培美曲塞对EGFR—TKI治疗失败肺腺癌患者的临床疗效

目的探讨培美曲塞对表皮生长因子受体酪氨酸激酶抑制剂（EGFR—TKI）治疗失败肺腺癌患者的疗效和不良反应。方法选择30例经过EGFR-TKI治疗后肿瘤进展的晚期肺腺癌患者,采用培美曲塞500mg／m^2。于化疗周期第1天静滴,每21 d为1个周期,并口服地塞米松、叶酸和肌肉注射维生素B12以减轻不良反应;完成2个周期以上化疗后根据实体瘤疗效评价标准评价疗效并记录不良反应。结果30例中,部分缓解6例（20％）,疾病稳定11例（36．6％）,疾病进展13例（43．4％）,中位生存期为11．1个月,1年生存率为37．0％。最常见的不良反应为Ⅰ～Ⅱ度骨髓抑制。结论晚期肺腺癌患者在EGFR-TKI治疗失败后给予培美曲塞解救治疗有显著临床疗效。     

用生理盐水与稀盐酸对离体猪肝行增强射频消融的研究

目的 比较相同条件下生理盐水增强型射频消融(NS-RFA)和稀盐酸增强型射频消融(HCl-RFA)对消融灶大小的影响,探讨影响增强型单灌注电极射频消融灶大小的因素,观察消融灶的病理组织学改变.方法以消融时间(5、10、15和20 min)、温度(83、93、103和113℃)和功率(20、30和40 W)为变量形成9种组合(103℃、30 W条件下分别消融5、10、15、20 min 4种组合;30 W、15 min,83、93、113℃3种组合;103 ℃、15 min,20和40 W 2种组合),用单灌注射频消融电极对30个离体猪肝分别行NS-RFA和HCl-RFA对照实验,然后测量消融灶的纵轴、横轴并计算其体积,采用多因素方差分析法分析影响消融灶大小的因素.通过肉眼大体观察和显微镜下观察消融灶病理改变.结果 (1)NS-RFA 9种条件组合下消融灶的体积分别为(3.53±0.34)、(6.41±0.42)、(10.69±0.37)、(11.40±0.51)、(3.20±0.23)、(6.59±0.50)、(12.11±0.70)、(11.12±0.52)、(11.81±0.64)cm3,HCl-RFA 9种条件组合下消融灶的体积分别为(11.97±1.00)、(28.72±0.99)、(59.45±1.33)、(105.65±2.40)、(13.64±0.60)、(29.70±0.58)、(59.22±1.32)、(57.22±3.99)、(59.74±2.18)cm3;不同消融方式(F=948.9)(主变量)、消融时间(F=269.3)和温度(F=214.6)(协变量)引起消融灶体积的差异具有统计学意义(P值均＜0.01);不同功率(F=0.2)(协变量)引起消融灶体积的差异无统计学意义(P＞0.05).(2)NS-RFA和HCl-RFA消融灶中心横切面大体形态均呈椭圆形,NS-RFA分3个区,HCl-RFA分5个区.显微镜下观察,NS-RFA消融灶Ⅰ区边缘见少量肝细胞碎片,Ⅱ区部分肝细胞变形、碎裂,Ⅲ区多数肝细胞形态正常;HCl-RFA消融灶Ⅰ区边缘残留少量肝细胞碎片,Ⅱ、Ⅲ区呈均质红染结构的典型凝固性坏死,Ⅳ肝窦增宽、肝细胞连接疏松或脱落到肝窦内;V区多数肝细胞结构保持正常形态结构,少数肝细胞发生核固缩、碎裂和溶解.结论 与NS-RFA相比,HCl-RFA能产生更大的组织消融灶;消融时间和温度是影响消融灶大小的因素,消融功率对消融灶大小没有明显影响.HCl-RFA消融灶病理组织上呈典型凝固性坏死改变.

