目的：探讨射频消融(RFA)规范化治疗及综合措施对提高肝肿瘤疗效的应用价值。方法：302例计476个肝脏恶性肿瘤行RFA治疗，应用规范化治疗方案及附加治疗方法，总结疗效。原发性肝癌(HCC)181例，282个癌灶，肿瘤大小平均412cm。肝转移癌(MLC)121例，194个癌灶，肿瘤大小平均319cm。根据肿瘤大小、形态及邻近膈肌、胆囊、胃肠等不同位置，采用相应的规范化方案及个体化方案相结合治疗；重视相邻重要结构区域的消融布针方法及操作技巧；应用辅助定位、局部注水、加强肿瘤血管消融等附加方法综合治疗。结果：综合应用以上方法，RFA后1个月增强CT或超声造影显示肿瘤灭活率HCC为9517%（270/282），MLC为9418%（184/194）；邻近肠管肿瘤为9111%（51/56），邻近膈肌肿瘤为8815%（69/78），邻近胆囊肿瘤为9413%（49/52）。随访3～57个月，局部复发率HCC为1013%（29/282），MLC为1414%（28/194）。患者1年、2年、3年的生存率HCC为8716%、6714%、5816%；其中50例Ⅰ～Ⅱ期肝癌的生存率分别为9017%、8519%、7317%。MLC为8714%、4812%、2513%。并发症占212%（13/583）；分别为出血5例，采用局部消融、全身用药等处理措施；肠穿孔1例，对邻近肠管肿瘤采用治疗后延长禁食时间等措施进行预防。余7例为邻近脏器结构轻度损伤，无与射频治疗相关死亡。结论：采用规范化RFA治疗方案及适宜的个体化治疗方案，重视附加方法的应用，有助于提高肝肿瘤灭活率；掌握主要并发症的类型及对应预防措施，是提高疗效及推广RFA治疗的重要环节。

[目的]：研究建立超声引导射频消融复发率较高的肝肿瘤（>3.5cm）的治疗方案，评价临床应用效果。[方法]：根据治疗范围至少达肿瘤周边0.5～1.0cm的原则，采用5cm消融灶设计不同大小肿瘤重叠消融的方案。按照数学模型计算建立的治疗方案包括覆盖肿瘤所需的最少消融灶数目、定位模式及实施程序。设立易于把握的实际布针方法。临床应用对象为根据计算方案治疗的原发性肝癌患者83例及肝转移癌患者58例，计141例162个肿瘤，大小为3.6～7.7（4.79±0.96）cm。[结果]：162个肿瘤共穿刺消融712个球灶。治疗后1个月CT检查显示肿瘤完全灭活率达90.1%（146/162灶），随访3～38个月，局部复发率为21.0%（34/162灶），其中肝转移癌高于原发癌（P<0.05）；26例因肿瘤复发共进行了39次再次治疗，其中18例再治疗1次，8例再次治疗2～3次。严重并发症为4.9%（7/141例），仅1例复发癌再治疗1周后肠穿孔需外科手术治疗。[结论]：本计算方案的制定为超声引导射频消融治疗3.5cm以上肝肿瘤提供了依据，并可指导临床实际应用。治疗结果显示该方案可显著提高肝肿瘤消融灭活率，减少复发，具有较高的临床应用。

目的：研究建立超声引导对射频消融治疗直径>3.5cm肝肿瘤的方案，评价对大肿瘤的消融灭活效果。方法：根据治疗范围至少达肿瘤周边0.5～1.0cm的原则，采用5.0cm消融灶设计不同大小肿瘤重叠消融的方案。按照数学模型计算建立的治疗方案包括覆盖肿瘤所需的最少消融灶数目、定位模式及实施程序。设立易于把握的实际布针方法。临床应用对象为根据计算方案治疗的原发性肝癌患者71例及肝转移癌患者42例，计113例124个肿瘤，大小为3.6～7.0cm，平均（4.75±0.92）cm。结果：124个肿瘤共穿刺消融554个球灶。治疗后1个月CT检查显示肿瘤完全灭活率达87.9%（109/124灶）；随访3～27个月，局部复发率为24.2%（30/124 灶），预测平均无复发生存时间为17.3个月。25例因肿瘤复发共进行了38次再次治疗，其中17例再治疗1次，8例再次治疗2～3次。并发症7例（6.2%），仅1例复发癌再治疗1周后肠穿孔需外科手术治疗。结论：超声引导射频消融治疗方案的制定对治疗较大肝肿瘤提供了依据，并可指导临床实际应用。治疗结果显示该方法可显著提高肝大肿瘤消融灭活率，减少复发，证实是一项有效可行的治疗方案。

