冷循环射频消融治疗肝肿瘤近期疗效观察

目的：观察冷循环射频消融治疗肝肿瘤的近期疗效。方法：运用HG-3000型单针冷极射频肿瘤治疗机对43例肝癌患者总计117个瘤体进行消融治疗。运用CT及B超观察瘤体的变化,测定AFP、CEA、肝功能,并与治疗前进行比较。结果：117个瘤体的生长均受到明显抑制,AFP值较治疗前明显下降（P〈0.05）;CEA值呈持续升高趋势,治疗后第3、4、5月CEA值与治疗前比较有明显差异（P〈0.05）;肝功能在治疗后1、2周变化较为明显,4、5周后恢复治疗前水平。结论：冷循环射频消融治疗肝肿瘤近期疗效满意,并发症少。     

射频消融治疗原发性肝癌疗效分析

[目的]评价原发性肝癌射频消融治疗的效果及其影响因素.[方法]对63例原发性肝癌病人共81个肝癌结节进行射频消融治疗.[结果]进行一次射频消融治疗后,直径≤4cm和直径>4cm的肿瘤的完全毁损率分别为80.6%和24.0%(P<0.01);经过多次射频消融后,肿瘤完全毁损率分别为93.5%和42.0%(P<0.01).平均随访时间为13个月,直径≤4cm和直径>4cm的肿瘤的局部复发率分别为6.9%和14.2%(P>0.05).12个月和18个月的生存率分别为81.0%和71.4%,生存率与肿瘤大小和Child-Pugh分级有关(P<0.05).[结论]对于肿瘤≤4cm和Child-Pugh分级A的肝癌病人,射频消融治疗的局部效果和长期生存率均较好.     

微波消融治疗肝癌的现状

肝癌微波消融治疗取得了令人满意的临床疗效,已成为肝癌综合治疗中的一种重要手段。本文对肝癌微波消融治疗的原理、引导方法、适应证、禁忌证、并发症、联合治疗的疗效等进行综述。     

经皮射频消融联合瘤内无水酒精注射与单纯射频消融治疗小肝癌的疗效比较

目的比较经皮射频消融联合瘤内无水酒精注射（RFA-PEI）与单纯射频消融（RFA）治疗单发小肝癌的疗效。方法随机应用RFA—PEI和RFA分别治疗小肝癌45例和41例,并按病灶大小分为A组（最大直径≤3．0cm）和B组（最大直径3．1～5．0cm）,以生存率和无局部复发率作为评价指标,比较两种疗法的疗效、结果RFA-PE组和RFA组的6,12,18,24个月生存率分别为88．9％、84．0％、80．6％、73．9％和87．6％、78．3%、73．7％、61.4％（P=0．6181）,无局部复发率分别为95．4％、95．4％、87．8％、73．7％和94．9％、72．7％、68.4％、57.0％（P=0．0393）,其中A组为95．7％、95．7％、79．1％、79．1％和923％、83．2％、81.3％、65．9％（P=0．3679）;B组为95．0％、95．0％、95．0％、72．6％和100．0％、583％、45．4％．45．4％（P=0．0440）结论RFA-PEI治疗肝癌安全有效,操作简单易行,可以提高RFA治疗的疗效, 特别是对于肿瘤直径为3-5cm的病灶,可以减少局部复发率,提高远期生存率。     

微波消融与动脉介入联合微波消融治疗原发性肝癌的对比研究

目的:比较原发性肝癌局部治疗中单纯微波消融(MTC)与动脉介入后联合微波消融治疗(TACE+MTC)的疗效.方法:选取48例原发性肝癌患者作为研究对象(共88个肿瘤灶),按肿瘤最大径分为小瘤组(≤5 cm)和大瘤组(＞5 cm).每组44个瘤灶.不完全随机行单纯MTC治疗(22个肿瘤灶)和MTC+ TACE治疗(22个肿瘤灶;5-氟尿嘧啶1.0g,多柔比星60 mg,顺铂80 mg,羟基喜树碱20 mg).治疗结束后对肿瘤进展情况进行观察.结果:小瘤组,TACE+ MTC治疗组和单纯MTC治疗组比较,有效率分别为54.5％(12/22)和50.0％(11/22),P=0.763;1年生存率分别为83.3％(10/12)和81.2％(9/11),P=1.000.大瘤组,TACE+MTC治疗组和单纯MTC治疗组比较,有效率分别为40.9％(9/22)和18.2％(4/22),P=0.023;1年生存率分别为69.2％(9/13)和25.0％(3/12),P=0.047.结论:直径≤5 cm的肝肿瘤可以采用单纯MTC治疗;而＞5 cm的肿瘤,TACE+ MTC治疗能取得更好的疗效.     

