CDFI引导下经皮微波热凝固联合血管介入法治疗肝癌的综合应用

目的:探讨应用彩色多普勒超声显像(CDFI)引导经皮微波热凝固(PMCT)联合血管介入法治疗肝癌的可行性与治疗效果。方法:56例肝癌患者,应用PMCT治疗26例,30个结节;PMCT联合TACE30例,42个结节,先行肝动脉化疗栓塞(TACE),3d后行PMCT治疗,其中8例合并门静脉癌栓的病例,在TACE治疗2周后行经皮门静脉化疗(PVC)。结果:肿瘤<5cm的肝癌结节53个,PMCT与联合治疗组均获较好疗效。肿瘤≥5.0cm的19个结节中,联合治疗组在肿瘤缩小、血流信号消失、生存期方面均优于PMCT组。结论:PMCT联合TACE治疗肝癌具有协同作用,是中晚期肝癌有效的综合治疗方法。     

超声引导下经皮微波凝固治疗肝癌的临床应用

目的探讨超声引导下经皮微波凝固治疗肝癌的临床应用价值。方法治疗３２例肝癌５７个结节。每个点的凝固治疗采用输出功率６０Ｗ,作用时间２４０～３００秒。５７个结节进行９２次１８２个点的治疗。结果随访５～１８个月,平均１０．４个月,２９例健在,３例死亡。治疗后８５．９％（４９／５７）的肿块缩小,超声显示７８．２％（３６／４６）的肿块内血流消失,增强ＣＴ显示７６．４％（２５／３４）的肿瘤内无强化。原血ＡＦＰ升高１３例,治疗后１１例降至正常。２７例患者全身情况改善,１９例体重增加。１４例治疗后再次活检,１２例肿瘤呈完全性坏死,代之以纤维结缔组织增生。结论超声引导下经皮微波凝固肝肿瘤,在大部分病例可以达到使肿瘤完全性坏死的较好疗效,可望成为肝癌非手术治疗的重要途径。     

冷循环射频消融治疗肝脏肿瘤42例报告

探讨冷循环射频消融治疗肝脏肿瘤的可行性和有效性。应用冷循环电极射频消融治疗42例肝脏肿瘤60个结节。37例在局麻超声引导下、2例在腹腔镜辅助下和3例在开腹术中行射频消融,射频消融治疗75点次。治疗后通过CT和MR随访,随访时间2～14个月,肿瘤完全低密度灶者占70%(42/60),增强扫描局部病灶有强化(残留或复发)8.3%(5/60)。初步研究结果提示,冷循环射频消融治疗肝脏肿瘤是有效和安全的。     

经皮微波凝固治疗肝癌的研究进展

肝癌是我国常见的恶性肿瘤之一,手术切除是肝癌的首选治疗方法,但临床上由于受肿瘤部位、大小、数量、邻近大血管和肝外转移及肝硬化等因素的影响,肝癌的手术切除率＜30%[1].微波固化治疗肝癌近年来发展迅速,我们就微波凝固治疗肝癌的相应知识及进展情况作一简介,以提高对该技术的认识.     

彩超在多弹头射频消融治疗肝脏恶性肿瘤中的临床应用

目的:探讨彩色多普勒超声在多极射频消融(RFA)治疗晚期肝脏恶性肿瘤中的临床价值.方法:应用彩色多普勒超声对 12例晚期肝脏恶性肿瘤进行治疗前检查、定位,治疗时引导穿刺,治疗后评价治疗效果.结果:治疗后肿瘤缩小,肿瘤周边出现低回声带,肿瘤周边及瘤内血流信号减少,经随访姑息疗效较好.结论:应用彩色多普勒超声引导射频消融治疗肝脏恶性肿瘤具有不开刀、创伤小、准确、安全等优点,通过治疗前后声像图、血流变化情况,可为临床治疗和判定疗效提供依据.     

