目的：评估经皮微波消融（PMWA）治疗较大原发肝癌（HCC）的可行性和疗效。方法：回顾性收集2007 年1 月—2010 年1 月49 例接受了超声引导下PMWA 手术不可行的较大HCC（5~6 cm）患者的临床与随访资料。分析患者肿瘤完全消融率、严重并发症发生率，治疗后的总体生存（OS）和无瘤生存（DFS）情况，以及OS 影响因素。结果：49 例患者中首次肿瘤完全消融率为85.7%，二次消融后所有患者均达到完全消融率。严重并发症发生率为8.1%。截至随访结束（中位随访时间48 个月），41 例（87.5%）出现了肝内复发；平均生存时间（54.4±32.0）个月；1、3、5 年OS 分别为87.8%、63.3%、39.1%。平均DFS 时间为（35.8±30.6）个月，1、3、5 年DFS 率分别为69.4%、40.9%、21.8%。单因素分析显示术前乙肝病毒定量阳性和甲胎蛋白（AFP）高水平是影响OS 的不良因素（均P<0.05），多因素分析显示术前AFP 高水平是OS 的独立影响因素（HR=1.730，95% CI=1.135~2.635，P=0.011）。结论：PMWA 是较大肝癌安全可行且有效的治疗方式，但术后复发的治疗仍需探索。术前AFP 高水平是PMWA 术后OS 的独立影响因素。
Efficacy and feasibility of percutaneous microwave ablation for relatively large hepatocellular carcinoma
Objective: To investigate the efficacy and feasibility of percutaneous microwave ablation (PMWA) in treatment of relatively large hepatocellular carcinoma (HCC). Methods: The clinical and follow-up data of 49 patients with unresectable and relatively large (5~6 cm) HCC who underwent ultrasound-guided PMWA from January 2007 to January 2010 were reviewed. The complete ablation (CA) rate, incidence of severe complications, overall survival rate (OS), and disease-free survival rate (DFS) as well as prognostic factors for OS of the patients were analyzed. Results: Of the 49 patients, the CA rate after initial PMWA was 85.7%, and CA was achieved in all cases after a second session of PMWA. The incidence of severe complications was 8.1%. At the end of follow-up (median follow-up time was 48 months), intrahepatic recurrence occurred in 41 cases (87.5%), the average survival time was (54.4±32.0) months, and the 1-, 3- and 5-year OS was 87.8%, 63.3% and 39 .1%, respectively; the average DFS time was (35.8±30.6) months and the 1-, 3- and 5-year DFS was 69.4%, 40.9% and 21.8%, respectively. Univariate analysis showed that preoperative positive quantitative HBV DNA and high level of alpha fetoprotein (AFP) were unfavorable factors for OS (both P<0.05), and multivariate analysis showed that preoperative high AFP level was independent influential factor for OS (HR=1.730, 95% CI=1.135–2.635, P=0.011). Conclusion: PMWA is a safe, feasible and effective treatment for relatively large HCC. However, the treatment of recurrence remains a challenge. High preoperative AFP level is independent factor of the OS after PMWA.