肝癌射频消融治疗现状

原发性肝癌的治疗方法多样，手术切除仍占主导地位，但由于肝功能失代偿、肿瘤的多中心发生以及早期播散和转移，造成手术的切除率低和复发率高，仅20％左右的患者能获得手术切除的机会。从20世纪60年代开始不少学者进行了高热对癌细胞杀伤作用的系统研究，大量实验结果证明通过加热技术使肿瘤组织温度升高至41～45℃即可选择性杀灭肿瘤细胞。1990年Rossi在猪肝脏进行射频治疗试验，产生1．4～1．8cm的椭圆形坏死区，     

经皮射频消融与手术切除治疗小肝癌的疗效对比分析

目的探讨经皮射频消融(PRFA)与手术切除治疗小肝癌的临床疗效。方法收集120例小肝癌患者临床资料,按照不同的治疗方法,分为射频组以及手术组,各60例。射频组患者采取经皮射频消融术治疗,手术组患者实施手术切除治疗,随访3年,最后对比2组患者的生存率、复发率、并发症发生率等。结果观察组患者治疗后1年、2年、3年的生存率分别为96.67%、86.67%、63.33%,与对照组的95.00%、83.33%、61.67%差异不明显,无统计学意义(P>0.05);2组患者的肿瘤直径≤3 cm、肿瘤3~5 cm患者复发率对比,差异无统计学意义(P>0.05)。射频组患者并发症发生率为10.00%,明显低于手术组的25.00%,差异有统计学意义(P<0.05)。结论对直径≤5 cm的小肝癌PRFA治疗效果确切,近远期疗效与手术切除相近,且并发症发生率较低,可作为小肝癌的首选治疗手段。     

不同影像方法对射频消融治疗肝癌疗效的评价

目的通过对射频消融治疗肝癌前后的B超、CT和MRI的比较,探讨不同影像方法对射频消融治疗肝癌疗效评价的意义。方法对100例肝癌患者进行了B超引导下经皮射频消融（PRFA）治疗。患者治疗前行B超、MRI或CT检查;治疗后1个月复查MRI或CT,每个月进行肿瘤标记物和B超检查。结果100例中,PRFA治疗前34例行CT检查;治疗后14例行CT复查,其中5例肿瘤区域呈现较原肿瘤更低的密度,动态增强无强化,9例肿瘤部分区域有强化。66例患者PRFA治疗前行MRI检查,T1加权像为低信号,T2加权像为相对高信号,动态增强扫描后动脉期强化,门脉期强化减弱。治疗后,全组有86例患者复查MRI,44例肿瘤T1加权像为等或高信号,T2,肌权像为等或低信号,动态增强无异常强化;42例肿瘤T1加权像呈不均匀等低混杂信号,T2,加权像部分呈相对高信号,动态增强有强化。结论增强CT扫描可以显示出残存肿瘤;MRI的T1、T2加权像及Gd-DPTA动态增强的信号变化,能够更好地反映肿瘤的坏死或残存状况,血清肿瘤标记物阳性者术后转阴并MRI（或CT）显示肿瘤呈完全凝固性坏死,可作为PRFA治疗肝癌的临床治愈标准。     