冷循环射频消融治疗肝脏肿瘤42例报告

探讨冷循环射频消融治疗肝脏肿瘤的可行性和有效性。应用冷循环电极射频消融治疗42例肝脏肿瘤60个结节。37例在局麻超声引导下、2例在腹腔镜辅助下和3例在开腹术中行射频消融，射频消融治疗75点次。治疗后通过CT和MR随访，随访时间2～14个月，肿瘤完全低密度灶者占70%（42／60），增强扫描局部病灶有强化（残留或复发）8．3％（5／60）。初步研究结果提示，冷循环射频消融治疗肝脏肿瘤是有效和安全的。     

经皮微波热凝固治疗肝癌的疗效观察

目的:观察超声引导经皮肝穿刺微波热凝固治疗肝癌的疗效。方法:21 例肝癌患者经皮肝穿刺植入频率为2 450 MHz的单导或双导微波天线,在丙泊酚静脉麻醉下对肿瘤进行一次整体覆盖原位热凝固治疗。结果:对21 例患者的23 个瘤体进行28 次治疗,平均随访6.7 个月,16 例生存,4 例死亡,1 例失访,术后AFP正常或明显下降,10 个瘤径≤5.0 cm的瘤体一次整体凝固,13 个瘤径>5.0 cm的瘤体术后肿块内血流信号大部分消失,治疗前后肝功能无明显变化,16 例次术后2 d ~ 6 d中度发热,1 例出现胸腔积液。结论:超声引导经皮肝穿刺微波热凝固治疗肝癌近期疗效满意,是一种定位准确、操作简单、安全价廉、可重复的微创手术。     

50例超声引导下经皮微波凝固治疗肝肿瘤手术经验

二十世纪七十年代，微波凝固技术主要应用于术中止血和切割。一九九二年中国人民解放军总医院董宝玮教授与航天工业总公司共同研究超声引导微波凝固治疗技术，实现了对微波热场的球形调控。对于直径5．0cm以内的肝肿瘤实现了一次性原位整体灭活。2003年6月以来我们共行肝癌凝固治疗手术45例67个肿瘤、肝血管瘤4例收到了很好的治疗效果。该技术我国走在世界前列，由于该治疗技     

经皮微波固化联合无水酒精注射治疗原发性肝癌

经皮微波固化与瘤内无水酒精交替注射治疗 2 5例原发性肝癌。结果随访 6～ 15个月 ,中位生存期 12 .3个月 ;甲胎蛋白阳性 13例 ,治疗后降至正常 10例 ;组织学检查病变完全坏死率 76 % ( 19/ 2 5 ) ;3例 <5cm的小肝癌完全缓解 ,2 2例 >5cm的大肝癌治疗后病情好转达 16例 ,无效 6例。联合治疗副作用不大 ,未见严重并发症。初步研究的结果提示 :经皮微波固化联合无水酒精注射是治疗原发性肝癌的有效方法之一     

超声引导射频消融治疗肝脏恶性肿瘤30例近期疗效观察

[目的]观察超声引导射频消融(RFA)治疗肝脏恶性肿瘤的近期疗效。[方法]对30例肝肿瘤(52个病灶)进行48次治疗,采用螺旋CT增强检查及AFP水平综合评价疗效。[结果]1个月后增强CT检查显示45个病灶被完全灭活,有效率达86.5%(45/52),其中有8例(26.7%)行2～3次RFA治疗,1～3个月后CT检查显示20例(66.7%)肿瘤缩小。20例原发性肝癌AFP升高者术后复查,8例AFP明显下降(40%)。出现并发症2例(6.3%),1例自限性腹腔出血,1例肝功能指标异常加重,出现黄疸、腹水。[结论]超声引导RFA为不能或不适宜手术切除的肝脏恶性肿瘤提供了有效的微创治疗手段。     

超声引导经皮微波消融对紧邻胆囊肝癌的临床研究

目的探讨超声引导下经皮微波消融（PMCT）紧邻胆囊肝癌的有效性和安全性。方法2006年6月～2007年9月,31例患者的37个紧邻胆囊的恶性肿瘤行PMCT,本组病灶直径为0．8～5．9cm,平均3．2±1．7cm。随访患者2—16个月,平均随访期为7．1±4．3个月。并观察肿瘤灭活情况、肝功能、副作用及并发症。结果所有患者均未出现与操作相关的较严重并发症。其中术后17例患者发热,7例出现腹痛,17例出现发热,3例出现恶心、呕吐。肿瘤完全灭活率为89．1％;2例患者的3个结节分别于治疗后1个月、3个月、12个月出现肿瘤局部复发。结论PMCT对紧邻胆囊的肝癌病灶是一种安全、可行、有效的非手术治疗手段。     

