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1.
肾癌射频消融治疗后的影像学评价   总被引:1,自引:0,他引:1  
射频消融(RFA)已用于肾癌的临床治疗,具有微创、可重复操作、并发症少、有利于保留患者的肾功能等优点。通过影像学检查,可以准确评价肾癌RFA疗效,早期检测是否存在肿瘤残留及复发。本文对CT、MRI及超声在肾癌RFA治疗后疗效评价中的应用进行综述。  相似文献   

2.
肝癌射频消融治疗前后外周血微转移变化的研究   总被引:2,自引:0,他引:2       下载免费PDF全文
目的: 探讨射频消融(RFA)治疗是否促进原发性肝癌(PHC)患者的血源性转移。方法:应用RT-PCR检测32例PHC患者RFA治疗前后外周静脉血AFPmRNA的表达。结果:32例PHC患者RFA治疗前外周血AFPmRNA表达阳性18例(56.3%),阴性14例(43.7%);治疗后阳性12例(37.5%),阴性20例(62.5%)。RFA治疗前后PHC患者外周血AFPmRNA阳性率无显着性差异(P>0.05)。结论:RFA治疗肝癌不会促进肿瘤的血源性转移。  相似文献   

3.
目的:探讨肝癌射频消融(RFA)联合经导管肝动脉化疗栓塞(TACE)的疗效及必要性。方法:对65例肝癌患者RFA后进行1次以上的TACE治疗。其中男54例,女11例。肿瘤最大长径1.5~10.0 cm,其中≤3 cm者14例, 3.1~5.0 cm者17例,>5.0 cm者34例。按肝功能Child pugh分级,A级51例,B级14例。病理诊断肝细胞癌58例,胆管细胞性肝癌7例。采用RFA肿瘤治疗系统行RFA,并随后常规行CT以评价RFA的疗效,然后行TACE,术后1月行CT检查,以评价肿瘤消融情况,并观察生存率,以评价治疗效果。结果:RFA后完全消融24例,基本消融15例,部分消融26例。RFA+TACE的近期效果为根治性22例、亚根治性13例和姑息性30例。肿瘤消融程度与近期疗效密切相关(r=0.877,P<0.001)。肝癌RFA+TACE治疗后总体1,2,3年生存率为78.2%,65.3%,44.0%。Cox回归模型分析显示消融程度,是最终与生存时间有关的因素,获得完全消融、基本消融或部分消融者3年生存率分别为73.5%,45.0%和0.0%。肿瘤较小的肝癌容易获得完全消融、近期及远期疗效较好;反之预后较差。结论:TACE对RFA后残余的癌灶或微小转移病灶可起治疗作用;中大肝癌RFA后联合TACE是必要的。  相似文献   

4.
射频消融治疗兔肝脏肿瘤的实验研究   总被引:3,自引:0,他引:3  
目的探讨射频消融(RFA)对肿瘤组织的治疗效果及其意义。方法通过VX2肿瘤组织混悬液肝内注入法建立兔肝脏肿瘤模型,随机分为实验组及对照组,分别予以RFA治疗及假性处理,比较RFA治疗前后模型动物的肝脏功能变化及B超影像学改变。结果1周内肝功能出现明显异常改变,多数指标在2周左右恢复(P<0.05);RFA治疗后肿瘤呈逐渐缩小趋势;瘤体血流信号明显减少或消失。结论射频消融治疗术对肝脏肿瘤疗效确切,会造成肝脏功能一过性损害改变;B超等影像学检查手段为临床RFA治疗提供了重要技术支持。  相似文献   

