肝血管瘤的多途径射频消融治疗

目的探讨多途径射频消融治疗肝脏血管瘤的疗效和应用价值。方法在超声引导下经皮肝穿、腹腔镜下和开腹术中射频消融治疗肝脏血管瘤共116例,总结135个病灶,肿瘤平均直径为3．58（1．0～8．0）cm。结果经皮肝穿RFA共89例,平均治疗时间为43．3min。RFA后45例患者出现一过性发热（37．6～39．2℃）。67例ALT和AST升高（69～458,76—432IU／L）。无出血、胆漏等并发症发生。腹腔镜下射频8例,平均治疗时间为33．5min。LRFA后4例患者出现一过性发热（38．3—39．1℃）。全部病例ALT和AST升高（78—352,73～389IU／L）。术中射频19例,无明显相关并发症发生。92例（79．3％）得到随访,随访期现6—86个月,平均49个月。无任何远期并发症。92例患者中,病灶完全消失53例（57．6％）,缩小大于50％的24例（26．1％）,缩小小于50％的11例（12．0％）,缩小后再复发4例（4．3％）。结论对于中、小直径肝血管瘤,RFA疗效确切,且有微创、安全、简便、可靠的优点。     

射频消融治疗老年肝脏肿瘤（附126例临床分析）

目的 探讨射频消融（radiofrequency ablation，RFA）治疗老年肝肿瘤患者的安全性。方法 对126例老年肝肿瘤患者进行了161次RFA治疗，临床观察治疗后其对机体的反应、并发症发生及防治情况。结果 并发症发生率7．1％（9／126），其中皮肤烧伤3例，胸腔积液2例，肝功能不全2例，结肠穿孔1例，皮下出血1例，无临床死亡病例。结论 射频消融治疗老年肝肿瘤是一种较安全的方法，对机体影响轻微。     

原发性肝癌射频治疗后局部免疫功能的变化及其临床意义

目的对原发性肝癌（hepatocellular carcinoma，HCC）射频消融治疗（radiofrequency ablation，RFA）前后肿瘤内部及边缘热休克蛋白70（heat shock protein，HSP70）的表达、CD8^＋T细胞数量的变化以及RFA治疗后，肿瘤边缘HSP70表达与肿瘤边缘CD8^＋T细胞数量之间的关系进行观察，探讨RFA治疗对原发性肝癌局部免疫功能状态的影响及其可能的临床意义。方法对17例HCC分别在RFA治疗前、后1个月，于肿瘤内部和肿瘤边缘超声引导下穿刺活检取样；采用PowerVision^TM二步染色法进行免疫组化分析，测定HSP70的表达、CD8^＋T细胞的数量；随访HCC复发／新生情况。结果RFA治疗后肿瘤边缘组织HSP70表达增强（Z=3．337，P=0．001）、CD8^＋T细胞数量增多（Z=1．996，P=0．049）；RFA治疗后，≤4cm肿瘤组的占位边缘CD8^＋T细胞数量高于〉4cm肿瘤组（Z=1．966，P=0．048）。RFA治疗后，边缘组织HSP70表达与CD8^＋T细胞数量之间呈正相关关系（r=0．489，P=0．046）；RFA治疗后，无复发或新生组的占位边缘组织HSP70表达和CD8^＋T细胞数量分别高于复发或新生组（Z=2．009，P=0．045；Z=2．007，P=0．045）。结论RFA治疗后边缘HSP70表达增强、CD8^＋T细胞数量增多，显示RFA治疗后局部免疫原性提高，抗肿瘤效应细胞浸润增加。     