超声引导经皮微波凝固治疗在肝转移癌中的应用价值

目的　探讨超声引导经皮微波治疗肝转移癌的疗效和影响生存率的因素。方法　共治疗 74例患者 14 9个结节 ,肿瘤最大直径 0 .7～ 6 .8cm ,平均 (3.1± 1.8)cm。累计生存率采用Kaplan Meier方法 ,对生存率影响的单因素分析采用Logrank方法 ,多因素分析采用Cox逐步回归方法。随访患者 5～ 83个月 ,平均随访期 (2 5 .1± 11.4 )个月。结果　全部患者的 1,3,5年生存率分别为 91.4 %、4 6 .4 %和 2 9.0 %。单因素分析结果表明 ,肿瘤的数目、大小、分化程度和病灶有无复发或转移对生存率的影响差异有显著性 ;而患者的年龄、性别和原发灶的部位对生存率的影响差异无显著性。多因素分析结果表明 ,肿瘤的数目、病灶有无复发或转移以及肿瘤的分化程度对生存率的影响差异有显著性。结论　超声引导下经皮微波凝固治疗对单发结节、分化较好、且无复发转移的肝转移癌患者有较好的远期疗效。     

Indication of percutaneous microwave coagulation therapy for hepatocellular carcinoma

Multifocal carcinogenesis is caused by a persistent infection of hepatitis viruses, and is considered to be the main cause of post-operational recurrences of hepatocellular carcinoma. It has been generally believed that a single therapeutic modality (including resection therapy) cannot improve the survival rate. In this paper, we describe the efficacy of microwave coagulation therapy and its indications based on an analysis of cases experienced at our institution over a 10-year period. We compared the background factors, recurrence rate, and survival rate of various therapies, and concluded that microwave coagulation therapy is highly effective for tumor coagulation and necrosis. Microwave coagulation therapy is also technically easier than a surgical operation, has fewer complications, and results in an equally good survival rate when compared to hepatectomy. Due to these intrinsic advantages, microwave therapy is useful not only as a treatment after recurrence, but also as a primary therapy of small liver tumors. When the detection rate for small liver tumors increases, microwave coagulation therapy will start to play an even more important role in the treatment strategy for hepatocellular carcinomas as a less invasive option, in addition to laparotomic and percutaneous/laparoscopic surgeries.     

Sequential pathological and immunologic analysis of percutaneous microwave coagulation therapy of hepatocellular carcinoma

Purpose: To evaluate sequential pathologic and immunologic changes and their prognostic significance after percutaneous microwave coagulation therapy (PMCT) of hepatocellular carcinoma (HCC). Methods: Eighty-nine nodules in 82 consecutive patients were studied. The 89 nodules were divided into two groups: a treatment group, with 82 primary nodules (average dimension was 3.4 &#45 1.2 cm) in 82 patients, and a control group, of seven nodules (average dimension was 1.4 &#45 0.6 cm) in seven patients. The criteria for a nodule's inclusion in the control group was that the nodule was one of two nodules in the same patient and that the two nodules were located in different liver lobes. This guarantees that while one nodule is treated by PMCT, the distant one will not be directly affected by the microwave thermal field. The control group nodules were treated after the study was completed. Specimens were taken with ultrasound-guided liver biopsy from the treated nodule and the control nodule, pre- and post-PMCT. Infiltration by T-lymphocytes, B-lymphocytes, NK cells and macrophages in the tumour tissue were observed immunohistochemically using a panel of monoclonal antibodies against CD3, CD45RO, CD20, CD56 and CD68. The extent of immune cell infiltration was compared both before and after PMCT, as well as between the treated and control nodules. The relationship between the prognosis and the extent of immunocyte infiltration was analysed. Results: The patients were followed for 2-26 months (mean 14.6 &#45 6.3) post-treatment. The recurrence rates at 1 and 2 years were 20.4% and 28.1% within the liver in treatment group, respectively. The survival rates at 1 and 2 years were 92.5% and 75.3% for the treatment group. T-cells, NK cells and macrophages increased significantly in both treated and untreated nodules after PMCT, albeit less markedly within untreated nodules when compared to the treated ones. There is a statistically significant correlation between survival outcome and the extent of immunocyte infiltration. Conclusions: For inoperable HCC patients, PMCT is one of the treatment choices shown to be effective. Apart from its tissue coagulation effect, an increased systemic immune response directed against the tumour may also play an important role in improved survival.     

