射频消融治疗肝癌的近期疗效评价(附38例报告)

目的评价射频消融治疗肝癌的近期疗效。方法 38例肝癌患者共49处病灶接受射频消融治疗,术后1月行超声造影及肝脏增强CT、血清肿瘤标志物检测等以评价射频消融的疗效。结果 38位患者中27位病灶完全消融;18例术前AFP升高的原发性肝癌患者16例AFP下降。结论射频消融治疗肝癌具有安全、微创的特点,对肝癌尤其是小肝癌具有很好的疗效。     

射频消融术治疗原发性肝癌（附58例报道）

目的探讨射频消融术在无法实施手术的原发性肝癌患者中的临床应用效果。方法回顾性分析2007年9月至2011年3月期间我院收治的58例由于各种原因无法手术治疗的大肝癌（〉5cm）并接受射频消融治疗患者的临床资料,射频消融前后结合超声造影的方法,术后随访并定期复查血清甲胎蛋白水平和超声造影或者肝脏增强CT。结果58例中无一例发生与射频消融相关的死亡,22例达到完全消融（37．9％,22／58）。共51例（87．9％,51／58）获得随访,随访至2012年5月,随访时间（12．6±6．4）个月（2～21个月）,随访12个月以上患者有20例（39．2％,20／51）,有10例（19．6％,10／51）无肿瘤复发或者转移的迹象。22例达到完全消融的患者无瘤生存时间为（13．6±10．4）个月（3～21个月）;36例未能达到完全消融的患者中,有19例随访期间死亡,生存时间（8．3~6．1）个月（4～16个月）。结论由于各种原因不能接受手术的大肝癌患者,射频消融作为一种有效、安全治疗方法,部分能达到完全消融的效果,而部分作为姑息性治疗手段,能一定程度上减轻患者的疼痛,达到提高生活质量的目的。     

RFA联合TACE治疗中晚期肝癌的疗效观察

目的观察射频消融术(RFA)联合导管动脉栓塞化疗(TACE)治疗晚期肝癌的临床效果。方法回顾性分析2005年6月～2011年6月蚌埠医学院第一附属医院肝胆外科92例接受TACE及RFA治疗的中晚期原发性肝癌患者,其中88例具有完整的临床治疗过程及随访资料,共43例接受TACE治疗(TACE组),45例接受TACE联合RFA治疗(TACE.RFA组),两组患者的一般临床资料及肿瘤情况差异无统计学意义,比较其生存状况并予以分层分析。结果手术前后螺旋CT摄片或彩超比较显示消融效果良好,两组治疗后肿瘤坏死总有效率(CR+PR)分别为67.4%(29/43)、91.1%(41/45),两组间差异有统计学意义(P<0.05)。接受RFA的患者与对照组相比其生存质量及生存时间均有显著提高。结论对于难以手术切除的原发性肝癌患者,RAF联合TACE的治疗效果明显优于单纯TACE。     

腹腔镜超声探头引导下射频消融术治疗原发性肝癌的临床应用分析

目的:探讨腹腔镜超声探头引导下射频消融术治疗原发性肝癌的临床应用价值。方法:回顾分析由肝胆外科完成的19例腔镜超声探头引导下肝癌射频消融术和17例B超引导下肝癌射频消融术的临床资料。结果:腹腔镜组19例均消融完全无肿瘤残留,术后出现肝区胀痛1例,胸腔积液2例,随访均无肿瘤复发。B超组17例中15例消融完全,术后出现肝区胀痛11例,胸腔积液10例,随访有4例肿瘤复发。结论:腹腔镜超声探头引导下射频消融术治疗原发性肝癌具有安全、微创、并发症少、消融彻底的优点,尤其对位于肝实质内邻近膈顶和胃肠道的肿瘤射频消融治疗有明显优势,值得临床推广。     

手术切除与射频消融对原发性肝癌合并Ⅰ型门静脉癌栓的临床疗效观察

目的 比较手术切除与射频消融术(RFA)治疗原发性肝癌合并Ⅰ型门静脉癌栓(portal vein tumor thrombus,PVTT)临床效果.方法 回顾分析2006年1月至2009年12月我院收治的30例原发性肝癌合并Ⅰ型门静脉癌栓患者的临床资料.结果 手术切除组(n=15)和射频消融组(n=15)均顺利完成治疗,无围手术期死亡病例.分析显示手术切除和射频消融治疗均能使患者获益.射频消融的疗效与手术切除接近,而且微创安全、并发症少.结论 外科手术切除肝肿瘤病灶+门静脉癌栓取出术以及射频消融术均是治疗原发性肝癌合并Ⅰ型门静脉癌栓的安全、有效的方法,均能改善患者的预后、降低肿瘤的复发.     

