胆道消融剂在选择性胆道消融栓塞中的选用

目的观察不同胆道消融剂选择性胆道消融栓塞对肝脏结构和功能的影响。方法无水乙醇、醋酸、盐酸、氢氧化钠分别消融胆道,OB胶栓塞巴马小型猪左外叶胆管,观察术后肝功及病理变化。结果术后各组肝功能各项指标除白蛋白外,均出现一过性增高,术后两周内恢复正常。无水乙醇肝功变化没有其他组显著。其它各组坏死范围较无水乙醇大。其中氢氧化钠出现急性肝坏死,醋酸坏死范围大于左外叶。光镜下左外叶汇管区纤维明显增生,肝细胞数目减少,假小叶形成。Masson染色提示胶原纤维显著增生。结论无水乙醇与OB胶联合使用,行选择性胆道消融栓塞能使消融栓塞胆道引流区域肝组织萎缩纤维化,肝内假小叶形成。而且对机体影响最小,是目前安全的胆道消融剂。     

不同浓度氢氧化钠消融胆道的研究

目的 观察氢氧化钠溶液消融家兔胆道后肝脏病理及肝功能改变.方法 观察家兔右外叶胆道于5%至1%浓度氢氧化钠溶液消融后肝脏功能状态、组织病理改变和术后存活情况.结果 动物存活率100%(24/24).各组间肝功能改变差异无统计学意义(P>0.05),但均与术前比较差异有统计学意义(P<0.05).5%氢氧化钠溶液组右外叶肝脏完全坏死(6/6).2.5%氢氧化钠组右外叶肝脏几乎完全坏死(5/6).1.5%氢氧化钠组右外叶以汇管区为中心的大片坏死(1/6).1%氢氧化钠组右外叶以汇管区为中心的点片状坏死,肝叶边缘仅胆管坏死(0/6).结论 1%为氢氧化钠溶液消融胆道的较理想浓度.     

不同浓度盐酸消融兔胆管的实验研究

目的：了解不同浓度盐酸消融胆管后兔的肝功及胆管组织改变,为临床应用消融栓塞胆管治疗肝内胆管结石提供实验依据。方法：观察20%、15%、10%和5%的盐酸消融右外叶胆管后兔的存活情况、肝脏功能和胆管组织病理改变。结果：胆管消融术后所有动物均未死亡,存活率100%。20%盐酸及15%盐酸胆管消融造成兔右外叶肝脏几近坏死。10%盐酸胆管消融导致兔右外叶近肝门部肝实质完全坏死,肝叶中部及边缘组织以汇管区为中心的大片坏死。5%盐酸胆管消融后兔右外叶近肝门部及中部肝实质以汇管区为中心的坏死,肝叶边缘仅胆管坏死。与20%、15%和10%盐酸组兔相比,5%盐酸组的肝功能损害最轻。结论：盐酸作为胆管消融剂,能够导致胆管组织凝固性坏死,破坏胆管上皮,终止胆管上皮及胆管周围腺体的分泌;5%为盐酸消融胆管的较理想浓度。     

应用胆道化学性栓塞治疗难治性肝胆管结石症的首例报道

目的探讨胆道化学性栓塞在预防肝内胆管结石复发中的应用。方法52岁女性病人,术前胆道造影显示左外叶下段胆管多发结石合并胆管狭窄,在胆道镜取石后,应用无水乙醇加α氰基丙烯酸酯的组合对病变的胆管腔进行胆道化学性栓塞治疗。结果术后两个月的T管造影证实靶胆管完全破栓塞。结论胆道化学性栓塞有效的预防了肝内胆管结石的术后复发。     

肝动脉栓塞术后的肝内外胆道损毁性病变

目的 探讨经导管肝动态栓塞术后对胆道损伤的病因、治疗及预防。方法 总结５例因肝动脉栓塞引起的胆道损伤患者,其中４例为肝血管瘤经导管动脉栓塞术后,１例为手术时结扎肝动脉注射ＴＨ胶后。动物实验观察向大鼠肝动脉内注射乙醇复制血管栓塞剂对肝脏的损伤。结果 ５例患者均有胆道毁坏性病变,甚至造成胆汁性肝硬化,４例进行胆管空肠吻合及胆道支撑。实验结果证实肝动脉注射血管硬化剂无水乙醇后可以引起邻近汇管区肝脏局部坏     