5.
目的探讨氩氦刀冷冻消融与冷循环射频消融(cool-tip radiofrequency ablation,RFA)在恶性肝肿瘤治疗中的临床应用价值。方法超声引导下氩氦刀冷冻消融治疗肝癌38例共42个病灶;经超声引导下RFA治疗肝癌40例共44个病灶,治疗前后经超声造影、增强CT或增强MRI检查明确诊断及评价疗效。结果 42个病灶经一次冷冻消融治疗后32个达完全消融,10例经再次冷冻消融后达到完全消融;44个病灶经一次RFA治疗后完全消融33个,11例经再次RFA后达到完全消融。两者一次完全消融率分别为76.2%(冷冻消融)和75%(RFA),差异无统计学意义。结论氩氦刀冷冻消融和冷循环RFA均能有效地原位灭活肝癌细胞,是有效的非手术治疗恶性肝肿瘤的方法之一。  相似文献   

6.
目的 探讨热灌注(hyperthermic perfusion)经肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)、射频消融(radiofrequency ablation,RFA)联合125I粒子植入治疗原发性肝癌(primary hepatical carcinoma,PHC)的临床应用价值.方法 PHC患者15例,共25个肿瘤灶,病灶大小1~8cm,所有患者均先进行热灌注TACE,然后在CT引导下RFA及125I粒子植入治疗.本组内放疗处方剂量规定为60Gy,随访观察疗效及相关并发症.结果 随访时间6~40个月(平均26.8个月),全组肿瘤完全坏死率为96%,除1例粒子游走外,未出现其他严重并发症.结论 热灌注TACE、RFA联合125I粒子植入治疗PHC,近期疗效明显,可望成为PHC更有效的治疗新模式.  相似文献   

7.
射频消融治疗肝肿瘤的现状及其临床地位的评价   总被引:2,自引:0,他引:2  
射频消融(radiofrequency ablation,RFA)作为治疗肿瘤的新方法,在得到临床医生重视的同时,尽早界定RFA的评价和地位是临床应用的迫切需要,但其界定义不得不等待相当长的一段时间。国内外对肝肿瘤射频消融的基础研究和临床应用已经有13年的经验,相关的研究越来越多。本文纵览近年文献,概括与归纳射频治疗肝肿瘤技术的发展,适应证,临床疗效、预后、影响因素以及并发症,并对RFA与其它治疗方法进行比较。对其在肝肿瘤治疗领域中的地位,做出初步的评价。  相似文献   

8.
原发性肝癌射频消融后综合征的临床观察   总被引:1,自引:1,他引:0  
目的研究原发性肝癌(HCC)经皮射频消融术(RFA)后出现消融后综合征的发生率,分析其发生的原因。方法2002年7月至2006年4月,37例HCC采用经皮RFA技术进行治疗。治疗前后分别行实验室及影像学检查。观察治疗后出现的各种临床症状及持续时间。结果37例均顺利完成RFA治疗。32.4%(12/37)病人出现消融后迟发性症状。其中发热12例、寒战1例、全身不适7例、消融部位疼痛9例、恶心5例、呕吐2例、呃逆2例。治疗后3d症状最明显,均在对症处理后14d内消失。消融后症状的发生与肿瘤体积、消融区体积、射频治疗时间及血清转氨酶(AST、ALT)水平呈明显相关性(P〈0.01)。肿瘤体积〈50cm^3(直径4.5cm)共19例,均未发生消融后综合征;肿瘤体积〉50cm^3共18例,66.7%(12/18)病人发生消融后综合征。结论HCC经皮RFA治疗后,约1/3病人可发生消融后综合征,其发生率与病灶大小相关,对症处理后2周内可自行消失。  相似文献   

9.
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。  相似文献   

10.
超声造影在肝癌射频消融治疗中的作用   总被引:1,自引:0,他引:1  
目的:探讨超声造影(CEUS)在肝癌冷循环射频消融(RFA)治疗中的应用价值。方法:选取肝癌患者20例25个病灶为观察对象,RFA治疗前行CEUS确定肿瘤的性质、数目和大小,治疗后1个月内和随访10个月后行CEUS与增强CT对比疗效评价。结果:治疗后1个月内CEUS复查,20个消融病灶各期均无异常增强区,提示肿瘤完全灭活;4个边缘局部有早期增强,提示肿瘤残留,增强区经增强CT及穿刺活组织检查证实为肿瘤残留,当即补充RFA治疗;1个CEUS图像模糊,未能作出诊断。随访10个月,1个消融病灶有残留复发,4例患者行CEUS发现新生病灶11个,直径0.6-3.8 cm,其中2例4个直径〈1.0 cm的病灶增强CT未能发现。结论:CEUS可以在RFA治疗前为治疗方案提供依据,在治疗后判断RFA疗效,是一种有效方法,并有助于发现微小新病灶。  相似文献   