PURPOSE: The purposes of this study were to investigate a treatment strategy to increase liver tumor necrosis and minimize complications with ultrasound-guided percutaneous radiofrequency (RF) ablation and to evaluate its therapeutic efficacy. MATERIALS AND METHODS: A total of 332 patients with 503 liver malignancies underwent RF ablation according to a mathematical protocol with adjunctive measures. In the 332 patients, 205 had 308 hepatocellular carcinomas (HCCs) with a mean largest diameter of 4.1cm and 127 had 195 metastatic liver carcinomas (MLCs) with a mean largest diameter of 3.9cm. In patients with HCC, 60 (29.3%) had stage I/II disease and 145 (70.7%) had stage III/IV disease. Depending on tumor size, shape, and location, a defined treatment strategy was adopted that consisted of a mathematical protocol, an individualized protocol, and adjunctive measures. The mathematical protocol was followed for tumors larger than 3.5cm. The individualized protocol was used for tumors located adjacent to the diaphragm, gastrointestinal tract, or gallbladder. Some adjunctive measures such as supplementary fine needle localization, local saline solution injection, and feeding vessel ablation were used to deal with different features of these liver tumors. Patients were followed regularly to assess treatment efficiency, and the tumor was considered to have early complete necrosis if no viability was found on enhanced computed tomography 1 month after RF ablation. RESULTS: In this series, the early necrosis rates were 95.8% for HCC (295 of 308 tumors), 94.9% for MLC (185 of 195 tumors), 91.3% for tumors larger than 3.5cm (189 of 207 tumors), 90.7% for tumors near the gastrointestinal tract (49 of 54 tumors), 91.5% for tumors near the diaphragm (86 of 94 tumors), and 90.6% for tumors near the gallbladder (48 of 53 tumors). The local recurrence rates were 10.7% for HCC (33 of 308 tumors) and 14.9% for MLC (29 of 195 tumors). The 1-, 2-, and 3-year overall survival rates were 89.6%, 69.4%, and 59.6%, respectively, for HCC and 80.3%, 52.8%,and 30.9%, respectively, for MLC. The 1-, 2-, and 3-year survival rates in 60 patients with stage I/II HCC were 93.7%, 87.1%, and 76.2%, respectively. The incidence of major complications was 1.4% (eight of 574 sessions), which included of three hemorrhages, four injuries to adjacent structures, and one case of needle tract seeding. CONCLUSION: In RF ablation of hepatic tumors, application of a proper protocol and adjunctive measures play important roles in improving tumor necrosis rate and minimizing potential complications.

AIM: To investigate the treatment efficacy of radiofrequency ablation (RFA) of hepatic malignant tumor and the relevant complications. METHODS: A total of 338 patients with 763 hepatic tumors underwent ultrasound-guided RFA (565 procedures). There were 204 cases of hepatic cellular carcinoma (HCC) with 430 tumors, the mean largest diameter was 4.0cm. Of them, 48 patients (23.5%) were in stages I-II (UICC Systems) and 156 (76.5%) in stages III-IV There were 134 cases of metastatic liver carcinoma (MLC), with 333 metastases in the liver, the mean diameter was 4.1cm, the liver metastases of 96 patients (71.6%) came from gastrointestinal tract. Ninety-three percent of the 338 patients were treated using the relatively standard protocol. Crucial attention must be paid to monitor the abnormal changes in ultrasound images as well as the vital signs of the patients to find the possible hemorrhage and peripheral structures injury in time. The tumors were considered as ablated completely, if no viability was found on enhanced CT within 24 h or at 1 mo after RFA. These patients were followed up for 3-57 mo. RESULTS: The ablation success rate was 93.3% (401/430 tumors) for HCC and was 96.7% (322/333 tumors) for MLC. The local recurrence rate for HCC and MLC was 7.9% (34/430 tumors) and 10.5% (35/333 tumors), respectively. A total of 137 patients (40.5%) underwent 2-11 times of repeated ablations because of tumor recurrence or metastasis. The 1st, 2nd, and 3rd year survival rate was 84.6%, 66.6%, and 63.1%, respectively; the survival rate from 48 patients of I-II stage HCC was 93.7%, 80.4%, and 80.4%, respectively. The major complication rate in this study was 2.5% (14 of 565 procedures), which consisted of 5 hemorrhages, 1 colon perforation, 5 injuries of adjacent structures, 2 bile leakages, and 1 skin burn. CONCLUSION: RFA, as a minimally invasive local treatment, has become an effective and relatively safe alternative for the patients of hepatic malignant tumor, even of advanced liver tumor, tumor recurrence, and liver metastases. Knowledge about possible complications and their control may increase the treatment efficacy and help to promote the use of RFA technique.