射频消融联合醋酸及高渗氯化钠对消融体积的影响

目的探讨射频消融（RFA）联合醋酸及高渗氯化钠对消融体积的影响。方法RFA联合50％醋酸及5％NaCl对离体牛肝进行消融。实验分5组，Ⅰ组：单纯RFA组，Ⅱ组：RFA联合纯醋酸组，Ⅲ组：RFA联合蒸馏水组，Ⅳ组：RFA联合10％氯化钠组，Ⅴ组：RFA联合50％醋酸及5％氯化钠组。结果在固定消融条件的情况下，所形成的平均消融体积长径Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ组分别为3．08、3．18、3．08、4．32和4．46cm；短径分别为2．99、2．98、2．77、4．29和4．44cm。Ⅳ组和Ⅴ组所形成的平均消融体积明显大于其他各组，消融时间较其他各组明显延长，Ⅱ组和Ⅴ组对血管旁组织有一定的消融作用。结论RFA消融联合50％醋酸及5％NaCl可显著扩大消融体积，醋酸溶液可沿组织间隙渗透，对血管旁组织进行消融。     

肝肿瘤消融相关胆道出血的临床表现及治疗

目的探讨肝肿瘤消融所致胆道出血的临床表现及治疗情况。方法回顾性分析8例肝肿瘤消融术后胆道出血患者,1例接受内科保守治疗,对4例患者行动脉栓塞治疗,3例行动脉栓塞+胆囊穿刺引流治疗。结果肝肿瘤消融术后8例胆道出血患者均无休克表现,均有腹痛,黑便7例,术中呕血2例;血红蛋白较术前下降6~62g/L(中位值18.0g/L)。4例胆红素明显升高(正常水平4倍以上)。对3例行血/尿淀粉酶检查的患者中,2例血/尿淀粉酶升高。8例患者CT图像上均见胆囊内液性高密度影。7例接受动脉造影的患者中,2例见假性动脉瘤。治疗后随访1~3个月,8例患者均恢复良好,无死亡病例。结论胆道出血是肝癌消融治疗的少见并发症,根据临床表现、实验室及影像学检查可及早做出诊断。对于出血量大或保守治疗无效的患者应及早考虑动脉栓塞,对于胆红素明显升高的患者可联合胆道引流。     

超声空化联合乙醇消融治疗兔VX2肿瘤

目的探讨超声空化阻断兔VX2皮下肿瘤血供对无水乙醇消融肿瘤的增强作用。方法将32只VX2皮下肿瘤兔随机分为4组:超声空化组、乙醇消融组、超声空化联合乙醇消融组、对照组。对各组肿瘤治疗前、治疗后即刻及24h均行CEUS检查,分析肿瘤造影峰值强度及曲线下面积,最后获取肿瘤标本估算肿瘤坏死率。结果超声空化联合乙醇消融组治疗后24h,肿瘤CEUS峰值强度和曲线下面积均低于其余各组(P均0.05);超声空化联合乙醇消融组肿瘤坏死率显著高于其余各组(P0.05)。结论超声空化治疗可显著提高无水乙醇对兔VX2肿瘤的消融效果。     

肝癌射频消融治疗的临床研究进展

肝癌的治疗模式已由过去的单一外科切除转变为以外科切除为主的多手段、多学科综合治疗模式。在多种治疗方法中,以射频消融(radiofrequen-cy ablation,RFA)为代表的局部消融治疗进展迅速,已发展为继手术切除、肝动脉栓塞化疗之后又一常用的肝癌治疗方法。除了RFA外,常用的局部消融治疗方法还有瘤内无水乙醇注射术、冷冻治疗     