肝癌射频消融治疗技术进展

<正>射频消融(radiofrequency ablation,RFA)是将射频电极针(或电极导管)直接插入到肿瘤组织中,利用460kHz射频电流在组织中产生的热效应(90℃¹10℃)直接杀灭肿瘤细胞的一种微创治疗技术。RFA应用于肝癌的治疗已有近20年的历史,随着治疗设备的不断改进和临床技术的不断提高,RFA在肝癌治疗中的应用范围不断扩展,疗效确切、微创安全,正发挥越来越大的作用。一、肝癌病灶原位灭活消融技术RFA治疗时,射频电极针直接插入肝癌病灶中。射频电极针的构造、输出功率、消融时间与消融体积及消融效果密     

胃癌手术治疗预后因素回顾性分析

探讨影响胃癌手术后疗效的因素及各因素的价值,对经手术治疗、资料完整的232例患者进行回顾性分析。行根治性胃癌切除者1、3、5年生存率分别为98.90%、80.20%和43.30%,肿瘤分化程度、浸润范围及分期对术后生存率有明显影响,其结果比较有统计学意义。初步研究结果提示,对进展期胃癌应行D2或选择性D2术式;对晚期胃癌应尽可能行姑息性切除术及辅助化疗,重视老年胃癌患者的积极治疗。     

小肝癌患者术后肝内早期复发的生存因素分析

目的:探讨小肝癌术后早期复发的影响因素。方法:回顾性分析2001-01-04-2007-12-31我院收治经病理确诊的原发性小肝癌患者68例,分析宿主情况、肿瘤情况和治疗因素与小肝癌术后早期无瘤生存率的关系。采用SPSS13.0 for windows软件包进行统计学处理,应用Cox回归模型确定影响小肝癌术后复发预后的因素。结果:68例患者中早期肝内复发20例。术后1和2年无瘤生存率分别为82.3%和70.6%。Cox回归模型多因素分析结果表明,肿瘤大小、门脉瘤栓、肿瘤部位和术中输血是影响小肝癌术后早期复发的独立危险因素。结论:小肝癌切除术后患者早期无瘤生存与否取决于宿主情况、肿瘤情况和治疗因素。     

不宜切除小肝癌射频与射频联合全身化疗的随机对照初步研究

目的 研究射频联合化疗治疗不宜切除小肝癌的临床安全性以及对肝癌原位复发率的影响。方法 ≤3cm不宜切除的原发性肝癌患者38例,其中27例1年随访资料完整。根据射频与射频联合全身化疗的随机分组方案入选标准,射频组12例,射频联合全身化疗组15例。在超声引导下行多电极射频治疗。化疗方案为：表阿霉素50mg,d1,3,静推;顺铂40mg,d1,3,静滴;氟脲嘧啶500mg,d1,2,3,静滴。观察患者术后1,4,7d的肝功能、血常规和并发症,术后1,6,12个月复查GT(增强),评价两组患者治疗的安全性及原位复发率。结果 两组射频术后1个月,均无原位复发。射频联合全身化疗组6,12个月的原位复发率较单射频组明显下降,差异有显著性。两组均无严重并发症,肝功能、血常规变化差异无显著性。结论 对≤3cm不宜切除的原发性肝癌患者,射频联合全身化疗是安全的,并能降低肝癌原位复发率。     

肝癌肝移植术后骨转移的放射治疗及其对预后的影响

目的通过回顾性分析肝细胞肝癌(以下简称肝癌)肝移植后骨转移患者的临床特征、放疗疗效及预后因素,探讨其有效治疗方法。方法 随访853例肝癌患者。其中30例在肝移植后出现骨转移,接受针对骨转移部位放疗,剂量范围8～60 Gy(中位剂量为40 Gy)。用Kaplan-Meier法进行生存分析,单因素分析用Log-rank方法,多因素分析采用Cox回归模型Backward-Wald法。结果 30例患者肝移植后出现骨转移,1年、2年生存率分别为39.7%、24.4%,中位生存时间8.6月。96.7%的患者接受放疗后疼痛缓解(29/30)。放疗剂量在30～60 Gy之间对疼痛的缓解在剂量效应关系上无相关性(P=0.670)。结论 放疗可以缓解肝细胞癌患者肝移植后骨转移的疼痛,从而提高患者的生存质量。     

Clinical application of hepatic wedge ablation for treating liver malignancies of the inferior margin: a new ablation technique

Purpose: To determine the efficacy and safety of percutaneous hepatic wedge ablation in treating hepatic malignancies of the inferior margin.