11.
目的探讨经肝动脉化疗栓塞(TACE)联合经皮肝穿刺射频消融术(RFA)治疗中晚期原发性肝癌(PHC)的临床疗效和安全性。方法将125例中晚期PHC患者按治疗方法不同分为TACE组(40例)、RFA组(38例)及TACE+RFA组(47例),观察3组近期疗效和并发症发生情况;采用Kaplan-Meier法计算复发率、生存率及中位生存期,比较采用Log-Rank时序检验。结果 TACE+RFA组总有效率为74.5%,明显高于TACE组的52.5%和RFA组的47.4%(P0.05);TACE+RFA组1、2年复发率分别为17.0%、31.9%,均明显低于TACE组(37.5%、57.5%)和RFA组(42.1%、60.5%)(P0.05);TACE+RFA组1、2年生存率分别为89.4%、70.2%,均明显高于TACE组(70.0%、47.5%)和RFA组(68.4%、44.7%)(P0.05);且TACE+RFA组中位生存期(26个月)明显长于TACE组(21个月)和RFA组(19个月)(P0.05)。结论 TACE联合RFA可有效治疗中晚期PHC,减少术后复发率并提高生存率,延长患者生存期,其疗效优于单纯TACE或单纯RFA治疗。  相似文献   

12.
TACE联合MRI引导下射频消融术治疗原发性肝癌   总被引:2,自引:1,他引:1  
目的探讨TACE联合MRI引导下射频消融(RFA)治疗原发性肝癌(PHC)的疗效。方法纳入接受TACE联合MRI引导下RFA的PHC患者50例(88个病灶),治疗后随访AFP水平及肿瘤复发情况。结果平均随访(15.35±8.49)个月。治疗后2个月,患者AFP水平为(33.94±11.64)μg/L,明显低于治疗前水平[(302.29±55.11)μg/L,P0.01]。共9个治疗病灶复发,治疗后0.5年、1年、1.5年、2年和2.5年治疗病灶累积复发率分别为0、0、1.14%(1/88)、4.55%(4/88)和10.23%(9/88);共35例患者复发,治疗后0.5年、1年、1.5年、2年和2.5年总累积复发率分别为4.00%(2/50)、32.00%(16/50)、52.00%(26/50)、64.00%(32/50)和70.00%(35/50)。结论 TACE联合MRI引导下RFA治疗PHC创伤小、治疗病灶复发率相对较低,具有较高临床应用价值。  相似文献   

13.
原发性肝癌的射频治疗效果分析   总被引:1,自引:1,他引:0  
目的 分析原发性肝癌患者接受射频消融治疗的近期疗效及并发症.方法 分析2006年6月到2009年6月接受以射频消融为初始治疗并获得随访的85例原发性肝癌患者的临床资料.选择同期手术切除肿瘤最大径小于5cm并获得随访的103例肝癌患者作为对照组.结果 RFA组85例共106个瘤体均进行消融,术后1年有7例局部肿瘤进展,9...  相似文献   

14.
射频消融治疗肝癌216例   总被引:3,自引:0,他引:3  
目的 探讨肝癌射频消融治疗的有效性和安全性。方法 对216例肝癌共行252次射 频消融治疗,观察射频消融治疗后病人的不良反应、肝功能、甲胎蛋白(AFP)水平、肿瘤血供变化、CT 影像学变化及1年生存率。结果 射频消融治疗后病人的不良反应发生率为82%,56%的病人有轻 度的转氨酶升高,射频消融治疗前AFP升高者有85%的病人有程度不同的下降。76%的病人射频消 融治疗后彩色多普勒超声观察肿瘤血供明显减少或消失。射频消融治疗后1~6个月肝脏增强CT 扫描全部病人均有程度不同的肿瘤液化坏死,不强化者占56%,病人1年生存率为84%。结论 射 频消融是治疗肝癌的一种安全有效的方法。  相似文献   