肝移植术后胆道铸型综合征103例治疗体会

目的总结治疗肝移植术后胆道铸型综合征（BCS）的经验。方法回顾性分析103例肝移植术后BCS病人的治疗方法及转归。术后〈3个月病人出现较重梗阻症状或合并有胆道感染时，以PTBD外引流管置换T型管。术后≥3个月病人，行纤维胆道镜治疗。BC取出后，对有吻合口以上胆道上皮坏死者，以支撑管支撑3～6个月。病人按照病变程度分成单纯BC组、中度坏死（累及肝门部及以下胆道上皮）BC组、重度坏死（累及肝内外各级胆管）BC组，统计各组在治疗前后1周的肝功酶指标（GPT、GGT、ALP、TB、DB），用SPSS11．5软件行统计学分析。结果经过治疗后，单纯BC组32例，在随访过程中，未发现再有BC出现，各项肝功酶均在正常范围。中度坏死BC组53例，经支撑管支撑3～6个月后，治疗前后各项肝功指标有显著性差异（P〈0．05）。重度坏死BC组18例，9例因经济原因未能再次移植死于多脏器衰竭，1例死于急性梗阻性化脓性胆管炎。8例接受了再次肝移植。其中4例围手术期死于多脏器衰竭，3例行再次肝移植后恢复正常未再有BCS存在，1例出现再次肝移植后BCS，行三次肝移植未再发现BCS存在。结论BCS大多可通过纤维胆道镜取BC和后续的支撑管支撑治疗而解除梗阻症状，明显改善BCS病人的生活质量，降低BCS的再次移植率。BC合并肝内外胆管弥漫坏死者应尽早再次移植。     

Hard tissue laser ablation mechanisms

The aim of this work is the experimental and theoretical investigation of the influence of variable laser parameters (wavelength, fluence, pulse repetition rate) and of the optical and thermophysical properties of bone tissue (absorption coefficient, tissue inhomogeneity) as well as of the sample thickness on ablation thresholds and ablation rate. Ablation and perforation experiments were conducted using a semiconductively pre-ionized transverse excitation atmospheric pressure (TEA) carbon dioxide (CO₂) laser (10.6m and a sliding discharge TEA [hydrogen fluoride (HF)] laser (2.9m). The experimental data are discussed with respect to the following ablation mechanisms: thermal melting and vaporization process, pressure oscillation of gases released by the thermal decomposition of collagen and/or apatite, stresses due to the expansion of superheated water.     

A primer on transarterial, chemical, and thermal ablative therapies for hepatic tumors

BACKGROUND: Surgical resection is the only potentially curative approach for patients with primary and metastatic liver tumors. Unfortunately, most patients with hepatic malignancy are precluded from resection due to multifocal disease, anatomic limitations, inadequate functional liver reserve, extrahepatic metastases, or medical comorbidities. Consequently, several methods of tumor ablation have been developed as alternate treatment strategies for patients with unresectable hepatic tumors or as adjuncts in total cancer therapy. The purpose of this review is to inclusively define the various ablation modalities available (transarterial, chemical, and thermal ablative), and to describe the procedures, general applications, and reported outcomes. DATA SOURCES: A MEDLINE and CINAHL search of the English-language literature was performed on transarterial, chemical, and thermal ablative therapies. CONCLUSIONS: Presently, radiofrequency thermal ablation is the most widely applicable liver-directed modality for hepatic tumor ablation, enabling treatment of primary and metastatic tumors. However, other transarterial and thermoablative techniques are available with accumulating data for their use. Lacking at present are studies that define the role and potential benefit of the various liver-directed modalities in the treatment algorithm for hepatic tumors.     

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目的　评估经皮热消融对不能再手术切除的复发性肝细胞癌 (RHCC)的临床治疗价值。方法　 1997年 10月至 2 0 0 2年 12月中山大学附属第一医院采用超声引导经皮射频消融 (RFA)或微波消融 (MWA)治疗不能再手术切除的RHCC ,35例共 87个肿瘤结节 ,直径 0 9～ 6 4cm。观察局部疗效、治疗并发症和远期生存情况。结果　肿瘤完全消融率 (完全灭活率 )为 97 7% (85 / 87) ,其中直径≤ 3cm结节为 98 6 %、3cm以上者为 94 1%。无治疗死亡 ,并发症发生率为 2 9% (1/ 35 )。平均随访 (2 7 7± 16 7)个月 ,肿瘤局部复发率为 10 6 % (9/ 85 ) ;远处复发率为 91 4 % (32 / 35 ) ,其中 15例 (4 7% )发生多次远处复发。经对局部复发和远处复发者的反复治疗 ,首次消融后 1、3、5年累积生存率分别为 77 1%、4 6 2 %和 14 9% ,中位生存期为 2 5 2个月 ;首次肝切除后 1、3、5及 10年生存率分别达到 96 2 %、6 4 1%、4 7 7%和 14 1% ,中位生存期为 5 7 0个月。结论　经皮热消融技术局部灭瘤效果满意 ,创伤微小且便于反复施行 ,能够显著改善病人的远期生存 ,是不能再切除的RHCC有效治疗手段。     

