经皮肝穿刺射频热凝治疗原发性小肝癌

目的：探讨经皮肝穿刺射频热凝（PRFA）治疗肝癌的效果和适应证。方法：对16例原发性小肝癌患者行PRFA治疗的临床资料进行回顾性分析。结果：16例肝癌的直径均≤3cm。PRFA治疗后甲胎蛋白转阴者占93．3％（14／15）。B超，CT复查肿瘤缩小，并有包膜形成。0．5，1，2年生存率分别为93．8％，100％，100％。结论：PRFA是一种具有微创、时间短、安全方便、疗效可靠的治疗小肝癌的新方法。尤其适于有手术禁忌症，或有手术指征但位于肝中央区、临近腔静脉或肝门区的小肝癌。     

B超引导经皮肝穿刺射频治疗肝癌

目的：探讨B超引导经皮肝穿刺射频（PRFA）治疗肝癌的价值。方法：1999年10月－2000年3月对70例肝癌患者进行了B超引导PRFA治疗,并于治疗后每个月进行肿瘤标记物和B超检查,治疗后1个月复查MRI或CT。结果：患者肝功能分级Child A级53例,B级15例,C级2例,原发性肝癌53例,继发性肝癌17例,原发性小肝癌（小于等于5cm,未手术）21例,其中AFP阳性17例,PRFA术后转阴12例,明显降低4例,未降低1例。MRI显示肿癌完全凝固性坏死16例,根治率76．2％,小肝 癌各组PRFA术后3,6个月生存率均为90．5％－100％,大肝癌各组术后3,6个月生存率分别为66．7％－72．7％和27．6％－72．7％,结论：射频作为肿瘤透热治疗的一种方法,对于肝癌尤其是无手术指征,或有手术指征但位于肝中央区,临近腔静脉或肝门区的小肝癌,PRFA具有微创,时间短,安全方便,疗效可靠,对于大肝癌,PRFA可与肝动脉介入化疗栓塞联合应用,以提高疗效。     

射频联合无水酒精注射治疗肝脏恶性肿瘤

目的　探讨经皮肝穿刺射频热凝联合无水酒精注射治疗肝癌的意义、适应证和疗效评价标准。方法　对共 78个肿瘤结节 ,共进行约 6 0次射频联合无水酒精注射治疗。病人治疗后每个月进行血清标记物检测和B型超声检查。结果　肿瘤结节直径≤ 5cm ,甲胎蛋白定量升高者 ,治疗后甲胎蛋白正常占 72 .0 % (31 / 4 3) ,明显下降占 2 7.9% (1 2 / 4 3)。肿瘤结节直径 >5cm 2例 ,治疗后甲胎蛋白也明显下降 ,2例AFP阴性B型超声复查肿瘤缩小。无手术死亡。结论　经皮肝穿刺射频热凝联合无水酒精注射作为肿瘤治疗的一种方法 ,可应用于肝癌切除术后局部复发转移病例     

经皮肝穿刺射频热凝与肝动脉化疗栓塞联合治疗肝细胞癌

目的：探讨对于无手术指征或考虑手术疗效欠佳的较大肝癌（3－7cm）和位于肝门区的小肝癌先行肝动脉化疗栓塞（TACE）,再行B超引导经皮肝穿刺射频热凝（PRFA）治疗肝癌的意义。方法2000年1月至2001年7月对符合条件的15例肝癌患者先行TACE,而后进行B超引导PRFA治疗,另15例肝癌患者直接给予B超引导PRFA治疗。治疗后定期复查甲胎蛋白（AFP）。1个月后复查MRI或CT确定肿瘤是否完全坏死,以后每2－3个月复查。Kaplan-Meier法计算无瘤生存率和累积生存率。结果：TACE加PRFA组肿瘤完全坏死率86．7％（13／15）,单纯PRFA组为26．7％（4／15）,差异有显著意义。前组AFP转阴率66．7％（6／9）,后组20％（2／10）。前组6个月无瘤生存率100％（13／13）,后组75．0％（3／4）。前组1、1．5、2年的生存率分别为100％、100％和66．7％,后组1和1．5年的生存率分别为80．0％和40．0％,差异有显著意义。结论：对于较大的（＞3cm）、位于肝门区的、边界不清的或较多个瘤灶的肝癌先行TACE,再适时给予PRFA,可以扩大肿瘤坏死范围,增加肿瘤完全坏死率、减少复发、提高生存率。     