1.5T磁共振导向下射频消融治疗肝转移癌的可行性

目的探讨1．5TMR引导下射频消融（RFA）治疗肝转移癌的可行性。方法收集34例肝转移癌患者,采用MR兼容多极射频针,于1．5TMR引导下行RFA。术后1个月行1．5T或3．0T肝脏MR平扫＋动态增强扫描,之后每2-3个月复查1次;随访3-37个月,平均（14．33±9．81）个月。结果34例患者共消融98个病灶,其中完全消融86个（86／98,87．76％）,不完全消融12个（12／98,12．24％）。MRI上射频电极针呈低信号。T2WI中消融灶呈低信号,周围可见薄层高信号环绕;T1WI中消融灶呈环样高信号,中央瘤灶呈相对低信号。结论1．5TMR引导下RFA治疗肝转移癌安全、有效,具有一定临床应用价值。     

射频消融治疗肝肿瘤315例报告

目的总结1999年6月至2003年8月用射频消融（radiofrequency ablation，RFA）治疗315例肝肿瘤病人的病例资料，探索RFA治疗肝肿瘤近远期疗效。方法采用了一次定位、多点穿刺，RFA联合肝动脉栓塞（TAE）、选择性门静脉栓塞（SPVE）治疗直径5～13cm的大肝癌，及经皮经肺经膈肌RFA治疗膈顶部肝癌。结果总并发症发生率为5．1％，无一例住院期间死亡。AFP阳性的169例肝癌病人中，RFA后有124例（73．6％）明显降低，其中有95例（56．2％）转阴。半年生存率为89．5％，1年生存率为80．1％，18个月生存率为61．4％，24个月生存率为48．3％，〉36个月生存率为35．6％。结论采用TAE、SPVE及RFA一次定位多点穿刺法治疗无手术切除指征的中晚期（含大肝癌）的病人，疗效明显，总并发症发生率低。     

射频消融技术在肝癌综合治疗中合理应用

近年来,射频消融（RFA）因其出色的局部肿瘤控制能力和显著的微创特点,使其在肝癌（HCC）治疗领域扮演着越来越重要的角色,并成为继肝切除、 肝移植后又一小肝癌根治性治疗手段。由于HCC的特殊性,其治疗策略也应该个体化。因此,应合理运用RFA的特点,使其在HCC的各种治疗策略中灵活运用,并与肝移植及肝切除术的优点互相补充,从而使更多的HCC病人受益。     

多电极射频消融治疗大肝癌的近期疗效评价

目的：探讨射频消融（RFA）治疗大肝癌的近期疗效。方法：对13例大肝癌病人行开腹手术、腹腔镜下、B超引导经皮肝穿刺定位射频消融治疗。术前诊断检查指标包括B超、增强CT、AFP、经皮肝穿刺活检。13例中有19个肝占位病变，单发病灶9例，2-3个病灶的4例，肿瘤直径6.0-15.0cm，原发性肝癌10例，转移性肝癌3例。结果：RFA治疗大肝癌近期疗效满意，症状明显改善，食欲明显增加，生活质量良好，肝功、AFP明显好转；术后1月彩超、增强CT复查全部肿瘤体内血供消失，瘤体缩小；3月后CT显示瘤体大片坏死、液化。13例中无手术死亡，存活时间3-12个月，其中1例术后3月死于上消化道出血。结论：RFA给不宜手术的大肝癌患又增加了一种安全、打击小、痛苦小、生活质量好的治疗方法和延长生命的机会。     