Materials and methods: Seventy-seven patients with hepatic malignancies at the inferior margin underwent percutaneous radiofrequency ablation (RFA). Thirty-two patients underwent hepatic wedge ablation and 45 patients underwent conventional tumour ablation. Comparative analysis of the two groups was performed including gender, age, tumour size, number of ablation cycles, ablation duration and injected hydrodissection volume. The rate of technical success, local tumour progression, intrahepatic distant recurrence, major complications and overall survival were assessed and compared. Survival analysis was analysed using the Kaplan–Meier method. Differences in the survival rates were compared with log-rank test.

Results: The mean number of ablation cycles and ablation duration were significantly higher in the hepatic wedge ablation group than conventional tumour ablation (1.6?±?0.9 vs. 1.2?±?0.4, p?=?.042, and 30.2?±?18.5 vs. 22.5?±?8.5?min, p?=?.031, respectively). The local tumour progression rate was significantly lower in hepatic wedge ablation group (0% vs. 17.78%, p?=?.038) at median follow-up of 21 months. The rate of technical success, intrahepatic distant recurrence, major complications and overall survival did not differ between the two groups.

Conclusion: Hepatic wedge ablation appears to be a highly effective treatment for hepatic malignancies in the inferior margin and provides a better local control than conventional tumour ablation.     

TACE序贯MWA或RFA治疗原发性肝癌的疗效及安全性比较

目的:比较经导管肝动脉化疗栓塞（TACE）序贯微波消融术（MWA）或射频消融术（RFA）治疗原发性肝癌的疗效及安全性。方法:回顾性分析武汉协和医院接受治疗的原发性肝癌患者70例,将其分为TACE+MWA组36例与TACE+RFA组34例,比较两组临床疗效、生存率、肿瘤体积、血供消失率、完全坏死率、甲胎蛋白（AFP）水平、丙氨酸氨基转移酶（ALT）水平、天门冬氨酸氨基转移酶（AST）水平以及不良反应发生率。结果:TACE+MWA组疾病控制率（91.67%）与TACE+RFA组（88.24%）比较差异无统计学意义(P＞0.05);两组肿瘤体积、血供消失率、完全坏死率比较差异无统计学意义(P＞0.05);治疗后两组AFP水平与治疗前比较均明显降低(P＜0.05),组间比较差异无统计学意义(P＞0.05),治疗后两组ALT、AST水平与治疗前比较均明显升高(P＜0.05),且组间比较差异具有统计学意义(P＜0.05);两组6个月、1年、3年生存率比较差异无统计学意义(P＞0.05)。结论:TACE序贯MWA或RFA治疗原发性肝癌,疾病控制率、生存率、血供消失率与完全坏死率等无明显差异,均能有效控制肿瘤发展,促进AFP、ALT、AST等因子水平恢复至正常范围,延长生存期,且安全性尚可,临床可替换使用,但TACE+MWA组治疗后应注意加强保肝治疗。     

Recent progress in understanding,diagnosing, and treating hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the few cancers in which a continued increase in incidence has been observed over several years. As such, there has been a focus on safe and accurate diagnosis and the development of treatment algorithms that take into consideration the unique complexities of this patient population. In the past decade, there have been improvements in nonsurgical treatment platforms and better standardization with respect to the diagnosis and patient eligibility for liver transplant. How to navigate patients through the challenges of treatment is difficult and depends on several factors: 1) patient‐related variables such as comorbid conditions that influence treatment eligibility; 2) liver‐related variables such as Child‐Pugh score; and 3) tumor‐related variables such as size, number, pattern of spread within the liver, and vascular involvement. The objectives of this review are to put into perspective the current treatment options for patients with HCC, the unique advantages and disadvantages of each treatment approach, and the evidence that supports the introduction of sorafenib into the multidisciplinary management of HCC. CA Cancer J Clin 2012;. © 2012 American Cancer Society.     