原发性大肝癌的射频治疗

目的　研究射频治疗对原发性大肝癌 (直径 >3cm)的效果及其并发症。方法　本院2 0 0 0年 8月～ 2 0 0 2年 6月间行射频治疗的 44例原发性大肝癌患者。 3 2例采用经皮肝穿刺射频治疗 ,12例行术中肿块射频治疗加门静脉、肝动脉分别置泵化疗。结果　 44例肝癌者一次治疗完全消融为 5 1.5 % ( 2 4/ 44 ) ,接近完全消融 ( 90 %～ 99% )为 3 0 .3 % ( 12 / 44 ) ,部分消融 ( 5 0 %～ 89% )为18.2 % ( 8/ 44 )。 1个月时AFP复常率 47.1% ( 16/ 3 4) ;术中肿块射频治疗发现新癌结节患者 4例 ;3 9例患者随访 6个月 ,9例患者复发 ;患者治疗后可出现发热、右侧胸腔积液、肝功能不全等并发症。结论　射频治疗对大肝癌患者是一种有效的、安全的方法。术中肿块射频治疗相对优于经皮肝穿刺射频治疗。对于肿瘤直径大于 10cm的肝癌患者应分次治疗及术后积极的护肝治疗     

术中超声在原发性肝癌手术以及射频消融中的应用

目的探讨术中超声在原发性肝癌手术切除以及射频消融治疗中的作用。方法对45例原发性肝癌患者行术中超声检查并将其结果与术前经腹超声检查进行对比，观察术中超声在原发性肝癌手术切除以及射频消融治疗中的作用。结果45例原发性肝癌患者共有肿瘤瘤灶60个，术前超声、术中超声诊断符合率分别为78．30％、95．00％，术中超声高于术前超声检查（P=0．0072）。对直径0．5～2．0cm的肿瘤瘤灶检出率术中超声为100％，高于术前超声的63．00％（P=0．012）。对术中未触及的8个瘤灶于术中超声引导下行肝脏局部切除术。对14个不宜手术切除的瘤灶行术中超声引导下射频消融治疗并短期随访观察，有效率为85．70％。结论术中超声可提高肝癌小瘤灶的检出率，减少漏诊以及误诊，并可在术中对无法触及以及不宜手术切除的瘤灶行术中超声引导的肿瘤切除以及射频消融治疗，具有很高的实用价值。     

16排螺旋CT对原发性小肝癌射频消融术后的随访价值

目的探讨16排螺旋CT对原发性小肝癌射频消融术后的随访价值。方法收集经临床确诊为原发性小肝癌并有射频消融治疗手术史的病例25例,对术后1个月~3年内CT和MRI检查的影像资料进行回顾性的分析总结,其中16排螺旋CT平扫及增强检查15例,MRI平扫及增强检查10例。结果 15例CT检查患者共有26个病灶,射频消融术后完全消融的病灶24个,不完全消融的病灶2个,5例患者肝内远处再发。10例MRI检查患者原共13个病灶,射频消融术后完全消融的病灶12个,不完全消融的病灶1个,2例患者肝内远处再发。CT与MRI检查结果差异无统计学意义(P0.05)。结论与MRI检查比较,16排螺旋CT扫描技术对原发性肝癌射频消融治疗术后病灶的变化同样能进行客观的监测评价,是原发性小肝癌射频消融治疗术后随访评价的重要手段。     

腹腔镜下冷循环射频消融治疗肝癌

目的探讨腹腔镜下冷循环射频消融在肝癌治疗中的价值. 方法肿瘤位于肝脏脏面不适于在B超引导下进行射频治疗的原发性肝癌12例,转移性肝癌3例,肝癌破裂出血4例,全身麻醉,术中先腹腔镜探查,明确肿瘤位置确定穿刺点,然后在腹腔镜引导下,穿刺肿瘤行射频消融治疗. 结果全组未发生手术并发症.4例肝癌破裂出血停止,术后复查肿瘤缩小,血AFP显著下降.术后1个月32个肝癌病灶,完全消融27个,消融不全5个,完全消融率84.4%(27/32).3个月后CT示9例肿瘤病灶完全坏死,AFP降至正常;6例病灶部分坏死.随访2～18个月,平均8.2月,15例生存,4例死亡(3例肝功能衰竭,1例消化道大出血). 结论腹腔镜引导下冷循环射频消融治疗肝癌比B超引导下射频治疗定位更加准确,治疗效果肯定,手术并发症发生率低.     