射频消融联合经导管肝动脉栓塞化疗序贯性治疗原发性肝癌

目的：探讨经皮射频消融（RFA）联合肝动脉栓塞化疗术（TACE）序贯性应用较单纯应用TACE治疗原发性肝癌的优势和实用价值。方法：55例原发性肝癌患者,30例行单纯TACE治疗,25例行RFA联合TACE治疗。观察指标：（1）治疗后第4周肝功能变化;（2）治疗后4周增强CT／MRI检查肿瘤坏死率的情况;（3）局部肿瘤的复发率;（4）治疗后的生存率的比较。结果：治疗后两周行肝功化验检查,两者相比无统计学意义（P〉0．05）。两组均在1个疗程结束后的2个月行强化CT和DSA检查,两组治疗后肿瘤坏死总有效率（CR＋PR）分别为63．3％（12／30）、92％（23／25）,两组间差异有统计学意义（P〈0．05）。对照组治疗后半年复查随访,有13例复发,复发率46．7％（14／30）;综合组半年复发率为12％（3／25）。复发率行统计学处理（X^2=7．34,P〈0．05）,两者间差异有统计学意义。两组生存率随访结果显示,两组半年生存率几乎相同,均在90％以上,无统计学意义。而1年及两年的生存率比较,综合组明显优于对照组,统计显示有较明显的差异（P〈0．05）。结论：对于难以手术切除的原发性肝癌,经皮射频消融联合肝动脉栓塞化疗的治疗效果明显优于单纯栓塞化疗。     

多电极射频消融治疗大肝癌的近期疗效评价

目的 探讨射频消融（RFA）治疗大肝癌的近期疗效。方法 对13例大肝癌病人行开腹手术、腹腔镜下、B超引导下经皮肝穿刺定位射频消融治疗。术前诊断检查指标包括B超、增强CT、AFP、经皮肝穿刺活检。13例中有19个肝占位病变,单发病灶9例,2-3个病灶的4例,肿瘤直径6.0-15.0cm,原发性肝癌10例,转移性肝癌3例。结果　RFA治疗大肝癌近期疗效满意,症状明显改善,食欲明显增加,生活质量良好,肝功、AFP明显好转;术后1月彩超、增强CT复查全部肿瘤体内血供消失,瘤体缩小;3月后CT显示瘤体大片坏死、液化。13例中无手术死亡,存活时间3-12个月,其中1例术后3月死于上消化道出血。结论 RFA给不宜手术的大肝癌患者又增加了一种安全、打击小、痛苦小、生活质量好的治疗方法和延长生命的机会。     

肝动脉化学栓塞联合经皮射频消融序贯治疗大肝癌的临床研究

目的：探讨肝动脉化学栓塞联合经皮射频消融序贯治疗大肝癌的临床应用价值。方法．42例原发性肝癌患者，14例行TACE联合RFA序贯治疗（联合组），与15例单纯TACE治疗及13例单纯RFA治疗组进行对照分析。比较3组的肿瘤坏死率以及平均生存期。结果：联合组的肿瘤坏死率达78．6％，明显高于单纯TACE组及单纯RFA组（分别为26.7％、46.2％，P〈0．05）。局部复发率分别为21．4％、46．7％和38．5％，三者差异无显著性意义（P〉0．05）。联合组的平均生存期为25．1月，高于TACE组（14．5月，P〈0．05），与单纯RFA组（19．9月）差异无显著性意义（P〉0．05）。结论：肝动脉化学栓塞联合经皮射频消触序贯治疗大肝癌与单纯TACE和单纯RFA组治疗结果相比，可提高肿瘤完全坏死率并延长患者生存期。     

Radiofrequency ablation of liver tumors: influence of technique and tumor size

BACKGROUND: Radiofrequency thermal ablation (RFA) of liver tumors is done by both radiologists and surgeons by using various techniques for a variety of indications. This report describes our initial experience with RFA in 45 patients with hepatic malignancies. METHODS: Patients with primary or secondary hepatic malignancies who were not candidates for resection underwent ultrasound-guided RFA under general anesthesia. End points were recurrence within or adjacent to the ablation zone or new hepatic or extrahepatic lesions. Product limit survival estimates for both ablation site recurrence-free survival and disease-free survival were calculated and compared for tumor size (less than 4 cm or 4 cm or greater), operative approach (percutaneous, laparoscopy, or open), and tumor type (hepatocellular cancer, colorectal cancer, or other metastatic disease). RESULTS: Patients with hepatocellular cancer (n = 11) and with secondary hepatic malignancies (n = 34) had 84 lesions ablated with a median follow-up of 12 months. Largest ablated tumor size of 4 cm or greater (P <.001) and the percutaneous approach (P <.02) were associated with worse ablation site recurrence-free survival but not overall disease-free survival (P =.06). The 15 patients with colorectal cancer had worse disease-free survival compared with other tumor types (P <.01). CONCLUSIONS: RFA of hepatic malignancies can be done by using a percutaneous, laparoscopic, or open approach. Local control appears superior for tumors less than 4 cm and when an open surgical approach is used. The difficulty in achieving prolonged disease-free survival, especially in colorectal cancer, underscores the need to investigate multimodality approaches that include local ablative techniques. Future RFA studies should consider tumor size, operative technique, and tumor type in trial design.     