第一肝门区小肝癌的经皮肝穿刺射频消融治疗

目的探讨对于位于第一肝门区的小肝癌行B超引导经皮肝穿刺射频消融(PRFA)治疗的可行性、疗效和应注意的问题。方法2000年4月至2002年10月选择肿瘤位于第一肝门区、≤5cm、病理或临床证实为原发性或继发性肝癌的21例患者进行PRFA治疗。治疗前甲胎蛋白(AFP)阳性者治疗后定期复查AFP。治疗后1个月复查MRI或CT确定肿瘤是否完全坏死,以后每3个月定期复查。Kaplan-Meier法计算“无瘤”生存率和累积生存率。结果AFP转阴率约为78％,MRI或CT显示第一肝门区肿瘤完全凝固坏死率为90．5％(19／21)。0．5、1、1．5、2年无原位复发生存率均为94．7％;0．5、1、1.5、2年无“瘤旁复发”生存率分别为90．0％、77．1％、77．1％和77．1％;0．5、1、1．5、2年总生存率分别为89．2％、82．8％、82．8％和55．2％。胆管狭窄发生率为4．8％。结论第一肝门区小肝癌并非PRFA治疗的禁忌证,只要治疗时穿刺点选择恰当、穿刺路径合理、超声监测下电极展开确切、热凝范围控制恰当,对于第一肝门区小肝癌PRFA是一种行之有效的治疗方法。     

不同影像方法对射频热凝肝癌疗效的评价

目前肝癌治疗是以手术切除为主的多种方法结合的综合治疗，随着电热技术的发展、射频电极的更新，组织热凝范围得以扩大，射频治疗成为肝癌的一种新的辅助治疗方法^[1,2]。但是，目前对于射频热凝后的疗效评价还没有一个统一的标准，除了血清肿瘤学指标作为一个评价标准外，影像学是另一个可行的评价标准^[3]。本文通过对经皮肝穿刺射频热凝(percutaneous radio frequency ablation，PRFA)治疗原发性和继发性肝癌后的B超、MRI和CT结果分析，探讨不同影像方法对射频热凝肝癌疗效评价的意义。     

经皮射频微创治疗小肝癌

目的　总结经皮射频消融 (PRFA)治疗肿瘤直径 <5cm小肝癌的疗效和经验。方法　1999年 8月至 2 0 0 2年 6月期间 ,以根治为目的 ,采用PRFA治疗肿瘤直径≤ 5cm的单个原发性肝癌共 84例 ,2 2例结合经皮肝动脉栓塞化疗 ;35例同时行PRFA联合瘤内无水酒精注射术。结果　肿瘤≤ 3cm组 5 5例中第 1年出现肝内复发者 2例 ,死亡 1例 ;第 2年出现肝内复发者 2例 ,死亡 1例。肿瘤大小介于 3～ 5cm组 2 9例中 ,第 1年出现肝内复发者 3例 ,死亡 2例 ;第 2年出现肝内复发者 4例 ,死亡 3例。结论　PRFA为小肝癌治疗提供了一种新的手段 ,经过近 3年技术的提高和经验的积累 ,射频消融完全有可能杀灭肿瘤直径 <5cm的小肝癌 ,达到根治性效果。本组对 84例小肝癌进行以射频消融为主的非手术微创治疗 ,近期疗效满意 ,远期疗效有待进一步随访观察 ,射频消融对小肝癌治疗有着良好的前景。     

经皮射频消融或联合肝动脉、门静脉栓塞化疗治疗原发性及复发性小肝癌

目的探讨经皮射频消融或联合肝动脉、门静脉栓塞化疗治疗原发性及复发性小肝癌的价值. 方法 2001年9月～2004年9月,采用经皮射频消融(percutaneous radiofrequency ablation,PRFA)方法治疗原发性小肝癌(肿瘤直径≤5 cm)11例和复发性小肝癌(肿瘤直径≤3 cm)13例,其中4例原发性肝癌和8例复发性肝癌结合肝动脉及门静脉栓塞化疗.结果在11例原发性小肝癌中,6例肿瘤直径≤3 cm者,MRI或CT提示瘤灶完全凝固性坏死;5例肿瘤直径3～5 cm者,MRI或CT提示4例肿瘤完全凝固性坏死.1、1.5、2年累积生存率分别为100%、85.71%、68.57%.在13例复发性小肝癌中,单发组(7例)MRI或CT提示瘤灶完全凝固性坏死;多发组(6例)共15个瘤灶,MRI或CT提示12个瘤灶完全凝固性坏死.1、1.5、2年累积生存率分别为88.89%、77.78%、64.81%. 结论 PRFA为原发性及复发性小肝癌的治疗提供了一种新的手段,对肿瘤直径超过3 cm以及复发性肝癌结合肝动脉、门静脉栓塞化疗有助于提高肿瘤坏死率,减少复发率,有效提高生存率.     