肝动脉球囊阻断下单次射频消融治疗中大肝癌的初步临床应用

目的 探讨肝动脉球囊阻断下单次射频消融(BORFA)在治疗无法手术切除的中大肝癌中的临床疗效.方法 对11例原发性肝癌患者(12个肿瘤结节,肿瘤直径4～8 cm)行BORFA治疗,术后监测和随访肝功能变化、并发症、局部复发和消融坏死范围.结果 本组病例中每个肿瘤结节均行单次消融,消融平均时间为68±15 min;消融坏...     

射频消融治疗肝肿瘤并发症的原因分析及其防治

目的 总结1510例次肝癌射频消融治疗并发症的发生原因及其防治对策。方法 对563例肝癌患者进行1510例次经皮肝穿射频消融治疗，通过临床观察，分析肝癌射频消融治疗后并发症发生的原因并总结预防处理措施。结果 在1510例次肝癌射频消融治疗后共发生14种并发症。最常见的为术后发热、出汗及肝区治疗部位疼痛；严重并发症为空腔脏器穿孔，腹腔内出血及心血管意外，共计4例，其死亡率为75％。结论 射频消融治疗中晚期肝癌是新开展的而疗效确切的治疗方法。认真选择适应证，规范术前准备和手术操作及合理的术后处理是避免并发症发生的关键。     

Early and late complications after radiofrequency ablation of malignant liver tumors in 608 patients

BACKGROUND: Radiofrequency ablation (RFA) has become a common treatment of patients with unresectable primary and secondary hepatic malignancies. We performed this prospective analysis to determine early (within 30 days) and late (more than 30 days after) complication rates associated with hepatic tumor RFA. METHODS: All patients treated between January 1, 1996 and June 30, 2002 with RFA for hepatic malignancies were entered into a prospective database. Patients were evaluated during RFA treatment, throughout the immediate post RFA course, and then every 3 months after RFA to assess for the development of treatment-related complications. RESULTS: A total of 608 patients, 345 men (56.7%) and 263 women (43.3%), with a median age of 58 years (range 18-85 years) underwent RFA of 1225 malignant liver tumors. Open intraoperative RFA was performed in 382 patients (62.8%), while percutaneous RFA was performed in 226 (37.2%). The treatment-related mortality rate was 0.5%. Early complications developed in 43 patients (7.1%). Early complications were more likely to occur in patients treated with open RFA (33 [8.6%] of 382 patients) compared with percutaneous RFA (10 [4.4%] 226 patients, P < 0.01), and in patients with cirrhosis (25 [12.9%] complications in 194 patients) compared with noncirrhotic patients (31 [7.5%] complications in 414 patients, P < 0.05). Late complications arose in 15 patients (2.4%) with no difference in incidence between open and percutaneous RFA treatment. The combined overall early and late complication rate was 9.5%. CONCLUSIONS: Hepatic tumor RFA can be performed with low mortality and morbidity rates. Though relatively rare, late complications can develop and physicians performing hepatic RFA must be cognizant of these delayed treatment-related problems.     

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(radiofrequencyablation,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。     

Radiofrequency-ablation of unresectable primary and secondary liver tumors: results in 88 patients

Background and aims Radiofrequency-ablation (RFA) is increasingly used for destruction of unresectable primary and secondary liver tumors. We report our experience in the use of RFA for the management of unresectable hepatic malignancies. Patients and methods Between February 2000 and December 2004 we have undertaken 120 RFA procedures to ablate 426 unresectable primary or metastatic liver tumors in 88 patients. RFA was performed via laparotomy (n=68), laparoscopy (n=9) or a percutaneous approach (n=43). Primary liver cancer was treated in seven patients (8%) and metastatic liver tumors were treated in 81 patients (92%). All patients were followed to assess complications, treatment response and recurrence of malignant disease. Results Procedure-related complication rate was low (3.4%). During a mean follow-up of 21.2 months, 15 patients had local tumor progression (17%), 21 patients (23,9%) had new malignant disease and 27 patients (30.7%) died from intervention-unrelated complications of their malignant disease. Additional liver lesions were identified in 27 (35%) of 77 cases by intraoperative ultrasound. Thirty-six patients received simultaneous resection and RFA. Conclusion RFA is a safe, well-tolerated and effective treatment for patients with unresectable primary and secondary liver malignancies.     