15.
The liver is the organ most commonly involved with metastatic disease. Surgical resection of hepatic metastases is the only potentially curative therapy, but it is possible in only 20 per cent of the patients. Radiofrequency ablation (RFA) of hepatic lesions is a therapeutic option for unresectable hepatic metastases. Today there is no clear consensus about which imaging technique is the most reliable to monitor RFA therapy. [18F]Fluorodeoxyglucose (FDG) positron emission tomography (PET) is a new imaging modality allowing evaluation of glucose metabolism that has become established for monitoring therapy and early detection of recurrence of various types of malignant tumors. We present a case report of a 61-year-old man treated for prostate carcinoma 3 years earlier who presented with rising serum prostate-specific antigen (PSA) levels. A CT scan demonstrated two hepatic metastases that were treated with RFA because the patient refused surgery. During 3 years of follow-up hepatic recurrence was monitored with serum PSA levels, CT of the abdomen, and FDG-PET imaging on multiple occasions. On three separate occasions FDG-PET revealed hypermetabolic foci despite no definite evidence of recurrence on CT. Furthermore FDG-PET imaging 2 months after the last RFA therapy showed two large photopenic areas without evidence of hypermetabolism consistent with successful RFA therapy. Serum PSA levels correlated better with FDG-PET than CT results. We conclude that in this patient FDG-PET imaging was more accurate than CT for monitoring recurrence of hepatic metastases from prostate carcinoma after RFA therapy. PET demonstrated hypermetabolic foci when there was recurrence and no evidence of hypermetabolism early after successful RFA therapy. In addition FDG-PET imaging helped to guide the placement of the RFA probe to the most metabolically active part of the tumor.  相似文献   

16.
We performed computed tomography (CT)-guided percutaneous radiofrequency ablation (RFA) for postoperative recurrent pulmonary metastases developed in a 77-year-old man with interstitial pneumonia. He had received left upper segmentectomy with ND 2a nodal dissection. RFA was safely performed for pulmonary metastases in right S6 and left S6. There was no evidence to suggest any deterioration on interstitial pneumonia, including KL 6 and CT findings. Autopsy revealed residual cancer cells in peripheral lesion in 1 of 2 tumors treated by RFA. Although RFA is palliative, it is a promising treatment for local control of pulmonary malignancy in high-risk patients.  相似文献   