超声引导经皮微波治疗原发性肝癌远期疗效评价

目的　评价经皮穿刺微波凝固治疗 (PMCT)原发性肝癌 (HCC)的远期疗效。方法　在超声引导下对 177例HCC患者共 2 6 5个肿瘤灶进行PMCT ,病灶最大直径 1.5～ 8.7cm ,平均4.12± 1.89cm。随访 5～ 74个月 ,定期复查影像 (彩超、CT、MRI)及血清AFP ,184个结节再次穿刺活检。结果　治疗后超声检查显示 ,92 .0 % (2 0 7/ 2 2 5 )的病灶血流消失 ,88.5 % (138/ 15 6 )的病灶增强CT无强化 ,88.9% (32 / 36 )的病灶增强MRI无强化。 184个结节治疗后再活检 ,92 .4% (170 / 184)完全坏死。 6例患者PMCT后外科切除病灶 ,病理显示肿瘤完全坏死 5例 ,大部分坏死 1例。全组 1～ 5年累计生存率分别为 90 .1%、76 .9%、6 8.3%、6 4.2 %和 5 7.8% ,高分化及中分化者的生存曲线均明显好于低分化者 (P <0 .0 5 ) ,中分化与高分化者之间无统计学差异。全组 1～ 5年累计新生病灶率分别为2 6 .1%、37.8%、43.5 %、48.6 %和 5 8.9%。全组无严重并发症。结论　PMCT治疗HCC安全有效 ,可使直径 <5cm的肿块一次原位灭活 ,患者的 5年生存率较高。     

Sequential pathological and immunologic analysis of percutaneous microwave coagulation therapy of hepatocellular carcinoma.

PURPOSE: To evaluate sequential pathologic and immunologic changes and their prognostic significance after percutaneous microwave coagulation therapy (PMCT) of hepatocellular carcinoma (HCC). METHODS: Eighty-nine nodules in 82 consecutive patients were studied. The 89 nodules were divided into two groups: a treatment group, with 82 primary nodules (average dimension was 3.4 +/- 1.2 cm) in 82 patients, and a control group, of seven nodules (average dimension was 1.4 +/- 0.6 cm) in seven patients. The criteria for a nodule's inclusion in the control group was that the nodule was one of two nodules in the same patient and that the two nodules were located in different liver lobes. This guarantees that while one nodule is treated by PMCT, the distant one will not be directly affected by the microwave thermal field. The control group nodules were treated after the study was completed. Specimens were taken with ultrasound-guided liver biopsy from the treated nodule and the control nodule, pre- and post-PMCT. Infiltration by T-lymphocytes, B-lymphocytes, NK cells and macrophages in the tumour tissue were observed immunohistochemically using a panel of monoclonal antibodies against CD3, CD45RO, CD20, CD56 and CD68. The extent of immune cell infiltration was compared both before and after PMCT, as well as between the treated and control nodules. The relationship between the prognosis and the extent of immunocyte infiltration was analysed. RESULTS: The patients were followed for 2-26 months (mean 14.6 +/- 6.3) post-treatment. The recurrence rates at 1 and 2 years were 20.4% and 28.1% within the liver in treatment group, respectively. The survival rates at 1 and 2 years were 92.5% and 75.3% for the treatment group. T-cells, NK cells and macrophages increased significantly in both treated and untreated nodules after PMCT, albeit less markedly within untreated nodules when compared to the treated ones. There is a statistically significant correlation between survival outcome and the extent of immunocyte infiltration. CONCLUSIONS: For inoperable HCC patients, PMCT is one of the treatment choices shown to be effective. Apart from its tissue coagulation effect, an increased systemic immune response directed against the tumour may also play an important role in improved survival.     