超声造影引导经皮穿刺射频消融治疗肝癌肝移植术后肝转移

目的通过临床总结,评价超声造影（CEUS）辅助射频消融（RFA）治疗肝癌肝移植术后肝转移的优点及应用价值。方法采用超声造影辅助定位经皮穿刺RFA治疗肝癌肝移植术后肝转移癌12例,直径1．2—5．5cm,发现病灶时间为肝移植术后3—12个月,每个病灶通过超声造影诊断定位进行RFA1—2次,术后通过超声造影及增强CT评价疗效。结果11例病灶术后两周复查全部消融,1例最大病灶有部分残余行再次RFA,1个月后复查无局部复发。结论超声造影辅助下经皮RFA治疗肝癌肝移植术后肝转移癌,定位准确,效果好,操作简便易行,微创无并发症,可作为肝移植术后肝转移癌的首选治疗。     

Radiofrequency ablation of hepatocellular cancer in 110 patients with cirrhosis

OBJECTIVE: To determine the treatment efficacy, safety, local tumor control, and complications related to radiofrequency ablation (RFA) in patients with cirrhosis and unresectable hepatocellular carcinoma (HCC). SUMMARY BACKGROUND DATA: Most patients with HCC are not candidates for resection because of tumor size, location, or hepatic dysfunction related to cirrhosis. RFA is a technique that permits in situ destruction of tumors by means of local tissue heating. METHODS: One hundred ten patients with cirrhosis and HCC (Child class A, 50; B, 31; C, 29) were treated during a prospective study using RFA. Patients were treated with RFA using an open laparotomy, laparoscopic, or percutaneous approach with ultrasound guidance to place the RF needle electrode into the hepatic tumors. All patients were followed up at regular intervals to detect treatment-related complications or recurrence of disease. RESULTS: All 110 patients were followed up for at least 12 months after RFA (median follow-up 19 months). Percutaneous or intraoperative RFA was performed in 76 (69%) and 34 patients (31%), respectively. A total of 149 discrete HCC tumor nodules were treated with RFA. The median diameter of tumors treated percutaneously (2.8 cm) was smaller than that of lesions treated during laparotomy (4.6 cm). Local tumor recurrence at the RFA site developed in four patients (3.6%); recurrent HCC subsequently developed in other areas of the liver in all four. New liver tumors or extrahepatic metastases developed in 50 patients (45. 5%), but 56 patients (50.9%) had no evidence of recurrence. There were no treatment-related deaths, but complications developed in 14 patients (12.7%) after RFA. CONCLUSIONS: In patients with cirrhosis and HCC, RFA produces effective local control of disease in a significant proportion of patients and can be performed safely with minimal complications.     

Locoregional recurrences are frequent after radiofrequency ablation for hepatocellular carcinoma