17.
目的 观察射频消融(RFA)膈下肝脏导致膈肌损伤的病理改变及其转归.方法 10只新西兰白兔的膈下肝脏行开腹RFA,制作膈肌损伤模型.RFA后1周和4周行腹部增强CT检查.第2次增强CT后处死兔,行大体标本和病理学观察.结果 RFA后即刻观察,见膈肌损伤区呈暗灰色,边缘呈灰白色,与正常膈肌分界清晰;膈肌损伤区面积为(0.89±0.19)cm2;无膈肌穿孔发生.RFA后1周和4周增强CT,无胸水、腹水、膈肌穿孔等征象.RFA后4周大体标本检查,膈肌损伤区域瘢痕形成,边缘明显肥厚;损伤膈肌与肝消融灶表面紧密粘连;瘢痕区面积为(0.73±0.17)cm2,无膈肌穿孔.病理学检查,膈肌损伤区肌纤维完全消失,纤维组织代偿性增厚;膈肌损伤区边缘肌纤维数目减少,排列紊乱;肌间隙纤维组织轻度增生,淋巴细胞浸润.结论 膈下肝脏RFA可致膈肌全层损伤,但这种损伤可通过瘢痕修复,不会发生膈肌穿孔等严重并发症.
Abstract:
Objective To assess the pathological changes and outcome of diaphragmatic injury after radiofrequency ablation (RFA) for the liver abutting the diaphragm in order to provide a theoretical support of percutanous RFA for hepatocellular carcinoma abutting the diaphragm. Methods The animal models of diaphragmatic injury were made by open surgery RFA for the liver abutting the diaphragm in 10 New Zealand rabbits. Helical enhanced computed tomography (CT) was performed one week and 4 weeks after RFA. The 10 rabbits were killed immediately after the second enhanced CT, and all diaphragmatic lesions underwent gross and histologic examinations. Results Immediately after RFA, the diaphragmatic lesions were gray with an outer pale rim, and no diaphragmatic perforation occurred. The boundaries between lesions and normal area were clear. The area of diaphragmatic lesions was (0.89±0.19) cm2. No major complications, such as diaphragmatic perforation, pleural effusion and ascites, were detected on the postablation CT scan (one week or 4 weeks after the procedure). At gross inspection 4 weeks after RFA, the diaphragmatic lesions became scar-like tissue with hypertrophy of margin. Adhesion formed between the diaphragmatic lesions and the surface of hepatic RFA lesions. The area of scar was (0.73±0.17) cm2. No diaphragmatic perforation was found. On microscopic examination 4 weeks after RFA, the muscle in diaphragmatic lesions disappeared and became fibrous. Diminution, disorder and degeneration of the muscle were found in the outer rim of diaphragmatic lesions, which were replaced by fiber and lymphocyte. Conclusion It is possible to cause full-thickness diaphragmatic injury when adjacent liver is treated with RFA, but it can be repaired by scarring and there is no diaphragmatic perforation.  相似文献   

18.

Background  

Computed tomography (CT)-guided radiofrequency ablation (RFA) is presumed to be less morbid and less costly than laparoscopic RFA. This analysis investigates the 30-day morbidity, hospital cost, and reimbursement for CT-guided RFA versus laparoscopic RFA used to manage hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM).  相似文献   

19.
Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? The natural history of renal angiomyolipomas (AML) shows increasing size and increasing risk of haemorrhage. For those patients undergoing treatment, extirpative surgery or renal angio‐embolization has increased morbidity. Due to its haemostatic effect, radio‐frequency ablation (RFA) may be used safely and effectively for the treatment of small (<4 cm), symptomatic renal AML. This study represents the largest case series reporting on RFA for renal AML.

OBJECTIVES

? To show that radiofrequency ablation (RFA) is safe and effective treatment for renal angiomyolipoma (AML). ? Current treatments to reduce the risk of haemorrhage include tumour extirpation, angio‐embolization, or ablative therapy.

PATIENTS AND METHODS

? Review of our prospective database revealed 15 patients with intraoperative biopsy confirmed renal AML undergoing RFA from February 2002 to March 2010. ? Patients underwent either laparoscopic or computed tomography (CT)‐guided percutaneous RFA using either the Cool‐tip? (Covidien, Inc. Boulder, CO, USA) or RITA? (Angiodynamics®, Latham, NY, USA) RFA probe. ? CT at 1 month, 6 months, 1 year, and annually thereafter.

RESULTS

? In all, two male and 13 female patients with seven left‐sided and eight right‐sided tumours with a mean (range) size of 2.6 (1.0–3.7) cm underwent laparoscopic (five) or CT‐guided (10) RFA. ? No intraoperative complications occurred. Minor complications included transient haematuria and intercostals nerve transection. Surgical complications included pneumonia and myocardial infarction. ? There was no radiographic evidence of persistent AML (CT enhancement) at a mean follow‐up of 21 months.

CONCLUSIONS

? The haemostatic effect of RFA allows renal lesions suspicious for AML to be treated without bleeding complications. ? Avoids surgical risk of extirpation or embolization. ? RFA for renal AML is safe and effective.  相似文献   

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