超声引导经皮穿刺微波消融治疗原发性肝癌患者的症状群研究

目的探讨超声引导经皮穿刺微波消融(UPMWA)治疗原发性肝癌患者的症状种类、发生率、症状严重程度及对日常生活干扰程度,并分析症状群种类及群内症状相关性。方法采用方便抽样法选择接受UPMWA治疗的151例原发性肝癌患者,采用M.D安德森症状评估量表中文版(MDASI-C)、原发性肝癌特异性症状模块(TSM-PLC)对肝癌患者进行问卷调查。以Cronbach’sα系数评估症状群信度,采用最大方差正交旋转因子分析和Cronbach’sα系数探索症状间相互关系并确定症状群。结果共回收有效问卷120份,共经历19个症状,症状评分最高的3个症状为疼痛、疲乏和口干,症状发生程度及对日常生活的干扰程度均为轻度,干扰以情绪、一般活动和行走为主。聚集为4个症状群,内部一致性信度Cronbach’sα分别为0.61、0.70、0.70和0.78,总方差贡献率60.27%,分别为疼痛症状群(疼痛、疲乏和气短)、病感症状群(黄疸、麻木、悲伤、瘙痒和健忘)、消融相关症状群(发热、体重减轻、呕吐、食欲下降和腹胀)、消化系统症状群(腹泻、睡眠不安、苦恼、恶心、口干和昏昏欲睡)。结论 UPMWA治疗肝癌患者所经历症状程度评分最高的3个症状分别为疼痛、疲乏和口干,对日常生活干扰程度均为轻度,但症状有普遍性且发生率高。     

经皮微波热凝治疗肝癌的疗效观察

目的 经皮微波肝穿刺对肝癌进行热凝损毁,观察其对肝癌的作用疗效。方法 52例患者在局麻或硬膜外麻醉下,使用2450MHz微波微型穿刺天线,在B超引导下直接经皮穿刺进入肝癌瘤体内,对其进行热凝固。结果 52例患者的97个瘤体中,直径均＜3cm的肿块61个（62．9％）能1次手术热凝损毁,其中57个（93．4％）经CT或MRI检查,并随访6－12个月,提示瘤体热损毁后未见复发;3－5cm的肿块36个（37．1％）,分2次手术,术后6个月CT或MRI检查提示,27个热凝损毁（75．0％）,9个大部分热凝损毁（25．0％）。经皮微波热凝治疗（PMCT）的患者均未见明显的副作用和其他并发症。结论 PMCT治疗肝癌,尤其对直径＜3cm的瘤体疗效可靠,对＞3．5cm或＜5cm的瘤体仍具有大部分或完全热损毁的作用。     

超声引导瘤区注射超抗原协同微波治疗肝癌的局部细胞免疫水平研究

目的 研究在超声引导下微波凝固治疗肝癌后瘤区注射超抗原(高聚生)对机体局部细胞免疫水平的影响.方法 92例原发性肝癌患者,分为单纯微波治疗组(A组,45例)和微波治疗后瘤区注射高聚生组(B组,47例),于微波治疗前后和高聚生瘤区注射前后进行超声引导下肝组织活检穿刺取材.采用免疫组化染色法,比较两组标本组织中免疫细胞CD3+、CD4+、CD57+和CD68+局部浸润情况的变化.在电镜下观察高聚生注射后局部浸润免疫细胞的功能状态.结果 高聚生注射后1周,B组标本组织中CD3+、CD4+、CD57+和CD68+细胞的密度值分别为54.50±18.44、38.14±12.44、33.38±10.79和45.56±16.53,较微波治疗前及高聚生注射前均有不同程度的增高(均P<0.05);高聚生注射后4周,B组CD3+、CD4+、CD57+和CD68+细胞的密度值分别为32.67±10.42、23.43±6.99、18.63±7.89和30.01±11.05,仍高于微波治疗前的水平(P<0.05).微波治疗后5周,B组标本组织中CD3+、CD4+、CD57+和CD68+细胞的密度值分别为54.50±18.44、38.14±12.44、33.38±10.79和45.56±16.53,明显高于A组(32.03±8.11、15.67±8.32、15.23±8.26和29.67±11.98,P<0.05).透射电镜观察结果 显示,高聚生局部注射后,B组标本组织中局部浸润的免疫细胞内可见较多的溶酶体、内质网和线粒体等.结论 超声引导瘤区注射超抗原协同微波治疗肝癌能进一步增强肝癌患者的局部抗肿瘤细胞免疫水平.