Liver Tissue Dissection: Ultrasonic or RFA Energy?

Background Hepatic resection is the only potential curative treatment for a wide variety of conditions. However, liver surgery is technically demanding and closely associated with a number of serious complications. New devices and techniques are currently being applied in practice, which will improve the surgical outcome. Methods This retrospective study compares two methods of liver parenchymal division: ultrasound energy, a modern but already widely used technique, and radio-frequency ablation (RFA), a completely novel method. The parameters investigated include the amount of blood transfused, the necessity of the Pringle maneuver, the length of time required for parenchymal division, and postoperative morbidity and mortality. The patients were divided into two groups. In one group (Group A), 15 patients underwent 17 ultrasound-assisted liver resections, in which ten metastatic tumors, six hepatomas, and one cholangiocarcinoma were resected. In Group B, 21 patients underwent 22 RFA-assisted hepatectomies in which 11 metastatic tumors, ten hepatomas, and two cholangiocarcinomas were removed. Results Thirteen patients (87%) in Group A and 11 (52%) in Group B received a transfusion, with an average of 3.5 and 1.6 units of red blood cells, respectively. The Pringle maneuver was necessary in two cases in Group A but was unnecessary in Group B. The mean length of time required for parenchymal dissection was 124 min in Group A and 93.18 min in Group B. One (6.7%) and four (19%) complications were observed in Group A and B, respectively (statistically not significant). Mortality remained zero in both groups. Conclusions RFA energy provides a novel reliable and safe alternative that can be used exclusively or as a supplement to the older techniques. Both resection time and amount of blood transfusion were reduced in the RFA group.     

Radiofrequency ablation of unresectable hepatic malignancies

Since radiation and chemotherapy have little impact on survival and no prospect for cure, surgery offers the best potentially option in patients with liver tumors. However, a lot of patients with liver tumors is not resectable due to stage combined with health problems, or poor liver function reserve. In this study, our preliminary clinical reports in patients with unresectable liver tumors treatment with RFA have demonstrated radiologic evidence of tumor necrosis and complications. Multielectrode, radiofrequency probes were supplied by RITA Medical Systems (Mountain View, California). This study involved a total of 28 liver tumors in 19 patients (including 17 patients with hepatomas and 2 patients with metastases). The mean age was 68.9 years old. The size of tumor was more than 3 cm in 15 patients. The approaches to the tumor were laparoscopic in 1 patients and open surgical in 18 patients. Hepatic vascular occlusion was combined with RFA in 5 cases. The reasons for unresectable were defined as total bilirubin, ICGR 15, cardiopulmonary function and multiplicity. The efficacy of this RFA therapy was evaluated by preoperative and follow-up CT scans or tumor makers. There tumor necrosis was shown in 15 patients (78.9%). The survival rates at the time up to 12 months were 84.2% in 16 patients. The present study has demonstrated that the RFA is able to provide a safe and effective means in controlling liver tumors.     

原发性小肝癌射频消融与无水乙醇注射治疗对比研究

目的探讨射频消融(RFA)和经皮穿刺无水乙醇注射治疗(PEIT)治疗原发性小细胞肝癌(SHCC)患者的最佳适应证。方法对127例SHCC进行了RFA和PEIT,其中RFA组81例共97个病灶,PEIT组46例共59个病灶。比较患者RFA及PEIT 1、2、3、4、5年生存率和并发症,统计两组患者的医疗费用。结果两组患者术后均无严重并发症;RFA组术后1、2、3、4、5年生存率分别为91.3%、76.4%、62.8%、51.7%和44.4%;PEIT组病患者术后1、2、3、4、5年生存率分别为78.0%、60.0%、47.8%、37.5%和33.3%;RFA组患者平均治疗费用明显高于PEIT组。结论对于SHCC,RFA疗效优于PEIT;对于位于肝包膜下、大血管分支旁、血供丰富的SHCC,以PEIT为宜;PEIT费用低廉,患者依从性较好。     

小肝癌射频消融术与手术切除术疗效的Meta分析

目的 比较小肝癌射频消融术(radiofrequency ablation,RFA)与手术切除术的临床疗效.方法 通过计算机检索Pubmed数据库、万方数据库、中国全文期刊数据库和维普数据库,并结合文献追溯、网上查询(www.baidu.com;www.google.com)的方法,收集关于RFA与手术切除术治疗小肝癌...     

