超声引导经皮射频消融治疗肝癌的体会

超声引导经皮射频消融 (PercutaneousRadiofrequencyAbla tion ,PRFA)治疗术是一种经皮肿瘤局部热疗的方法 ,为不能手术的原发性和继发性肝脏肿瘤提供一种新的有效治疗手段。我院自 2 0 0 0年 9月引进集束电极射频治疗仪以来 ,治疗肝癌2 6例 ,近期疗效满意。现将手术配合体会报告如下。1　资料与方法1.1　临床资料本组 2 6例中 ,男 2 0例 ,女 6例。年龄 41～ 70岁 ,平均 5 4岁。病程最长 3年 ,最短 45天。1.2　治疗方法病人取仰卧或侧卧位 ,B超探测肝癌部位、大小及有无腹水并确定穿刺点及进针方向。左肝肿瘤一般在剑突下进针 ,右肝肿瘤…     

CT引导经皮射频消融术治疗肝癌的护理体会

肝癌是最常见的恶性肿瘤之一,年病死率位居恶性肿瘤的第二位。CT引导肿瘤射频消融术（RAF）是近几年出现的一种微创治疗肝癌症的新技术,应用在直径小于3cm的肿瘤,对于心脏或肝功能不好,不能接受开刀手术或不愿开刀的病人,具有效果明显、创伤小、恢复快、并发症少等特点,对大多数肝癌病灶可以达到根治的目的。我院普外科2008年1月-2009年1月对62例不适于或不愿意手术切除的肝癌患者采用了RFA,取得较好效果,现将护理体会报道如下：     

肝癌的射频消融治疗进展

目的：探讨射频消融在肝癌治疗中的治疗进展。方法：查阅相关中外文献,对射频消融治疗肝癌的效果进行综述。结果：射频消融治疗肝癌疗效确切、微创小,发展迅速。射频消融联合其他治疗进一步扩大了治疗范围,提高了治疗效果。结论：射频消融是治疗手术不能切除的肝癌的理想方法。     

索拉非尼联合经皮肝动脉化疗栓塞及射频消融治疗中晚期大肝癌方案的初步探索

目的研究应用不同方案行索拉非尼联合经皮肝动脉化疗栓塞（TACE）及射频消融（RFA）（局部介入术前开始应用索拉非尼以及局部介入术后开始应用索拉非尼）治疗中晚期〉5cm肝癌的适用性及安全性,初步观察其疗效。方法 2008年11月始筛选纳入〉5cm的中晚期肝癌患者。随机分为2组,A组为先行TACE联合RFA,术后开始口服索拉非尼;B组为先口服索拉非尼1～2周,再行TACE及RFA。规律随访,观察毒副反应的发生情况及患者生存情况。结果截至2013年2月21日,A组与B组分别纳入患者15例。肝癌直径（8.9±3.1）cm,患者随访时间（27±11.8）月。两组均未发生与治疗相关的死亡,索拉非尼主要相关不良反应有手足皮肤反应（53.3%vs66.7%,P=0.710）、食欲下降（53.3%vs46.7%,P=0.999）、乏力（53.3%vs40.0%,P=0.715）以及腹泻（33.3%vs46.7%,P=0.710）等,只有1例患者出现4级的上消化道出血,两组比较差异均无统计学意义。两组患者的远期生存疗效差异无统计学意义（中位生存时间：A组31月vsB组32月,χ2=0.050,P=0.822）。结论两种联合方案在治疗中晚期大肝癌均是安全适用的,且治疗风险相当。生存分析并未显示出应用哪一种联合方案更具有优势。     

经皮肝穿刺注射无水乙醇治疗9例原发性肝癌护理体会

原发性肝癌在我国是一种常见病,发病率位于恶性肿瘤的第三位。随着介入放射学的迅速发展,肝癌的介入治疗在临床上得到广泛应用。为了达到更好的治疗效果,2004年2月至2006年2月,我科对9例介入治疗的患者加强了护理,取得了满意的疗效。现报告如下。1资料与方法1.1临床资料本组共9例患者,均为男性,年龄35￣58岁,平均年龄42.8岁,均伴有乙型肝炎和不同程度的肝硬化。癌栓长度为3￣6 cm,平均长度3.2 cm,位于门静脉主干5例,门静脉主干及右枝3例,矢状部1例。1.2治疗方法在B超引导下确定门静脉癌栓部位,选择最佳穿刺点及最短进针路径。局麻至肝包膜,…     

No-touch射频消融术治疗小肝癌的效果

目的:探究No-touch射频消融技术(No-touch radiofrequency ablation,No-touch-RFA)治疗小肝癌的效果.方法:选择2016年1月至2019年1月于许昌市中心医院就诊的小肝癌患者68例,按照手术方法的不同分为No-touch组(n=32)与传统射频组(n=36).收集患者的一...     

