肝癌冷冻治疗的临床研究进展

对于不能手术切除的肝癌,无论是原发或是继发,冷冻治疗都是一种重要选择。冷冻治疗具有坏死彻底、适应性广、创伤小、可控性强等优点;冷冻消融后的瘤苗作用还能提高患者的抗肿瘤免疫力,冷冻导致的血管栓塞能阻止肿瘤通过血行转移;冷冻治疗不仅能用于治疗小肝癌,对大肝癌和邻近大血管的肝癌均适用。冷冻疗法可在手术中应用,也町经腹腔镜或经皮穿刺完成治疗过程;在超声或CT引导下,经皮氩氦刀冷冻消融对于小肝癌的治疗效果等同于外科手术.     

局部化疗和冷冻治疗转移性肝癌

研究发现,当温度低于-20℃时,不论肿瘤细胞还是正常细胞均被冻结并被杀死。细胞死亡可能发生在冷冻时或融解时,此外,小血管的栓塞导致缺氧亦可引起细胞死亡。目前使用液氮作为冷冻剂,使治疗温度达到-196℃,可获得理想的治疗效果。通常应用直径为5或者9mm一根绝缘三腔管探头,可有效地破坏肝内多发的癌灶而对正常肝组织无过多损害。冷冻试验发现每间隔1mm则温差达10℃,基于     

肝癌的冷冻治疗

肿瘤的冷冻治疗指在原位通过低温和复温达到对肿瘤组织的灭活。对于无法手术切除的肝癌,冷冻治疗是目前较为理想的方法。温度低于－５０℃时,可对肿瘤达到理想的灭活,复温引起低张环境使细胞破裂。Korpan认为,对无法切除的肝癌冷冻治疗具有下列作用：①冷冻造成感觉神经灭活所产生的麻醉作用可减轻晚期肿瘤患者的痛苦;②冷冻可避免出血的发生;③冷冻引起肿瘤细胞不可逆坏死,并在坏死组织周围形成一个粒细胞区;④液氮冷冻使机体对肿瘤产生自身免疫反应,可减少肿瘤存活机体对肿瘤产生自身免疫反应,可减少肿瘤存活或复发;⑤与手术…     

氩氦刀冷冻治疗早期肝癌疗效分析

目的通过回顾性分析，评价氩氦刀冷冻治疗早期肝癌的临床疗效。方法选择48例经氩氦刀冷冻治疗的早期肝癌患者，以治疗后患者的临床表现、局部病灶CT变化、AFP下降情况、术后并发症的发生及平均生存时间作为评价指标。结果氩氦刀冷冻治疗肝癌后患者的并发症少，本研究结束后，共有23例患者存活，25例患者死亡。中位生存期为（33．91±1．39）个月，1、2、3、4年生存率分别为81．3％、62．1％、47．6％、44．4％。结论对于合并严重肝硬化的早期肝癌，氩氦刀治疗的并发症少、效果明显、生存期延长，是理想的治疗手段。     

肝癌的冷冻治疗

冷冻疗法已成为治疗不能手术切除肝癌的重要手段.冷冻方法可选择手术中冷冻,切除或不切除肿瘤、腹腔镜下冷冻,或在超声、cT或MRI监测下,经皮冷冻.作为一局部治疗,冷冻具有超越其他治疗方法的若干优点:仅消融肝内肿瘤组织,而少伤及正常组织;由于大血管流动血流的温热作用,冷冻可安全地治疗临近大血管的肝肿瘤:冷冻比之手术更适宜治疗肝多发性肿瘤.冷冻联合肝动脉化学栓塞(TACE)、酒精注射或125碘粒子植入,有相辅相成的作用.对于冷冻在肝癌治疗中应用,可归结如下:(1)小于5 cm,尤其小于3 cm的肝癌,数目不超过3个,可以手术中冷冻或经皮冷冻.(2)大于5 cm的肝癌,先作TACE,再给予经皮冷冻.(3)大于5 cm,边缘不整,预计冷冻不完全的肝癌,可予手术中或经皮冷冻,同时在冷冻区周边部注射酒精或植入125碘粒子.     

经皮氩氦刀冷冻消融治疗老年肝癌20例

磁共振导引下氩氦刀靶向冷冻消融术是近年开展的冷冻治疗新技术,利用局部超低温冷冻的方法损毁肿瘤组织,避免了因开刀手术导致过量肝组织被切除使肝脏功能受到影响,因而使一些无法耐受肝脏手术的老年肿瘤病人可以接受该治疗[1].本文通过对经皮穿刺氩氦刀冷冻消融治疗老年肝癌进行临床总结,探讨此疗法治疗肝癌的适应证、疗效及安全性和临床意义.     

肝癌的冷冻外科治疗72例

1材料和方法 1.1材料我院自1994年起,应用LSC-2000型冷冻机治疗肝癌72例,其中男63例,女9例,年龄30岁～65岁,平均47.7岁.其中原发性肝癌66例,转移性肝癌7例,均经病理证实.肿瘤最大直径＜5 cm者17例,5 cm～10 cm者34例,＞10 cm者21例.术前AFP＞400ng/L者35例(48.6%).仪器设备:①LCS-2000型冷冻机;②Toshiba SSA-240A型线阵实时超声显象仪,以及引导穿刺的全套设备;③Olympus腹腔镜及全套辅助设备;④WolfFoley扩张器,内径2mm～9mm.     

