulative survival rates of all 128 patients were 90. 88%, 73. 84%, 51.09%, 36. 14%, and 31.89% respectively. Univariate analysis showed that tumor size （P = 0. 028 ）, tumor differentiation （P = 0. 026） and local recurrence or new metastases （P 〈0.001 ） significantly affected the survival. Multivariate analysis revealed that tumor size （ P = 0. 035 ） , recurrence or new metastases （ P = 0. 001 ） and tumor differentiation （P = 0.038） each had a significant effect on survival. Conclusion. There is a significantly higher probability of long-term survival for patients with well-differentiated tumors 3.0 cm or less in diam