Intraoperative radiofrequency ablation or cryoablation for hepatic malignancies

BACKGROUND: The majority of patients with primary or metastatic malignancies confined to the liver are not candidates for resection because of tumor size, location, multifocality, or inadequate functional hepatic reserve. Cryoablation has become a common treatment in select groups of these patients with unresectable liver tumors. However, hepatic cryoablation is associated with significant morbidity. Radiofrequency ablation (RFA) is a technique that destroys liver tumors in situ by localized application of heat to produce coagulative necrosis. In this study, we compared the complication and early local recurrence rates in patients with unresectable malignant liver tumors treated with either cryoablation or RFA. PATIENTS AND METHODS: Patients with hepatic malignancies were entered into two consecutive prospective, nonrandomized trials. The liver tumors were treated intraoperatively with cryoablation or RFA; intraoperative ultrasonography was used to guide placement of cryoprobes or RFA needles. All patients were followed up postoperatively to assess complications, treatment response, and local recurrence of malignant disease. RESULTS: Cryoablation was performed on 88 tumors in 54 patients, and RFA was used to treat 138 tumors in 92 patients. Treatment-related complications, including 1 postoperative death, occurred in 22 of the 54 patients treated with cryoablation (40.7% complication rate). In contrast, there were no treatment-related deaths and only 3 complications after RFA (3.3% complication rate, P<0.001). With a median follow-up of 15 months in both patient groups, tumor has recurred in 3 of 138 lesions treated with RFA (2.2%), versus 12 of 88 tumors treated with cryoablation (13.6%, P<0.01). CONCLUSIONS: RFA is a safe, well-tolerated treatment for patients with unresectable hepatic malignancies. This study indicates that (1) complications occur much less frequently following RFA of liver tumors compared with cryoablation of liver tumors, and (2) early local tumor recurrence is infrequent following RFA.     

Radiofrequency Ablation of Unresectable Primary and Metastatic Hepatic Malignancies: Results in 123 Patients

OBJECTIVE: To describe the safety and efficacy of radiofrequency ablation (RFA) to treat unresectable malignant hepatic tumors in 123 patients. BACKGROUND: The majority of patients with primary or metastatic malignancies confined to the liver are not candidates for resection because of tumor size, location, or multifocality or inadequate functional hepatic reserve. Local application of heat is tumoricidal; therefore, the authors investigated a novel RFA system to treat patients with unresectable hepatic cancer. PATIENTS AND METHODS: Patients with hepatic malignancies were entered into a prospective, nonrandomized trial. The liver tumors were treated percutaneously or during surgery under ultrasound guidance using a novel LeVeen monopolar array needle electrode and an RF 2000 generator. All patients were followed to assess complications, treatment response, and recurrence of malignant disease. RESULTS: RFA was used to treat 169 tumors (median diameter 3.4 cm, range 0.5 to 12 cm) in 123 patients. Primary liver cancer was treated in 48 patients (39.1%), and metastatic liver tumors were treated in 75 patients (60.9%). Percutaneous and intraoperative RFA was performed in 31 patients (35.2%) and 92 patients (74.8%), respectively. There were no treatment-related deaths, and the complication rate after RFA was 2.4%. All treated tumors were completely necrotic on imaging studies after completion of RFA treatments. With a median follow-up of 15 months, tumor has recurred in 3 of 169 treated lesions (1.8%), but metastatic disease has developed at other sites in 34 patients (27.6%). CONCLUSIONS: RFA is a safe, well-tolerated, and effective treatment to achieve tumor destruction in patients with unresectable hepatic malignancies. Because patients are at risk for the development of new metastatic disease after RFA, multimodality treatment approaches that include RFA should be investigated.