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- 小型肝細胞癌
頁籤選單縮合
題名 | Percutaneous Local Ablation Therapy in Small Hepatocellular Carcinoma=小型肝細胞癌的經皮局部消除療法 |
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作者 | 林錫銘; 林灯寅; | 書刊名 | 長庚醫學 |
卷期 | 26:5 2003.05[民92.05] |
頁次 | 頁308-314 |
分類號 | 415.5362 |
關鍵詞 | 小型肝細胞癌; 經皮酒精注射; 經皮醋酸注射; 無線高頻消除治療; 微波電凝治療; Small hepatocellular carcinoma; Percutaneous ethanol injection; Percutaneous acetic acid injection; Radiofrequency ablation; Microwave coagulation therapy; |
語文 | 英文(English) |
中文摘要 | 以超音波及血清甲型胎兒蛋白檢查,定期篩檢慢性肝炎或肝硬化患者,已能大規模的早期發現小型肝癌(指數目[]3個、每個最大直徑[]3公分)。雖然手術切除仍為完全根治性療法的最優先選擇,但是術後五年的存活率仍只能與局部消除療法相當。時下的數種局部消除療法經常具有簡易、安全、可重覆操作的特性,它們包括經皮酒精注射(PEI),經皮醋酸注射(PAI),無線高頻消除(RFA)、以及微波電凝治療(MCT)。PEI及PAI的機轉是藉由酒精(99.5%)或醋酸(25%-50%)在腫瘤內造成脫水、蛋白質變性、細血管栓塞造成腫瘤缺血壞死的效果,RFA及MCT則藉由導電探針放射出的高頻及微波產生熱量造成凝結性壞死。依照過去比較性的研究結果顯示,RFA具有可以造成較大範圍的壞死、治療次數最少而且灼燒範圍最能臆測等優點,因此在四種方法中為最優先選擇。PAI僅有的一篇仍具爭議性的文獻報告中指出,因為治療次數較少且有較高的腫瘤壞死率,因此優於PEI。然而因為PEI較無嚴重的副作用如膽管炎、腎衰竭或肝膿瘍,因此在沒有RFA的裝備下,PEI仍被絕大多數的醫學中心視為最佳的治療。這四種治療的腫瘤完全壞死率在RFA約為90-98%,PEI為80-95%,PAI為90-95%,MCT則為94%。整體四種經皮局部消除療法的第一年存活率約為90%,第三年為70%,第五年為40-50%。結論:對大多數小型肝癌的經皮局部消除療法,RFA為最優先的選擇治療方法,若無RFA,則PEI為最佳選擇。 |
英文摘要 | Periodic screening programs conducted in various countries, applying sonography and serum alfa-fetoprotein to patients with chronic liver disease, have identified numerous small hepatocellular carcinoma (HCC). Although surgical resection is generally preferred for curative ablation, the long-term survival rates following resection are no better than those following local ablation. Current local ablation modalities are typically easily performed, safe and repeatable procedures, and include percutaneous ethanol injection (PEI), percutaneous acetic acid injection (PAI), radiofrequency ablation (RFA) and microwave coagulation therapy (MCT). The mechanisms of PEI or PAI are based on the dehydration, intracellular protein damage, and thrombo-ischemic effects of absolute ethanol or acetic acid on the tumor cells. Meanwhile, the mechanisms of RFA or MCT are based on the generation of friction heat between the tissue and electric current or microwave emitted by an RF or microwave electrode into the tumor. The heat causes coagulation, followed by cellular death as soon as the temperature in the target area exceeds 60[]C. From previous comparative studies of these procedures, RFA may be superior to PEI, PAI or MCT owing to its larger ablation volume, fewer treatment sessions and more predictable ablation size. The rate of complete necrosis of the target tumors was approximately 90-98% by RFA, 80-95% by PEI, 90-95% by PAI and 94% by MCT. Moreover, the survival rates of these four modalities were approximately 90% at 1 year, 70% at 3 years, and 40-50% at 5 years. In tentative conclusion, RFA is the preferred local ablation therapy for most small HCC. However, PEI is a useful alternative where RFA is unavailable. |
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