原发性肝癌行PRFA并发烧伤1例

本科室收治一例原发性肝癌患者，在行经皮肝穿刺射频热凝毁损肿瘤术（percutaneous radiofrequency ablmion，PRFA）时并发皮肤烧伤。现报道如下。     

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。     

Serum alpha-fetoprotein subfractions in hepatic malignancies identified by different reactivities with concanavalin A, lentil lectin or phytohemagglutinin-E

Using a modified method of concanavalin A (Con A), lentil lectin (LCH) or phytohemagglutinin-E (PHA-E) affinity crossed-line immunoelectrophoresis (ACIE), we studied alpha-fetoprotein (AFP) subfractions in 69 sera, including 58 from patients with primary liver cancer and 11 from patients with hepatic metastasis of gastric cancer. We found that Con A non-reactive subfraction (type b) or LCH weakly-reactive subfraction (type B) was more frequently detected in metastatic liver cancer, as compared with liver cancer hepatoma. The amount of Con A non-reactive subfraction (type b) or of PHA-E reactive subfraction (type X) was significantly higher in case of metastatic liver cancer than in primary liver cancer. Since different affinities between AFP and lectins are due to the microheterogeneity in AFP sugar chain, our findings suggest that AFP in primary liver cancer and metastatic liver cancer is glycosylated in a different manner. It is also indicated that different patterns of AFP subfractions identified by the combination of Con A, LCH or PHA-E ACIE facilitate a differential diagnosis of these hepatic malignancies.     

Serum alpha-fetoprotein subfractions in hepatic malignancies identified by different reactivities with concanvalin A,lentil lectin or phytohemagglutinin-E

Using a modified method of concanavalin A (Con A), lentil lectin (LCH) or phytohemagglutinin-E (PHA-E) affinity crossed-line immunoelectrophoresis (ACIE), we studied alpha-fetoprotein (AFP) subfractions in 69 sera, including 58 from patients with primary liver cancer and 11 from patients with hepatic metastasis of gastric cancer. We found that Con A non-reactive subfraction (type b) or LCH weakly-reactive subfraction (type B) was more frequently detected in metastatic liver cancer, as compared with liver cancer hepatoma. The amount of Con A non-reactive subfraction (type b) or of PHA-E reactive subfraction (type X) was significantly higher in case of metastatic liver cancer than in primary liver cancer. Since different affinities between AFP and lectins are due to the microheterogeneity in AFP sugar chain, our findings suggest that AFP in primary liver cancer and metastatic liver cancer is glycosylated in a different manner. It is also indicated that different patterns of AFP subfractions identified by the combination of Con A, LCH or PHA-E ACIE facilitate a differential diagnosis of these hepatic malignancies. These data were reported at the 22nd Congress of the Japan Society for Cancer Therapy, on September 26, 1984, in Tokyo, Japan     

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.     