BACKGROUND: Enthusiasm for radiofrequency ablation (RFA) therapy for patients with unresectable hepatocellular carcinoma (HCC) has increased. The data for recurrence after RFA for patients with HCC is not well documented. The purpose of this study was to evaluate tumor recurrence patterns after RFA in patients with unresectable HCC. STUDY DESIGN: Over a 3-year period, 50 patients having RFA for unresectable HCC were identified at a single institution. Medical records and radiologic studies were reviewed and outcomes factors analyzed. RESULTS: Of the entire cohort, 46 patients underwent RFA by a percutaneous approach under CT guidance. Most patients underwent either one (n = 22) or two ablations (n = 23). At the time of this report, 14 patients (28%) were tumor-free by radiologic and biochemical (alpha-fetoprotein) parameters. Eighteen additional patients had persistence of tumor at the ablation site and 14 patients had recurrence in the liver at sites different from the ablation site. An additional four patients had recurrence in extrahepatic sites. Twelve patients underwent orthotopic liver transplantation after RFA. Of these 12, 5 (42%) demonstrated no viable tumor in the explanted liver. Independent predictors of tumor recurrence included tumor size, serum AFP levels, and the presence of hepatitis. CONCLUSIONS: These data suggest that factors such as tumor size should be considered before employing RFA therapy. In addition to treating the primary tumor, other therapies aimed at the liver's inflammatory state might also be important in achieving a durable response after RFA.     

超声引导经皮复合热消融技术治疗中、大肝细胞癌

目的　评估超声引导复合热消融技术治疗中、大肝细胞癌 (HCC)的应用价值。方法在超声引导下经皮采用多针插入、多点能量输出的射频消融 (RFA)或微波消融 (MWA)技术 ,治疗 6 8例HCC患者共 73个肿瘤结节 ,平均直径 (4 5± 1 7)cm (3 1～ 13 0cm) ,经 1 9～ 6 7 6个月 [平均(16 0± 14 8)个月 ]随访 ,检测局部及远期治疗效果。结果　治疗后合并肝包膜下血肿及皮肤烧伤的患者各 1例。肿瘤完全消融率 78 1% (5 7/73) ,2 4 6 % (14 /5 7)的病灶出现局部肿瘤进展 ,远处复发率 5 6 7% (38/6 7) ,1、3、5年生存率分别为 6 2 3%、2 9 6 %、2 1 6 % ,中位生存时间为 18 6个月 (95 %可信区间为 10 9～ 2 6 3个月 )。RFA与MWA在完全消融率、局部肿瘤进展率与远处复发率、生存率方面差异均无显著意义。结论　经皮复合热消融技术治疗不能手术切除的中、大肝细胞癌创伤小 ,可获得良好的局部控制和远期疗效 ,RFA与MWA疗效无明显差异     

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.     

射频消融治疗复发性肝细胞癌疗效分析

目的探讨射频消融对肝细胞癌(HCC)手术切除后复发病例再治疗的效果,比较不同复发时间的疗效差别。方法以行超声引导经皮射频消融(RFA)治疗的手术切除后复发性肝细胞癌(RHCC)患者(RHCC组)和同期行RFA治疗的首发HCC患者(首发HCC组)为研究对象。(1)RHCC组42例患者,男34例,女8例,平均年龄(58±10)岁;复发灶大小1.5~6.6cm,平均(3.8±1.4)cm。RFA治疗前5例伴肝外转移。肝功能A级21例,B级19例,C级2例。手术切除距肝内初次复发时间为1~96个月,平均22.8个月。术后1年内肿瘤复发者20例40灶(RHCC近期组),术后1年以上复发者22例37灶(RHCC远期组)。(2)首发HCC组148例患者,男117例,女31例,平均年龄59岁。肿瘤大小1.2~7.0cm,平均(4.0±1.4)cm。RFA治疗后1个月采用增强CT检查评价消融成功率;比较RHCC近期组、RHCC远期组和首发HCC组的治疗效果、复发转移情况及生存期。结果首发HCC组RFA成功率为87.2%(129例),局部复发率为16.2%(24例),另位复发率为37.8%(56例),平均生存期为(39.0±2.1)个月;RHCC近期组、远期组RFA成功率分别为85.0%和95.5%(P>0.05),局部复发率分别为15.0%和13.6%(P>0.05),另位复发率为60.0%和18·2%(P=0.005),平均生存期为(15.4±2.3)个月和(39.5±4.5)个月(P<0.005)。与首发HCC组相比,RHCC远期组消融成功率与局部复发率均无显著性差异(P>0.05),RHCC近期组生存期低于首发HCC组(P<0.05)。RHCC远期组1例患者治疗后出血,经射频止血、输血等保守治疗缓解。结论RFA治疗RHCC的预后及疗效与复发的时间相关;对于术后远期复发者,行RFA治疗可获得同首发HCC相似的生存期,而手术后近期复发者疗效相对较差。     

