Objective: To investigate the safety and efficacy of radiofrequency ablation (RFA) with percutaneous iohexol-ethanol injection (PIEI), compared with RFA plus transcatheter arterial chemoembolization (TACE) for patients with primary liver cancer(PLC)in high-risk locations. Methods: From January 2012 to December 2014, 54 patients with PLC in high-risk locations were enrolled. They were divided into Group A (RFA combined with PIEI) and Group B (RFA plus TACE). The efficacy and adverse events were assessed. Results: 54 patients had 74 lesions in high-risk locations. There were 26 cases with 40 lesions in Group A, and 28 cases with 34 lesions in Group B. The complete ablation rate of Group A was significantly higher than that of Group B (92.5% vs 70.6%, P=0.014). The two-year local tumor progressionrateand two-year overall survival rate were similar between these two groups (Group A 20.0% vs Group B 38.2%, P=0.083; 90.3% vs 84.3%, P=0.523). Furthermore, the surgery-related severe adverse events of Group A (7.1%, one case of liver abscess and one case ofhematobilia) were more common than that of Group B (0%, P=0.491). No significant differences were found in common adverse events including fever, pain, elevation of aminotransferase and bilirubin. Conclusions: Compared with RFA plus TACE, RFA plus PIEI resulted inbetter complete ablation rate in patients with primary liver cancer in high risk locations. Prospective, randomized, controlled trials are warranted for further evaluation.
目的： 探讨CT引导下经皮碘海醇混合无水乙醇注射(PIEI)联合射频消融(RFA)与肝动脉化疗栓塞术(TACE)序贯RFA治疗高危部位肝癌的临床疗效和安全性。 方法： 收集2012年1月至2014年12月首都医科大学附属北京地坛医院收治的54例高危部位原发性肝癌患者的资料，分为PIEI联合RFA组和TACE序贯RFA组，观察疗效和不良反应。 结果： 54例高危部位原发性肝癌患者共有74个病灶，其中PIEI联合RFA组26例，共40个高危部位病灶；TACE序贯RFA组28例，共34个高危部位病灶。PIEI联合RFA组患者的肿瘤完全消融率为92.5%(37/40)，明显高于TACE序贯RFA组的70.6%(24/34，P＝0.014)。PIEI联合RFA组患者的2年肿瘤局部进展率为20.0%(8/40)，TACE序贯RFA组患者的2年肿瘤局部进展率为38.2%(13/34)，差异无统计学意义(P＝0.083)。PIEI联合RFA组和TACE序贯RFA组患者的2年生存率分别为90.3%和84.3%，差异无统计学意义(P＝0.523)。TACE序贯RFA组患者手术相关严重并发症的发生率为7.1%(2/28)，有1例患者出现肝脓肿，1例出现胆道出血，而PIEI联合RFA组患者无手术相关严重并发症(0%，P＝0.491)。两组患者的常见不良反应为发热、转氨酶升高、胆红素升高等，但发生率差异均无统计学意义(均P>0.05)。 结论： 与TACE联合RFA比较，PIEI联合RFA治疗高危部位原发性肝癌能进一步提高肿瘤的完全消融率，但尚需进一步证实。.
Keywords: Catheter ablation; Chemoembolization; High-risk location; Iohexol; Liver neoplasms.