综合治疗晚期原发性肝癌72例疗效观察

目的 探讨腹腔化疗或联合其他方法综合治疗晚期原发性肝癌的治疗效果.方法 72例不能手术切除的、合并门静脉癌栓、腹腔内转移或淋巴结转移的晚期肝癌,采取腹腔化疗或者联合TACE等其他方法治疗.5-氟尿嘧啶(5-FU)0.5～0.75 g,腹腔内注入1/日,连用10～15天,总量5.0～12.5 g,最后一天腹腔内注入丝裂霉素(MMC)10 mg或卡铂100 mg.7例胆管细胞癌联合使用健择800～1000 mg.结果 全组平均生存时间13.97±6.27月.累积1年、2年生存率分别为59.7%和30.6%.肝功能Child A级平均生存时间15.91±5.49月,B级8.55±5.09月,有显著性差别.结论 腹腔化疗或联合其他综合治疗方法是肝癌并腹腔内转移的有效治疗方法,可延长部分晚期肝癌患者的生存时间,改善生活质量.     

Radiofrequency-induced thermotherapy (RFiTT) in a porcine liver model and ex vivo great saphenous vein

Aims: To investigate the thermal spread achieved in porcine liver when using an optimised radiofrequency ablation protocol and correlate findings with the effects seen in ex vivo great saphenous vein (GSV), in order to justify clinical use with the new treatment protocol.

Material and methods: Porcine liver and GSV sections were treated with radiofrequency-induced thermotherapy (RFiTT) using the following settings: 20 W at 1?s/cm (linear endovenous energy density; LEED 20 J/cm), 18 W at 1?s/cm (LEED 18 J/cm), 18 W at 3?s/cm (LEED 54 J/cm), 6 W interrupted pull-back 6?s stationary every 0.5?cm (LEED 72 J/cm). Thermal spread in the liver was measured via digital imaging. GSV sections were sent to an independent laboratory for histological analysis. Previous work suggests a thermal spread of?>0.65?mm in liver correlates with transmural thermoablation of a GSV.

Results: Parameters giving a LEED of 72 J/cm produced the best results, with a clear transmural effect in the GSV and maximal thermal spread of 1.65?mm, without excessive thermal damage or carbonisation in the ablation tract.

Conclusions: Our porcine liver model correlated well with histological findings and was representative of the thermoablative effects observed in the GSV wall treated with RFiTT. Clinical investigations are now being carried out to investigate the efficacy of this protocol in the clinical setting.     

Comparative Effectiveness of Computed Tomography- Versus Ultrasound-Guided Percutaneous Radiofrequency Ablation Among Medicare Patients 65 Years of Age or Older With Hepatocellular Carcinoma

Background

For patients with hepatocellular carcinoma (HCC) not eligible for surgical resection, radiofrequency ablation (RFA) is a promising technique that reduces the risk of disease progression.

MSCT引导下经皮肺穿刺对31例周围型肺癌射频消融术的护理

目的探讨MSCT引导下经皮肺穿刺对周围型肺癌射频消融(RFA)术的护理。方法对31例周围型肺癌患者施行MSCT引导下经皮肺穿刺RFA的过程进行配合与护理。结果本组患者术程顺利,其中2例出现气胸,经卧床休息后气体自行吸收,1例出现麻醉后血氧饱和度(SPO2)下降,经改用吸氧加止痛方法后,SPO2恢复正常,全部病例手术均获得成功。结论本术安全有效,围术期积极配合与护理有助于手术顺利完成、及早发现并发症及处理。     

Post-recurrence survival in hepatocellular carcinoma after percutaneous radiofrequency ablation

Background

Overall survival in hepatocellular carcinoma patients treated with percutaneous radiofrequency ablation is influenced by both recurrence and successive treatments. We investigated post-recurrence survival after radiofrequency ablation.

Methods

Data on 103 early/intermediate patients initially treated with radiofrequency ablation and followed for a median of 78 months (range 68–82) were retrospectively analysed. If intrahepatic disease recurrence occurred within or contiguous to the previously treated area it was defined as local, otherwise as distant; recurrence classified as Barcelona Clinic Liver Cancer stage C was defined by neoplastic portal vein thrombosis or metastases.

Results

A total of 103 patients were included (82.5% male; median age 70 years, range 39–86). During follow-up, 64 recurrences were observed. Median overall survival was 62 months (95% confidence interval: 54–78) and survival rates were 97%, 65% and 52% at 1, 4 and 5 years, respectively. Median post-recurrence survival was 22 months (95% confidence interval: 16–35). Child–Pugh score, performance status, sum of tumour diameters at recurrence and recurrence patterns were independent predictors of post-recurrence survival.

