探讨原发性肝癌（肝癌）热消融后发生局部肿瘤进展（LTP）的后继治疗方法及其疗效。

回顾性分析2008年1月至2012年12月中山大学附属第三医院收治的22例肝癌热消融后LTP患者临床资料。其中男17例，女5例；年龄38～77岁，中位年龄56岁。所有患者均签署知情同意书，符合医学伦理学规定。22例患者共30个LTP病灶纳入本研究。根据不同的后继治疗方法将病灶分为单一治疗组（21个）和联合治疗组（9个）。单一治疗组仅采用射频消融或微波消融治疗。联合治疗组采用TACE或无水乙醇注射联合射频消融治疗。两组均选择了适当的辅助消融手段，如人工胸/腹腔积液、单肺通气、超声造影等。比较两组肿瘤完全消融率及并发症发生率。率的比较采用χ²检验或确切概率法。

73%（22/30）的病灶采用了辅助消融手段。单一治疗组完全消融率为90%（19/21），联合治疗组为7/9，两组比较差异无统计学意义（P=0.563）。两组均无发生严重并发症。

对于肝癌消融术后LTP病灶，随着多样化辅助手段的应用，单一热消融治疗可获得与联合治疗相似的良好疗效。

To investigate the subsequent therapy and its effect for local tumor progression (LTP) of primary liver cancer after thermal ablation.

Clinical data of 22 patients with LTP of primary liver cancer after thermal ablation in the Third Affiliated Hospital of Sun Yat-sen University between January 2008 and December 2012 were retrospectively analyzed. Among the patients, 17 were males and 5 were females with the age ranging from 38 to 77 years old and the median of 56 years old. The informed consents of all patients were obtained and the local ethical committee approval was received. A total of 30 lesions of LTP in the 22 patients were included in this study. The lesions were divided into the single treatment group (n=21) and the combined treatment group (n=9) according to the different subsequent therapies. Patients in the single treatment group were treated with single method of radiofrequency ablation (RFA) or microwave ablation, while patients in the combined treatment group were treated with transcatheter arterial chemoembolization (TACE) or percutaneous ethanol injection combined with RFA. Appropriate auxiliary means of thermal ablation, such as artificial pleural/peritoneal effusion, one-lung ventilation and ultrasonography were utilized in both groups. The complete ablation rate of tumor and complication incidence rate in two groups were compared. The rate was compared using Chi-square test or Fisher's exact probability test.

Seventy-three percent (22/30) of the lesions were treated with auxiliary means. The complete ablation rate was 90% (19/21) in the single ablation group and 7/9 in the combined treatment group, and no significant difference was observed between two groups ( P=0.563). No serious complication was observed in two groups.

With the application of various auxiliary therapies, single thermal ablation may achieve the therapeutic effect as good as the combined treatment for the LTP lesions of primary liver cancer after thermal ablation.