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【Abstract】 Objective To explore therapeutic results of local microwave ablation for hepatic metastasis and the factors influencing the survival after pereutaneous mjcrowave ablation therapy．
Methods From July 1995 to June 2005 128 patients wi出282 hepatic metastases nedules with the primary diseases of upper gastrointestinal tumor(n=26)，colorectal tumor(n=44)，breast carcinoma(n=19)，pulmonary carcinoma(n：15)，and malignant tumor in other part of the body(n：24)，underwent pereutaneous mjcrowave ablation therapy and were foilowed up for 29．7 4-19．9 months(1～103 months)．The largest diameter of tlle metastatic nodules was 3．5 4-1．6 cm (0.7~8.6 cm)．Sixty-four cases had 140 nodules≤3．0 cm in diameter，and 164 cases had 142 nodules >3．0 cm in diam eter．Forty—seven patients had sine nodule，44 patients had 2 nodules，an d 93 patients had 3 or more nedules． Fifty．seven pailents had tumor of low diferentiation，53 had tumor of middie diferentiation．and 18 had highly diferentiated tunlors． Kaplan—Meier method was used to calculate the cumulative survival rate． Statistical comparison of the efects of potential predictivefactors on survival ratewas pe rformed usinglog．ran kan alysis． Multivariatean alysis of the survival rates was perform ed by using Cox s proportional hazard mode1．
Results The 1，2，3，4，and 5 year cum ulative survival rates of all 128 patients were 90．88％，73． 84％ 。51．O9％ ．36．14％and 31．89％ respectively．Univariate analysis showed that tumor size(P=0．028)，tumor diferentiation(P=0．026)and local recurrence ornew metastases(P<0．001)significantly afected the surviva1．Multivariate analysis revealed that tumor size(P=0．035)，recurrence or new metastases(P =0．001)and tumor diferentiation(P=0．038)each had a significant efect on surviva1．
Conclusion There is a significandv higher probability of long-term survival for patients with wel1-diferentiated tumors 3.0 cm or less in diameter and without recurrence or new metastasis after pereutaneous microwave ablation．
【Key words】Liver neoplasms； Microwave； Ablation； Neoplasm metastasis；Prognosis
恶性肿瘤的肝转移是导致死亡的主要原因之一，肝转移癌的治疗直接影响患者的生存时间，而80％的肝转移癌并不适合手术切除[1,2] 。为了提高恶性肿瘤患者的生存率，临床不断探求各种微创有效的介人治疗方法，我们总结了近10年行超声引导下经皮微波消融治疗(percutaneous microwave coagulation therapy，PMCT)肝转移癌的患者，分析疗效和影响因素。
对象与方法
一、对象
1．患者：1995年7月至2005年6月，北京解放军总医院超声科微波治疗肝转移癌患者128例282个肿瘤，随访至2005年7月。男72例、女56例，年龄27～81岁，平均54岁±12岁。原发灶分别为食道、胃肿瘤26例，结肠、直肠肿瘤44例，乳腺癌19例，肺癌15例，其他部位恶性肿瘤24例。所有患者均于微波消融前已行原发肿瘤根治术，并于消融前或后分别进行了全身化疗。结节最大直径(diameter，D)0.7～8.6cm，平均3.5cm±1.6cm。
2．分组：分别根据肿瘤的大小、数目及分化程度分组(表1)。根据肿瘤的大小分组：D≤3.0cm 64例140个结节；D>3.0cm 64例142个结节。根据肿瘤的个数分组：单发47例，2个44例，3个或3个以上37例。根据肿瘤的分化程度分组：低分化57例、中分化53例和高分化18例。
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