Treatment of small hepatocellular carcinoma with acetic acid percutaneous injection -: A single French center experience
Treatment of small hepatocellular carcinoma with acetic acid percutaneous injection -: A single French center experience
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DOI：
10.1016/s0399-8320(05)82203-1
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发表时间：
2005-12-01
影响因子：
--
通讯作者：
Rosmorduc, O
中科院分区：
文献类型：
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作者：
Fartoux, L;Arrive, L;Rosmorduc, O
使用醋酸的经皮消融术是一种有吸引力的方法，因为其发病率低，诱导肿瘤完全坏死所需的会话次数少。此外，实时荧光透视CT扫描可以通过改善肿瘤内坏死因子的分布来改善技术目的：确定在法国一个中心的一系列小肝癌患者中，在CT荧光透视引导下经皮注射乙酸的可行性和长期结果。1999年至2000年期间，对102例肝细胞癌患者进行了治疗评价。荧光透视CT扫描引导经皮醋酸消融术的选择标准为：1）1至3个结节< 5 cm; 2）Child-Pugh分级< 13; 3）凝血酶原指数> 40%和血小板计数> 50000/mm（3）和4）禁忌切除和肝移植。治疗后随访包括超声、磁共振和甲胎蛋白水平，每3个月一次。使用Kaplan-Meier方法估计复发率和生存率。结果：49例患者（48%）可以从根治性治疗中受益，其中大多数（37/49）符合荧光透视CT扫描引导经皮乙酸。平均随访时间为24.4 ± 2.7个月。平均1.6次治疗后，28例患者（76%）实现了肿瘤完全坏死。在这28例患者中，24个月和36个月时的复发率分别为34%和48%，生存率分别为76%和70%。结论：CT透视引导下经皮穿刺醋酸消融术是一种短期有效、低风险的治疗方法，即使在有腹水或严重止血异常的患者中也可应用。然而，高复发率和多灶性肝细胞癌的早期发生强调了这种方法以及所有其他经皮策略的局限性。
Percutaneous ablation using acetic acid is an attractive method because of its low morbidity and low number of sessions required to induce complete tumor necrosis. Moreover, the real-time fluoroscopy CT scan could improve the technique by improving distribution of the necrotizing agent within the tumorAim: To determine the feasibility and the long-term results of the acetic acid percutaneous injection under CT fluoroscopy guidance in a series of cirrhotic patients with small hepatocellular carcinoma in a single French center.Methods: One hundred and two patients with hepatocellular carcinoma were evaluated for treatment between 1999 and 2000. The selection criteria for fluoroscopy CT scan-directed percutaneous acetic acid ablation were: 1) one to three nodules < 5 centimeters; 2) Child-Pugh class < 13; 3) prothrombin index > 40% and platelet count > 50000 per mm(3) and 4) contraindication to both resection and liver transplantation. Post treatment follow-up included ultrasonography, magnetic resonance and alphafetoprotein levels every 3 months. Recurrence and survival rates were estimated using the Kaplan-Meier method.Results: Forty-nine patients (48%) could benefit from a curative treatment, most of them (37/49) being eligible for fluoroscopy CT scan-directed percutaneous acetic acid. The mean follow up was 24.4 +/- 2.7 months. Complete tumor necrosis was achieved in 28 patients (76%) after a mean of 1.6 sessions. In these 28 patients, the recurrence rates were 34% and 48% and survival rates were 76% and 70%, at 24 and 36 months, respectively. No serious complications occurred during or after the treatmentConclusions: Percutaneous ablation using acetic acid using CT fluoroscopy guidance may he considered as a short term efficient, low risk treatment and can be applied even in patients with ascites or severe hemostatic abnormalities. However, the high rate of recurrence and the early occurrence of multifocal hepatocellular carcinoma underline the limits of this method as well as of all other percutaneous strategies.