腔内射频消融术联合超声引导下泡沫硬化剂治疗非血栓性下肢静脉性溃疡

目的 探讨腔内射频消融术（RFA）联合超声引导下泡沫硬化剂注射（UGFS）治疗非血栓性下肢静脉性溃疡的疗效。方法 回顾性分析135例（患肢152条）经RFA联合UGFS或RFA联合点式剥脱治疗的非血栓性下肢静脉性溃疡患者的临床资料,其中RFA联合UGFS组的患者61例（68条患肢）,RFA联合点式剥脱组的患者74例（84条患肢）。比较2组患者手术时间、住院时间、手术前后溃疡愈合情况、静脉临床严重程度评分(VCSS)、视觉模拟量表(VAS)评分及术后并发症等指标。结果 2组患者手术时间、住院时间比较差异有统计学意义（P<0.05）。2组患者术后1个月、3个月溃疡愈合情况比较,差异无统计学意义（P>0.05）;2组患者术前和术后1个月、3个月VCSS评分比较,差异均无统计学意义（P>0.05）;2组患者术后1个月、3个月VAS评分比较差异均有统计学意义（P<0.05）。2组患者并发症发生率比较差异有统计学意义（P<0.05）。结论 两种方式对溃疡愈合的疗效相当,但RFA联合UGFS具有手术创伤更小、住院时间短、恢复快、并发症少等优点。     

性化护理对肝癌患者CT引导下射频消融术后 负性情绪及生活质量的影响

目的 研究人性化护理对肝癌患者CT引导下射频消融术后负性情绪、生活质量的影响。方法 选取我院自2016年8月~2017年8月收治的接受CT引导下射频消融术治疗的68例肝癌患者,按随机数字表法分为对照组35例和干预组33例。对照组采取常规护理干预,干预组则采取人性化护理干预,比较两组护理前后负性情绪及生活质量改善情况。结果 护理后,干预组SAS评分为（45.78±0.71）分、SDS评分为（19.65±0.81）分,均低于对照组的（53.55±0.82）分、（23.67±0.89）分,差异具有统计学意义（P＜0.05）;护理后,两组生活质量评分均上升,且干预组高于对照组[（93.64±3.11）分 vs （89.61±5.07）分],差异有统计学意义（P＜0.05）。结论 对接受CT引导下射频消融术治疗的肝癌患者,采取人性化护理干预可有效缓解其负性情绪,提高生活质量。     

射频消融在肝癌破裂出血治疗中的应用

原发性肝癌破裂出血,是肝癌患者的一种严重而致命的并发症,治疗难度较大,预后较差,如不积极救治,多数患者迅速死亡。我科采用射频消融的方法对2例难治性肝癌破裂出血患者进行了止血治疗,取得了一定的疗效。现结合治疗经验和文献资料讨论射频消融在肝癌破裂出血中的应用价值。     

超声引导下微波消融治疗肝癌的疗效

目的：本文主要探讨超声引导下微波消融治疗肝癌的临床效果。方法在我院2013年1月~2014年6月所收治的肝癌患者中选取60例作为此次观察对象,随机分为观察组和对照组,对照组患者采用手术切除进行治疗,观察组患者在超声引导下进行微波消融治疗,比较两组患者的治疗效果。结果观察组患者的肿瘤完全消融率为90.0%,对照组患者的肿瘤完全消融率为66.7%,观察组患者的肿瘤完全消融率明显高于对照组患者,<0.05,差异具有统计学意义。结论对于肝癌患者而言,使用微波消融治疗和手术切除治疗都具有良好的治疗效果,但是相对而言,微波消融治疗的效果更好,肿瘤完全消融率更高,具有一定的应用价值和治疗优势,值得大力推广使用。     

Percutaneous Image-guided Radiofrequency Ablation of Tumors in Inoperable Patients - Immediate Complications and Overall Safety

Introduction:

Percutaneous destruction of cancer cells using a radiofrequency energy source has become an accepted part of the modern armamentarium for managing malignancies. Radiofrequency ablation (RFA) is a relatively novel procedure for treating recurrent and metastatic tumors. It is used for debulking tumors and as adjuvant therapy for palliative care apart from its role as a pain management tool. Its use in the third world countries is limited by various factors such as cost and expertise. In the remotest parts of India, where economic development has been slow, abject poverty with poor health care facilities advanced malignancies present a challenge to health care providers. We undertook this study to assess the safety of the percutaneous RFA tumor ablation as a therapeutic or palliative measure in patients where surgery was not possible. We observed that RFA may be an effective, alternative therapeutic modality for some inoperable tumors where other therapeutic modalities cannot be considered.

