肝臟腫瘤的冷凍治療

Cryoablation Therapy for Hepatic Neoplasm

肝臟腫瘤無法以傳統手術方法行肝切除時，可以冷凍療法進行。自1994年11月至1996年9月底為止，林口長庚紀念醫院一共治療了21位肝臟腫瘤的病人，其中男性14位，女性7位，年齡由36歲至75歲不等，平均53歲。腫瘤的病理以原發肝細胞癌14例最多，大腸癌轉移6例及膽管癌1例。腫瘤數目單顆14例，二顆6例、三顆者1例。腫瘤大小最小為3公分，最大為9公分。使用冷凍療法的適應症，14例肝癌中，10例為嚴重肝硬化，2例為橫跨左右兩葉的大腫瘤，1例為位於尾狀葉，另1例為身體狀況太差，不適合傳統切除。6例轉移癌中有4例為二顆分在不同葉的病變，而其他兩側則位於較深部。1例膽管癌使用冷凍療法的理由為病變侵犯太廣泛。手術進行視病變大小及數目決定使用幾支及何種大小的冷凍針。操作時，以術中超音波定位及監視冰球的變化，大部份均使用兩個冷凍解凍的標準療程。無術後立即死亡例。併發症包括1例發生肝莢膜龜裂，2例短暫性血小板減少，無肌蛋白尿引起的腎衰竭。全部病例的預後，肝癌14例中，1例身體情況太差者只存活28天，再發者3例，1例仍存活，已達18個月，而2例死亡分別存活5及20個月；無再發者9例，平均存活11個月。膽管癌1例，發生肺轉癌，只存活5個月。轉移癌6例，目前仍存活，平均為8個月。由本院的21例經驗，顯示在無法以傳統手術進行切除的肝腫瘤，以冷凍療法治療不失為另外的選擇。

We present our experience using cryosurgery to treat hepatic neoplams. Twenty-one patients with liver malignancy underwent cryosurgery from November 1994 through September 1996. Fourteen were male and 7 were female. Their ages ranged from 36 to 75 years, with an average of 53 years. The pathology of the tumors included primary hepatocellular carcinoma (HCC) in 14 patients, colorectal liver metastasis in 6, and cholangiocarcinoma in 1. Among them, 1 patient had 3 nodules, 6 patients had 2, and the other 14 patients had only 1 nodule. The largest tumor was 9 cm in diameter. Of the 14 HCC patients, 10 underwent cryosurgery for severe liver cirrhosis with poor liver reserve, 2 for centrally located large tumor, 1 tor tumor located at the caudate lobe, and 1 because of poor general condition. Of the six patients with colorectal liver meteastasis; 4 underwent cryosurgery for bilobar lesions, and 2 for deep seated lesions. One patient underwent cryosurgery for extensive cholangiocarcinoma lesion. The CMS Accuprobe system (Cryomedical Science, Rockvill, MD), was used to deliver the liquid nitrogen through cryoprobes to the lesions, under echoguidance. Most patients received 2 freeze-thaw cycles. There were no immediate postoperative deaths. The HCC patient with poor general condition died of sepsis 28 days postoperatively. The patient with cholangiocarcinoma developed lung metastasis, and died 5 months postoperatively. During the 2 years follow up period, 3 HCC patients developed recurrence, two of them died, with 5 and 20 months survival respectively. Among the 9 HCC patients without recurrence, the average survival was 11 months. All patients with colorectal liver metastasis were still alive at the last follow up (average, 8 months). We conclude that cryosurgery is a good alternative to treat the hepatic lesions that are difficult to resect with traditional hepatectomy.