Conclusions

In patients with hepatocellular carcinoma after radiofrequency ablation, clinical and tumour parameters assessed at relapse, in particular the type of recurrence pattern, influence post-recurrence survival.     

射频消融术(RFA)治疗继发性甲状旁腺功能亢进(SHPT)的安全性及有效性分析

目的 探讨超声引导下射频消融术治疗慢性肾脏病（chronic kidney disease,CKD）继发性甲状旁腺功能亢进（secondary hyperparathyroidism,SHPT）的安全性及有效性。方法 选取复旦大学附属中山医院2017年10月至2018年9月确诊为SHPT并进行超声引导下射频消融术（radiofrequency ablatio,RFA）的患者15例,共15枚甲状旁腺增生结节,以超声造影作为测量消融术前后甲状旁腺结节大小的标准方法。对比消融术前后甲状旁腺结节大小、甲状旁腺激素（parathyroid hormone,PTH）、血钙（Ca）、血磷（P）、碱性磷酸酶（alkaline phosphatase,ALP）、活性维生素D[1,25-（OH）₂D]、临床症状（骨痛、皮肤瘙痒、失眠、手抖）及并发症情况。结果 与消融术前比较,患者术后1、3和6个月甲状旁腺结节明显变小（P<0.05）,结节缩小率分别为66%、93%和98%,术后1天、1、3和6个月血清PTH、Ca、P、ALP水平明显下降（P<0.05）,活性维生素D水平无明显改变,患者的临床症状明显好转。并发症声音嘶哑的发生率为6.7%,低钙血症的发生率6.7%,治疗后均恢复,且未再复发,无其他并发症。结论 超声引导下经皮RFA治疗SHPT安全有效,能明显改善患者症状,且并发症较少。     

Thermometry during coblation and radiofrequency ablation of vertebral metastases: a cadaver study

Purpose

To evaluate safety of coblation of simulated lytic metastases in human cadaveric vertebral bodies by measuring heat distribution during thermal tissue ablation and comparing it to radiofrequency ablation (RFA).

Materials and methods

Three devices were compared: a 10 mm single-needle RFA electrode, a 20 mm array RFA electrode and the coblation device. To simulate bone metastases, a spinal tumor model was used stuffing a created lytic cavity with muscle tissue. Measuring of heat distribution was performed during thermal therapy within the vertebral body, in the epidural space and at the ipsilateral neural foramen. Eight vertebral bodies were used for each device.

Results

Temperatures at heat-sensitive neural structures during coblation were significantly lower than using RFA. Maximum temperatures measured at the end of the procedure at the neural foramen: 46.4 °C (±2.51; RFA 10 mm), 52.2 °C (±5.62; RFA 20 mm) and 42.5 °C (±2.88; coblation). Maximum temperatures in the epidural space: 46.8 °C (±4.7; RFA 10 mm), 49.5 °C (±6.48; RFA 20 mm) and 42.1 °C (±2.5; coblation). Maximum temperatures measured within the vertebral body: 50.6 °C (±10.48; RFA 10 mm), 61.9 °C (±15.39; RFA 20 mm) and 54.4 °C (±15.77; coblation).

Conclusion

In addition to RFA, the application of coblation is a safe method to ablate vertebral lesions with regards to heat distribution at heat-sensitive neural spots. The measured temperatures did not harbor danger of thermal damage to the spinal cord or the spinal nerves.     

Malignant liver tumours

The liver is commonly affected by malignant tumours, both primary and secondary. The majority of liver tumours are diagnosed radiologically and MRI and CT scan are accurate at detecting even small tumours. Hepatocellular carcinoma (HCC) is the most common primary tumour and often presents on the background of liver cirrhosis. The curative options for HCC are liver resection and transplant. However non-curative management such as radiofrequency ablation (RFA) and trans-arterial chemo-embolization (TACE) can prolong survival in patients not suited to curative management. Cholangiocarcinoma is a less common malignancy but unfortunately has poorer outcomes. It affects the bile ducts and treatment relies on resection of the affected liver and biliary tree, requiring reconstruction of the biliary drainage system. Postoperative morbidity is high and long term survival is often short. Colorectal liver metastases (CLM) are the most common liver tumours. With improvements in preoperative chemotherapy and surgical techniques such as portal vein embolization (PVE) and two stage resections, curative resection with good long term outcomes are often achieved.