Context:

Palliative and therapeutic image-guided RFAs of tumors may be the only treatment option in patients who are inoperable for a variety of reasons. To assess the safety and complications of RFA in such a patient population is important before embarking upon any interventions given their physically, mentally, and socially compromised status in a country such as India.

Aims:

To assess the safety of percutaneous image-guided radiofrequency tumor ablation and to note the various immediate and early complications of the intervention.

Settings and Design:

This was a prospective, observational study conducted in Tata Main Hospital, Jamshedpur, Jharkhand, India.

Subjects and Methods:

After approval by the Hospital Approval Committee all patients who consented for percutaneous RFA of their tumor admitted in the hospital were included after taking fully informed consent from patient/close relative keeping the following criteria in view.

Inclusion Criteria:

Patients who were likely to derive a direct benefit in the survival or as a palliative measure for relief in their symptoms and patients who were inoperable because of any of the following reasons: (1) Exhausted conventional treatment options, (2) technical and anatomical contraindications to conventional treatment, (3) medical comorbidities precluding surgery, (4) patient refusal, (5) recurrent tumors, and (6) advanced tumor stage. Conventional Treatment has been defined as surgical resection, radiotherapy, and/or chemotherapy, although the patient eligibility for each treatment may vary.

Exclusion Criteria:

Patients with the following were excluded: (1) Severe coagulopathy, (2) heart, renal, or liver failure, (3) lesions within 1 cm of gall bladder, hilum, bowel wall, and major blood vessels, (4) patient with any metal implant, (5) patients in sepsis, and (6) tumor adjacent to structures at risk (main bile ducts, pericardium, stomach, or bowel).

Results:

The duration of procedure as well as ablation of tumor free margin was significantly related to the size of the tumor. As the size of tumor increased, duration of procedure increased significantly. A good tumor-free margin also needs to be ablated for optimum results as it prevents residual tumors and recurrences in the future. We observed that tumors sized <3.1 cm were optimal in this regard. Most common adverse event in postprocedure period was pain in and around ablation site. Post-RFA syndrome is also a common and benign self-limiting side effect. Patient counseling and proper selection of patients in the early stages of malignancy can enhance the efficacy of the procedure and patient satisfaction.

Conclusions:

Percutaneous image-guided RFA is an option in patients where most other tumor management modalities have been exhausted or rejected. RFA may not be free from side effects such as postablation syndrome, pain, and there may be other serious complications such as bleeding, but based on our observations, percutaneous image-guided RFA of tumors is a safe palliative and therapeutic treatment option.     

Radiofrequency Ablation for Hepatic Metastasis from Gastric Adenocarcinoma

The prognosis for gastric cancer with liver metastasis continues to be poor. We present our preliminary findings from 4 cases of liver metastasis from gastric adenocarcinomas treated using radiofrequency ablation (RFA). Between 1995 and 2004, the clinical history and course of 4 patients who underwent radiofrequency ablation for liver metastases from gastric cancer were reviewed. Two patients with smaller metachronous metastasis are currently alive without recurrence at 16 and 14 months and the other patients with larger synchronous metastatic lesions died after 4 and 12 months after RFA. Although this study was limited to a few cases and had a short follow-up duration, our findings suggest that RFA may provide an alternative treatment modality for liver metastasis resulting from gastric adenocarcinoma. Additional study is needed with a larger group of patients and longer follow up to evaluate the efficacy of RFA.     

洛铂联合表柔比星化疗栓塞治疗原发性肝细胞癌的疗效

目的 观察洛铂联合表柔比星化疗栓塞治疗原发性肝细胞肝癌的近远期疗效及安全性。方法 收集 2014年1月~2016年12月我院收治的原发性肝细胞肝癌患者133例,所有患者接受灌注化疗和化疗栓塞治疗,根据治疗方案分为实验组（71例）和对照组（62例）,实验组采用洛铂联合表柔比星治疗;对照组接受顺铂联合表柔比星治疗;比较两组近期疗效、远期疗效、肝功能（ALP、ALT、AST、TBIL）及毒副反应。结果 实验组近期总有效率为87.32%,高于对照组的69.35%,差异有统计学意义（P＜0.05）;治疗6、12个月后,两组生存率比较,差异无统计学意义（P＞0.05）;治疗18、24 个月后,观察组生存率均高于对照组,差异有统计学意义（P＜0.05）;治疗后,两组ALP、ALT比较,差异无统计学意义（P＞0.05）,但实验组AST低于对照组、TBIL高于对照组,差异均有统计学意义（P＜0.05）;实验组胃肠道反应、骨髓抑制及肾脏毒性发生率均低于对照组,差异有统计学意义（P＜0.05）。结论 洛铂联合表柔比星化疗栓塞治疗原发性肝细胞肝癌近期疗效及患者远期生存期率高于顺铂联合表柔比星,其肝功能损害和毒副反应轻,患者耐受性较好。     