Intraoperative Ablation for Small HCC not Amenable for Percutaneous Radiofrequency Ablation in Child A Cirrhotic Patients

Background

Radiofrequency ablation (RFA) was initially started by radiologists as a percutaneous treatment, but surgeons started to use RFA by surgical approach for patients with tumors at locations difficult for the percutaneous procedure. The aim was to evaluate the results of intraoperative RFA for small hepatocellular carcinomas (HCCs) (<3 cm) in locations difficult for a percutaneous approach.

Methods

Two hundred forty-seven patients with small solitary HCC (<3 cm) were treated; 196 via percutaneous RFA while 51 patients presented at sites not amenable for percutaneous route. Twenty-seven out of 51 patients underwent surgical resection, while 24/51 patients underwent intraoperative RFA.

Results

The location and depth of the tumor from the liver capsule was the only significant factors in the choice of the surgeon between resection and RFA. RFA was successful in all tumors (complete ablation rate of 100 %). In the surgery group, all patients achieved R0 resection. Complication rate was comparable (p?=?1.0). After a median follow-up of 37 months (range, 10–45 months), no tumors showed neither local progression nor local recurrence and no significant difference was observed between two groups as regards early recurrence and number of de novo lesions (p?=?0.49). One-year and 3-year survival rates were 93 % and 81 %, respectively, in the resection group comparable to the corresponding rates of 92 % and 74 % in the RFA group (p?=?0.9).

Conclusion

For small HCC in locations difficult for a percutaneous approach, intraoperative RFA can be an alternative option for deep-seated tumors necessitating more than one segmentectomy achieving similar tumor control, and overall and disease-free survival.     

射频消融治疗复发性肝癌的应用价值

目的：评价经皮射频消融术（RFA）治疗复发性肝癌的疗效及安全性。
　　方法：回顾性分析2008年5月—2014年3月期间79例行经皮RFA治疗的肝癌复发患者临床资料,79例患者复发病灶共106个,病灶大小0.8~5.0cm,平均（2.8±1.0）cm。
　　结果：消融治疗成功率为98.1%,肿瘤完全消融率94.2%。术后常见不良反应为发热（72.7%）、肝区疼痛（90.9%）、胃肠道症状（20.8%）、黄疸（6.5%）,无肝功能衰竭、胆瘘、感染、出血等严重并发症,无围手术期死亡病例。术后住院时间1~5d,平均（2.2±1.0）d。术后随访7~64个月,平均（38±14）个月,54例出现复发,复发率70.1%。术后1、3年生存率分别为89.6%、66.2%。
　　结论：经皮RFA治疗复发性小肝癌是一种安全有效的微创治疗方法,可优先考虑作为该病治疗的术式选择。     

Delayed colonic perforation after percutaneous radiofrequency ablation of hepatocellular carcinoma

Radiofrequency ablation (RFA) is an effective treatment for hepatocellular carcinoma. Colonic perforation secondary to RFA of the liver is an uncommon complication that has been reported to have an incidence between 0.1% and 0.3%. Lesions adjacent (within 1 cm) to the colonic wall and those in patients with history of upper abdominal surgery or chronic cholecystitis are particularly at risk. More importantly, thermal injury leading to colonic perforation has proved to have a fatal outcome. We present a case of percutaneous RFA in a patient with hepatocellular carcinoma that was abutting the colonic hepatic flexure. Colonic perforation was diagnosed on the eighth day postablation when the patient was readmitted with peritonitis.