探討電腦斷層導引射頻灼燒術治療肝臟腫瘤的效能和總生存率之研究

Investigation of efficacy and overall survival rate for the treatment of liver carcinoma by using CT-guided radiofrequency ablation

簡嘉嫻(Chia-Hsien Chien)

指導教授 ： 蔡佳容

義守大學/智慧科技學院/資訊工程學系/碩士(2021年)

摘要

在使用射頻灼燒術(radiofrequency ablation, RFA)治療肝臟腫瘤時，超音波已是相當成熟的導引儀器，然而超音波掃描易受肺部空氣與腸氣干擾，且極仰賴操作者之技術與經驗，因此容易增加其困難度。若使用電腦斷層作為導引儀器，可提供清晰全面之影像判斷，使其可增加灼燒之準確度與安全性，但因使用電腦斷層為導引之文獻篇幅不多，故本研究目的為探討此兩者導引技術於RFA治療肝臟腫瘤之差異性。
本研究為回顧性研究，收集2008年1月至2019年11月期間接受肝腫瘤RFA治療之病患，共982次RFA治療，包含553位病患；由放射科醫師執行RFA與臨床報告診斷，透過收集之病人報告進行分析，針對導引儀器、治療次數、腫瘤大小、治療成效、復發率以及病人存活率等，比較兩著導引儀器在術後的差異。
在整體病人存活率中發現，兩者導引技術並無統計上明顯差異(p=0.628)，其使用電腦斷層導引技術僅增加些許存活率；但在併發症分析上發現，患者在電腦斷層導引下治療併發症發生頻率高於超音波導引技術(p <0.01)，其因為併發症發生頻率與治療時間具有高度正相關(p<0.05)，而耗時長短也與腫瘤大小及腫瘤數量有關(p<0.01)。
從研究中發現使用電腦斷層導引技術為可適用於治療肝臟腫瘤之射頻灼燒術，但因治療時間的增加會導致併發症發生頻率的上升，故若可降低治療時間下，使用電腦斷層導引技術實質可提升肝臟腫瘤RFA之治療品質和安全性。

關鍵字

肝腫瘤 ； 射頻灼燒術 ； 電腦斷層導引 ； 超音波導引 ； 生存率 ； 併發症

並列摘要

Radiofrequency ablation (RFA) has been accepted as the most effective non-surgical method for the treatment of hepatocellular tumor, in this study, we retrospectively review the clinical data and follow-up images of the patients with liver tumor received RFA in 11 years. The therapeutic effectiveness and complication rate of RFA for managing HCC in this series were evaluated.
From January 2008 to November 2019. A total of 982 RFA treatments, including 553 patients. Analyze the collected patient reports, and compare the difference between the two guiding devices after the operation for the guiding device, the number of treatments, the size of the tumor, the treatment effect, the recurrence rate, the complications rate and the patient survival rate.
In the overall patient survival rate, there was no statistically significant difference between the two guidance techniques (P=0.628). CT guidance technology increased the survival rate slightly. The frequency of complications of CT-guided (CTG) treatment is higher than that of US-guided (USG) technique (P<0.01), because the frequency of complications is highly positively correlated with the treatment time (P<0.05), and the length of time is also related to tumor size and tumor, the quantity is related (P<0.01).
US or CT was used in the guidance of RFA widely. CTG technology is suitable for RFA in the treatment of liver tumors. However, the increase in the treatment time will lead to an increase in the frequency of complications. Therefore, if the treatment time can be reduced, it may improve the quality and safety of the treatment of liver tumor RFA.

並列關鍵字

hepatocellular tumor ； radiofrequency ablation ； computed tomography guided ； ultrasound guided ； complication

參考文獻

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