康艾注射液对TACE联合MWA治疗后肝癌患者疗效影响的研究

目的 探究康艾注射液对肝动脉插管化疗栓塞(TACE)联合微波消融(MWA)治疗后肝癌患者疗效的影响.方法 对92例肝癌患者的病历资料进行回顾性分析.根据治疗方法不同将患者分为治疗组及对照组,每组各46例.对照组患者接受TACE联合MWA治疗方案进行治疗,治疗组患者在对照组治疗方案的基础上加用康艾注射液进行治疗.对两组患者治疗前后甲胎蛋白(AFP)水平、丙氨酸转移酶(ALT)水平、凝血功能、治疗总有效率以及不良反应发生情况进行比较.结果 治疗前,两组患者的AFP水平、ALT水平及凝血功能比较,差异均无统计学意义(P﹥0.05);治疗后,治疗组患者的ALT及AFP水平均低于对照组(P﹤0.05);治疗组患者的治疗总有效率高于对照组(P﹤0.05);治疗过程中,治疗组患者的白细胞下降、血红蛋白下降发生率均低于对照组(P﹤0.05).结论 康艾注射液可增强TACE联合MWA方案对肝癌的治疗总有效率,降低治疗用药对肝功能的不良影响及不良反应发生情况.     

Higher Efficiency of Percutaneous Microwave (MWA) Than Radiofrequency Ablation (RFA) in Achieving Complete Response in Cirrhotic Patients with Early Hepatocellular Carcinoma

Background: Contrasting data are available in the literature regarding the superiority of percutaneous microwave ablation (MWA) or radiofrequency ablation (RFA) in very early or early (BCLA 0 or A) hepatocellular carcinoma (HCC). Aims: The primary outcome was to compare the efficacy of RFA and MWA in achieving complete response in cirrhotic patients with early and very early HCC. The secondary outcomes were to evaluate the overall survival and the recurrence rate. Methods: A retrospective, observational, single-center study was performed. Inclusion criteria were liver cirrhosis, new diagnosis of a single node of HCC measuring a maximum of 50 mm or up to three nodules with diameter up to 35 mm, treatment with RFA or MWA. Radiological response was evaluated with multiphasic contrast-enhanced Computed Tomography or Magnetic Resonance Imaging at 5–7 weeks after thermal ablation. Complete response was defined when no vital tissue was detected after treatment. Results: Overall, 251 HCC patients were included in this study; 81 patients were treated with MWA and 170 with RFA. The complete response rate was similar in MWA and RFA groups (out of 331 nodules, 87.5% (91/104) were treated with MWA and 84.2% (186/221) were treated with RFA, p = 0.504). Interestingly, a subanalysis demonstrated that for 21–35 mm nodules, the probability to achieve a complete response using MWA was almost 5 times higher than for RFA (OR = 4.88, 95% CI 1.37–17.31, p = 0.014). Moreover, recurrence rate in 21–35 mm nodules was higher with RFA with respect to MWA (31.9% versus 13.5%, p = 0.019). Overall survival was 80.4% (45/56) when treated with MWA and 62.2% (56/90) when treated with RFA (p = 0.027). No significant difference was observed between MWA and RFA treatment in the 15–20 mm nodules group. Conclusion: This study showed that MWA is more efficient than RFA in achieving complete response in HCC nodules with 21 to 35 mm diameter.     

高龄壶腹周围肿瘤患者胰十二指肠切除术的围手术期特点

目的分析高龄壶腹周围肿瘤患者胰十二指肠切除术的围手术期诊治特点。方法回顾性分析128例行胰十二指肠切除术的老年壶腹周围肿瘤患者的围手术期资料,其中〉70岁高龄患者27例、60～69岁老年患者101例,对比两组资料。结果两组在术前心电图检查异常、胸片检查异常且术前白蛋白水平有差异,在并发症的发生和术后30天死亡上差异无统计学意义。结论高龄不是胰十二指肠切除术的禁忌证。慎重选择合适老年患者,正确处理围手术期的相关问题,是降低老年胰十二指肠切除术后并发症及病死率的关键。