肝細胞癌に対する肝血流遮断下経皮熱凝固療法

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With the aim of achieving curable a radical coagulation for hepatocellular carcinoma by a single treatment, we have developed and reported a therapeutic method of percutaneous thermocoagulation under interruption of the hepatic blood flow. In the present study, the treatment outcome of thermocoagulation therapy is compared with that of hepatic resection performed in the same period, allowing a controlled evaluation of our therapeutic modality.We examined 52 cases with solitary hepatocellular carcinoma of less than 5cm in diameter which had not been treated before. The first-line therapy for these patients was percurtaneous thermocoagulation under interruption of the hepatic blood flow, and when it was difficult to carry our the thermocoagulation therapy involving a wide margin of non-cancerous tissues around the tumor, e.g., a lesion not depictable by echography, a superficial lesion of the liver and a lesion adjacent to the large vessel were chosen for hepatic resection. The hepatic blood flow was interrupted by an intravenous balloon at the outlet of the liver, then blockage of the portal blood flow was ensured by CTAP (computerized tomography aortoportography), and the hepatic artery was embolized. Thermocoagulation was achieved by percutaneous insertion of a microwave- or radiofrequency-emitter, making it a rule to cause coagulation at a time.The treated patients consisted of group A ; 26cases who recieved percutaneous thermocoagulation therapy under interruption of the hepatic blood flow (microwave n=21 ; radiofrequency n=5), and group B ; 26 cases who underwent hepatic resection. The mean tumor diameters in group A and B were 24.0±8.1mm and 33.7±10.1mm, respectively. The mean postoperative hospitalization periods for gruoup A and B were 11±3 days and 22±9 days, respectively, showing a statistically significant difference between these two groups (p<0.01). No local recurrence was observed in either group. One case of biliary fistula that needed postoperative treatment was encountered in each groups, while there was no postoperative death in either group. In 25 cases of group A and 24 cases of group B excluding deaths by other causes, the 2- and 4-year survival rates without recurrence were 49% and 49% for group A, and 55% and 33% for group B, respectively, and the 2- and 4-year cumulative survival rates were 90% and 90% for group A, and 90% and 70% for group B, respectively. In 18 cases of group A (28±6mm) and 17 cases of group B(33±6mm) having tumors ranging in diameter from 20 to 40mm, the 2- and 4-year survival rates without recurrence were 38% and 38% for group A, and 50% and 32% for group B, respectively, and the 2- and 4-year cumulative survival rates were 87% and 87% for group A, and 87% and 52% for group B, respectively, indicating no statistically significant difference between these two groups.In the choice of therapeutic modality for solitary hepatocellular carcinoma, localization of the hepatocellular carcinoma played a significant role. Our study showed that the treatment by percutaneous thermocoagulation under interruption of the hepatic blood flow provided a long-term result comparable to that of hepatic resection, and the former method was considered as an established, less invasive therapeutic modality having an advantage of a shorter hospitalization period.
特定非営利活動法人 Microwave Surgery研究会の論文

肝細胞癌に対する肝血流遮断下経皮熱凝固療法

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