Abstract：

Objective To compare the size of ablation lesions created by normal saline enhanced radiofrequency ablation (NS-RFA) and dilute hydrochloric acid enhanced radiofrequency ablation (HCl-RFA), explore their affecting factors, and observe the morphological manifestations of the ablated lesions.Methods NS-RFA and HCl-RFA were performed on 30 excised porcine livers with 9 different combinations of durations (5, 10, 15, and 20 minutes), temperatures (83, 93, 103, and 113 ℃ ) and powers (20, 30,and 40W). For each ablated lesion, the longitudinal and transverse diameters were measured, and volumes calculated. Multifactor analysis of variance was used to analyze the affecting factors of the size of ablated lesions. Macroscopic and microscopic morphological characteristics of lesions were observed. Results ( 1 )NS-RFA lesion volumes under 9 combinations were ( 3.53 ± 0. 34 ), (6. 41 ± 0. 42 ), ( 10. 69 ± 0. 37 ),(11.40±0.51), (3.20±0.23), (6.59 ±0.50), (12.11 ±0.70), (11.12 ±0.52), (11.81 ±0. 64) cm3, respectively. HCl-RFA lesion volumes under 9 combinations were ( 11.97 ± 1. 00), (28.72 ±0.99), (59.45 ±1.33), (105.65 ±2.40), (13.64±0.60), (29.70±0.58), (59.22±1.32),( 57. 22 ± 3.99 ), ( 59. 74 ± 2. 18 )cm3, respectively. The size differences of ablation zones caused by different types of ablation ( F = 948.9 ) ( main factor), durations ( F = 269. 3 ) and temperatures ( F =214. 6) (covariates) were statistically significant (P ＜ 0. 01 ), whereas which caused by power ( F = 0. 2 )(covariate) was not statistically significant (P ＞ 0. 05 ). (2)At gross examination, all ablation lesions were elliptical in cross section and there were three zones in NS-RFA induced lesions and five zones in HCl-RFA induced lesions. At microscopic examination of NS-RFA induced lesions, a small amount of liver cell debris were found at the edge of zone Ⅰ , a few of deformed and ruptured liver cells in zone Ⅱ. The shape of the most of the liver cells in zone Ⅲ was normal. At microscopic examination of HCl-RFA induced lesions, a small amount of liver cell debris were found at the edge of zone Ⅰ , classical coagulation necrosis in zone Ⅱ and Ⅲ, widened hepatic sinusoids lossened junction of hepatocytes and some hepatocytes detached into sinusoids in zones Ⅳ. The liver cells in zone V were normalexcept a small amount of hepatoeytes with pyknosis, karyorrhexis and karyolysis. Condusion Compared with NS-RFA, HCl-RFA can produce lager ablation zones. The duration and temperature were the factors that affected the size of ablation zone. HCl-RFA lesions typically showed coagulation necrosis at microscopical examination.     

CT引导下经皮射频消融治疗卵巢癌肝脏转移肿瘤的初步疗效

目的探讨CT引导下经皮射频消融治疗（RFA）治疗卵巢癌肝脏转移瘤的近期疗效、安全性和不良反应。方法 2006年1月至2010年7月,本院8例卵巢癌肝转移的患者在CT引导下进行RFA治疗,病灶总数12处,平均直径为3.0cm（1.5～4.5cm）。RFA治疗前2周内和治疗后1月常规进行CA125、肝功能、CT双期增强检查,了解局部治疗效果、安全性和不良反应。结果 所有病人均平稳安全完成治疗,11处病灶术后复查增强CT肿瘤完全坏死,有1例患者1处病灶在射频消融治疗后肝脏病灶边缘残留。所有患者CA125出现了不同程度的下降,术中及术后没有出现严重的并发症。结论 CT引导下RFA治疗卵巢癌肝脏转移瘤是一种安全、有效、并发症少的微创治疗方法。通过RFA治疗,卵巢癌肝脏转移患者可以实现理想的肿瘤细胞减灭治疗。     

微波消融毁损活体猪脾的实验研究

目的 探讨微波消融毁损淤血肿大的活体猪脾的安全性、可行性及其规律.方法 麻醉并开腹分别结扎5头活猪脾静脉2～4 h,待脾脏淤血肿大后进行微波消融(共56个位点),观察术中针道渗血、微波电极周围组织炭化情况,并记录不同功率、时间及消融部位对脾脏毁损体积的影响,同时观察消融术后消融灶及其周围组织的病理改变.结果 消融术中针道渗血发生率为8.9%(5/56),均为微波电极周围组织炭化所致;炭化发生率为8.9%(5/56);微波消融范围受消融功率、时间、部位的影响;消融范围与消融时间成正相关(r=0.975 36,P<0.01);消融范围与消融功率成正相关(r=0.981 84,P<0.01);远离脾门区域(Ⅱ区)消融范围明显大于靠近脾门区域(Ⅰ区)(P<0.01);消融术后即时病理改变与1周后病理改变中均可见较大面积的凝固性坏死,后者坏死组织周边可见较明显的炎性反应及组织水肿改变.结论 微波消融是一种毁损淤血肿大脾脏较为安全、可靠的微创方法,并可通过调整消融功率、时间、部位控制其毁损体积.