Role of Percutaneous Nephrostomy in Advanced Cervical Carcinoma with Obstructive Uropathy: A Case Series

Aims and Objective:

Over 70% of the cases present in advanced stages of the disease and are associated with poor prognosis and high mortality rates. In many of them, it is difficult to offer definitive treatment as they present in uremia due to associated obstructive uropathy. There are no clear-cut guidelines for performing percutaneous nephrostomy (PCN) in patients of advanced cervical cancer. The results are unpredictable in terms of benefits achieved in these cases. Thus, we evaluated our experiences with PCN in the management of cervical cancer patients presenting with obstructive uropathy.

Material and Methods:

15 patients of cervical cancer with obstructive uropathy and deranged renal functions were retrospectively evaluated for the role of PCN in their management

Results:

PCN was done in 15 patients of advanced cervical cancer. The mean age of patients was 44.5 years. Twelve (80%) patients presented primarily with advanced cervical carcinoma and obstructive uropathy. Three (20%) were already treated. Symptomatic improvement and significant fall of mean serum creatinine value from 7.5 mg% to 0.9 mg% over a period of 1-3 weeks was noted post PCN. Out of 12 patient with primary untreated advanced disease, curative treatment was possible in 3, palliative radiotherapy/chemo-therapy in 7 and only symptomatic treatment in 2 cases, after obstructive uropathy was managed with PCN insertion. Out of 3 already treated patients, 2 were disease free after curative radiotherapy/surgery. PCN was done to prevent permanent kidney damage in them. One patient was defaulter of curative radiotherapy. She had progressive residual disease. Complications like hemorrhage (20%), infection (26%), reinsertion for dislodgment/misplacement (53%), percutaneous leak or perinephric leak (20%), blockage of PCN (33%) were noticed.

Conclusion:

In spite of inherent, albeit manageable complications, PCN is a simple and safe technique. One of the major benefits observed was ability to administer either curative/palliative radiotherapy or chemotherapy in 85% of patients (11 out of 13 with disease). There was no active disease in remaining 2 patients. Therefore, the decision to attempt PCN in carefully selected cervical cancer patients is justified.     

参芪扶正注射液联合姑息性化疗对晚期结直肠癌疗效的临床观察

目的观察晚期结直肠癌姑息性化疗中联合应用参芪扶正注射液的疗效遥方法将118 例晚期结直肠癌患者随机分为 治疗组(参芪扶正注射液联合姑息性化疗)61 例和对照组(单纯姑息性化疗组)57 例,对比观察两组患者3 周期姑息性化疗后的 总体有效率尧化疗不良反应和生活质量改善情况遥结果治疗组总有效率77.05%,对照组56.14%,治疗组总有效率明显优于对 照组,两组间差异显著( 约0.05)曰治疗组患者胃肠道反应尧骨髓抑制等不良反应发生率均显著低于对照组( 约0.05)曰患者生存质 量改善情况治疗组（68.85%）优于对照组（49.12%）,两组差异有统计学意义( 约0.05)遥结论晚期结直肠癌患者姑息性化疗联合 应用参芪扶正注射液,能够取得较好疗效,同时减轻化疗不良反应尧改善生活质量     

复方苦参注射液联合XELOX方案对晚期结肠癌患者疗效及免疫功能的影响

目的探讨复方苦参注射液联合卡培他滨和奥沙利铂方案(XELOX方案)对晚期结肠癌患者疗效及免疫功能的影响。方法将我院收治的78例晚期结肠癌患者随机分为实验组和对照组,各39例,对照组给予XELOX方案治疗,实验组加用复方苦参注射液,比较两组客观疗效、胃肠道不良反应及治疗前后免疫功能、卡氏(KPS)评分、癌胚抗原(CEA)的变化。结果实验组总有效率为84.62%,显著高于对照组的64.10%(P<0.05);两组治疗后KPS评分均明显升高(P<0.05),实验组升高幅度大于对照组(P <0. 05);两组治疗后CEA值均无明显变化,组间比较差异无统计学意义(P>0.05);治疗后,实验组CD4^+、CD8^+、CD4^+/CD8^+、NK细胞活性均明显升高(P <0.05),对照组CD4^+、CD4^+/CD8^+、NK细胞活性均明显降低(P <0. 05),组间比较差异均有统计学意义(P <0. 05);实验组胃肠道反应、骨髓抑制发生率显著低于对照组(P<0.05);两组肝功能异常发生率比较,差异无统计学意义(P>0.05)。结论复方苦参注射液联合XELOX方案对晚期结肠癌患者疗效较好,可提高免疫功能,减少胃肠道不良反应。