腹腔镜下射频消融治疗小肝癌的临床疗效分析

目的:探讨腹腔镜下射频消融(LRFA)治疗原发性小肝癌的临床效果。方法:回顾性分析2011年8月—2013年10月南昌大学第二附属医院行LRFA治疗的30例小肝癌患者(LRFA组)以及同期行经皮射频消融(PRFA,PRFA组)和手术切除(手术切除组)各30例的小肝癌患者临床资料。比较3组患者的相关临床指标。结果:3组患者术前一般资料具有可比性,所有患者均顺利完成手术。术后,3组AFP水平均较术前明显降低(均P0.05),但3组间AFP水平无统计学差异(P0.05);3组肝功能指标均较术前明显升高(均P0.05),但手术切除组较另两组升高程度大、恢复慢(均P0.05)。在手术时间、术中出血量、围手术期并发症、住院时间方面,LRFA组与PRFA组均优于手术切除组(均P0.05),而LRFA组手术时间长于PRFA组(80.7 min vs.45.2 min,P0.05),并发症发生率低于PRFA组(6.7%vs.26.7%,P0.05);术后1个月,LRFA组和手术切除组肿瘤完全清除率均为100%,而PRFA组为86.7%,两组间差异有统计学意义(P0.05)。LRFA组、PRFA组、手术切除组3年复发率分别为33.3%、60.0%、26.7%;3年无瘤生存率分别为66.7%、40.0%、73.3%;3年总生存率分别为86.7%、76.7%、90.0%,其中,PRFA组的3年无瘤生存率明显低于另两个组,复发率明显高于另两组(均P0.05),而LRFA组和手术切除组之间无瘤生存率及复发率差异无统计学意义(均P0.05);3组患者3年总生存率差异无统计学意义(P=0.302)。结论:对于原发性小肝癌,LRFA较PRFA消融率高,且远期疗效与开腹手术相当,同时具有微创、术后恢复快的优点,可作为小肝癌的首选治疗手段之一。     

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.     

Evaluation of risk factors in the development of postoperative complications in patients undergoing liver resection for cancer

A consecutive series of 134 hepatic resections for primary and metastatic cancer were analyzed to identify the risk factors for post-operative complications in patients with and without impaired liver reserve. Between January 1992 and January 2000 were performed 55 hepatectomies (41%--group 1) in 54 cirrhotic patients for hepatocarcinoma and 79 hepatic resections (59%--group 2) in 66 patients for primary hepatic malignancies or metastatic liver tumours in non cirrhotic liver. Among major postoperative complications bile leakage was recorded in 8 patients (6%) (6% with impaired liver reserve and 6% with normal reserve), hepatic failure in 8 patients (6%) (9% vs 4%; P = NS), ascites in 7 patients (5%) (11% vs 1%; P = 0.01), pneumonia in 4 patients (3%) (5% vs 1%; P = NS), intra-abdominal abscess in 2 patients (1%) (2% vs 1%; P = NS), postoperative haemorrhage in 2 patients (1%) (4% vs 0; P = NS), and gastrointestinal bleeding in 2 patients (1%) (4% vs 0; P = NS). There were 6 perioperative deaths (4%) (7% vs 2%; P = NS). The mean hospital stay was 21 +/- 10 days (range: 5-57) (24 +/- 10 vs 20 +/- 10; P = 0.02). Liver resection is a safe procedure even in cirrhotic patients providing they are well selected and there is minimal intraoperative blood loss.     

原发性肝癌术后复发行经皮肝穿刺新型射频治疗的疗效分析

目的观察原发性肝癌术后复发行经皮肝穿刺新型射频治疗的疗效，探讨新型射频在治疗原发性肝癌术后复发的应用。方法在B超引导下，将射频电极针经皮穿刺入肝肿瘤内，对其进行原位毁损消融。结果28例患者共34个病灶中：直径≤3cm的23个瘤体，21个完全毁损，热毁损率为91．3％；直径为3～5cm的11个瘤体中8个瘤体获得完全毁损，热毁损率为72．7％。术后无严重并发症发生。术后6、12个月无瘤生存率分别为75％、53．6％；术后6、12、18个月生存率分别为100％，96．4％，92．9％。结论经皮肝穿刺射频消融术对于原发性肝癌术后复发疗效可靠，是一种安全、有效治疗肝癌术后复发的方法。     

经皮肝穿刺氩氦刀冷冻治疗第二肝门区小肝癌

目的探讨B超引导氩氦刀冷冻治疗第二肝门区小肝癌的技术可行性、疗效和安全性。方法2002年10月至2006年6月选择肿瘤位于第二肝门区、直径≤5cm、病理或临床证实为原发性或继发性肝癌的8例患者进行氩氦刀冷冻治疗。治疗前甲胎蛋白（AFP）阳性者治疗后定期复查AFP。治疗后1个月复查MRI或CT确定肿瘤是否完全坏死，以后每3个月定期复查。结果AFP转阴率约为75％，MRI或CT显示第一肝门区肿瘤完全凝固坏死率为62．5％。术后0．5、1年无原位复发生存率均为100％、87．5％；血管壁损伤或大出血发生率为0％。结论第二肝门区小肝癌并非氩氦刀冷冻治疗的禁忌症，只要治疗时穿刺点选择恰当、穿刺路径合理、范围控制恰当，对于第二肝门区小肝癌是一种行之有效的治疗方法。