Combined hepatectomy and microwave ablation for multifocal hepatocellular carcinoma: Long-term outcomes and prognostic factors

BackgroundIt remains to be clarified whether combined hepatectomy and microwave ablation for multifocal hepatocellular carcinoma (HCC) is feasible. This aim of this study was to examine the perioperative and oncological outcomes after combined hepatectomy and microwave ablation for multifocal HCC.MethodsThis retrospective study included 81 patients who underwent combined hepatectomy and microwave ablation for multifocal HCC in our institute between June 1998 and December 2017. We analyzed overall survival (OS) and recurrence-free survival (RFS), and evaluated factors related to prognosis.ResultsMedian follow-up time was 45.6 months for the entire cohort. OS rates were 1-year: 96%, 3-year: 72%, and 5-year: 54%; RFS rates were 1-year: 77%, 3-year: 37%, and 5-year: 22%. The major complication rate (Clavien–Dindo classification IIIa or above) after surgery was 10%, with one patient of in-hospital mortality. Multivariate analysis revealed that des-γ-carboxy prothrombin level >200 mAU/mL and >5 tumors were independent risk factors for OS, and des-γ-carboxy prothrombin level >200 mAU/mL, > 5 tumors, and maximum tumor size >5 cm were independent risk factors for RFS.ConclusionsOur results indicate that combined hepatectomy and microwave ablation is safe and feasible for selected patients with multifocal HCC.     

下肢静脉曲张微创治疗的技术选择

静脉曲张是一种常见疾病,严重影响患者的生活质量.延误诊治会给患者健康带来严重隐患,并增加医疗支出.随着时代的发展,许多新的医疗技术应运而生,具有重要的应用价值.所有方法运用得当都能达到较理想的治疗效果.腔内热消融技术已经日趋成熟,并具有很高的闭合率和安全性;非热消融技术为患者和外科医师提供了更多治疗选择.本文在总结国内...     

超声引导经皮热消融治疗肝细胞性肝癌

目的评价经皮热消融方法治疗肝细胞性肝癌的疗效。方法97例肝细胞性肝癌病人共190个结节接受了经皮微波或射频消融治疗。结果完全消融率93％。对直径≤2cm、2．1～3．9cm和≥4．0cm的结节完全消融率分别为93％、94％和86％。局部复发率10％，直径≤2cm、2．1～3．9cm、≥4．0cm的结节局部复发率分别为3％、10％和32％。1，2，3年无远处复发生存率分别为47％、35％和31％。1，2，3年累积生存率分别为76％、59％、50％。结论微波及射频热消融是治疗肝癌有效和安全的方法，但在较大肿瘤局部复发率较高。     

Current status of radiofrequency ablation of hepatocellular carcinoma

Loco-regional treatments for hepatocellular carcinoma (HCC) are important alternatives to curative transplantation or resection. Among them, radiofrequency ablation (RFA) is accepted as the most popular technique showing excellent local tumor control and acceptable morbidity. The current role of RFA is well documented in the evidence-based practice guidelines of European Association of Study of Liver, American Association of Study of the Liver Disease and Japanese academic societies. Several randomized controlled trials have confirmed that RFA is superior to percutaneous ethanol injections in terms of local tumor control and survival. The overall survival after RFA is comparable to after surgical resection in a selected group of patients with smaller (< 3 cm) tumors. Currently, the clinical benefits of combined RFA with transarterial chemoembolization for intermediate stage HCC are increasingly being explored. Here we review the ongoing technical advancements of RFA and future potential.