原发性肝癌的冷冻消融治疗

随着科学技术的不断进步,20世纪90年代末美国Endocare公司把高压氩气(冷媒)和高压氦气(热媒)运用于冷冻治疗中.其降温及升温的速度、时间和温度以及冰球的大小与形状是完全可以控制和精确设定的,产生了现在的氩氦超导手术治疗系统--氩氦刀,并迅速普及.     

肝细胞癌冷冻消融术后早期复发的危险因素

目的:探讨肝细胞癌(hepatocellular carcinoma,HCC)患者冷冻消融术后影响早期复发的相关危险因素.方法:回顾分析90例直径≤5.0 cm的HCC行冷冻消融治疗后复发的患者的临床资料,分析影响冷冻消融术后早期复发的危险因素.结果:本组患者随访8-47(平均随访时间21.9±10.1)mo,共有57...     

Sequential use of transarterial chemoembolization and percutaneous cryosurgery for hepatocellular carcinoma

AIM： To evaluate the efficacy of sequential use of transarterial chemoembolization （TACE） and percutaneous cryosurgery for unresectable hepatocellular carcinoma （HCC）. METHODS： Four hundred and twenty patients were enrolled in this study. The patients, who were considered to have unresectable tumors due to their location or size or comorbidity, were divided into sequential TACE-cryosurgery （sequential） group （n = 290） and cryosurgery alone （cryoalone） group （n = 130）. Patients in the sequential group tended to have larger tumors and a greater number of tumors than those in the cryo-alone group. Tumors larger than 10 cm in diameter were only seen in the sequential group. TACE was performed with the routine technique and percutaneous cryosurgery was conducted under the guidance of ultrasound 2-4 wk after TACE. RESULTS： During a mean follow-up period of 42 ± 17 mo （range, 24-70 mo）, the local recurrence rate at the ablated area was 17% for all patients, 11% and 23% for patients in sequential group and cryoalone groups, respectively （P = 0.001）. The overall 1-, 2-, 3-, 4- and 5-year survival rate was 72%, 57%, 47%, 39% and 31%, respectively. The 1- and 2-year survival rates （71% and 61%） in sequential group were similar to those （73% and 54%） in cryo-alone group （P = 0.69 and 0.147）, while the 4- and 5-year survival rates were 49% and 39% in sequential group, higher than those （29% and 23%） in cryo-alone group （P = 0.001）. Eighteen patients with large HCC （〉 5 cm in diameter） survived for more than 5 years after sequential TACE while no patient with large HCC （〉 5 cm in diameter） survived more than 5 years after cryosurgery. The overall complication rate was 24%, and the complication rates were 21% and 26% for the sequential and cryo-alone groups, respectively （P = 0.06）. The incidence of hepatic bleeding was higher in cryo-alone group than in sequential group （P = 0.02）. Liver crack only occurred in two patients of the cryoalone group. CONCLUSION： Pre-cryosurgical TACE can increase the cryoablation efficacy and decrease its adverse effects, especially bleeding. Sequential TACE and cryosurgery may be the better procedure for unresectable HCC, especially for large HCC.     

Chemokines and hepatocellular carcinoma

Chemokines play a paramount role in tumor progres-sion. In hepatocellular carcinoma (HCC) progression, chemokines and their receptors play an intricate role. Currently, chemokines and their receptors such as the CXCL12-CXCR4 axis, CX3CL1-CX3CR1 axis and the CCL20-CCR6 axis have received much research attention. Although a large number of studies show that these axes are strongly associated with HCC, the exact mechanism by which these axes promote the growth and progression of HCC remains unknown. In this pa...     

The optimal selection of radiotherapy treatment for hepatocellular carcinoma

The majority of patients who present with hepatocellular carcinoma (HCC) are already at an advanced stage, and the tumors are unresectable. Radiotherapy (RT) technology can safely provide focused high-dose irradiation to these patients. A wide spectrum of RT technologiesis currently available, including internal RT consisting of Yttrium-90 ((90)Y), Iodine-131 ((131)I) anti-ferritin antibody and Homium-199 ((199)Ho) and external RT, such as three-dimensional conformal RT, intensity-modulated RT, helical tomotherapy, stereotactic body RT, and image-guided RT. However, it may be difficult for physicians to understand all of the available options and to select the optimal RT treatment. Physicians frequently query radiation oncologists on the practical indications of RT for managing patients with HCC. According to the Korean Liver Cancer Study Group practice guidelines, RT is considered appropriate for unresectable, locally advanced HCC without extrahepatic metastasis, a Child-Pugh class A or B, and tumors that occupy less than two-thirds of the liver with level II evidence. In this review, we discuss the application of various RT modalities based on disease status and the detailed indications for RT according to the Barcelona Clinic Liver Cancer staging system.     

原发性肝癌的非手术治疗

原发性肝癌（下简称肝癌）主要是肝细胞癌，少数是胆管细胞癌。我国是肝癌高发地区，其恶性程度高，进展快，治疗棘手，预后差。外科手术切除或肝移植是最有效的治疗，但绝大多数病例属于中晚期或有严重的肝硬化，而不适合外科手术治疗^[1]，因而非手术治疗适用于大多数病例或与外科手术相结合提高治疗效果^[1,2]。     

表观遗传变化与肝癌

表观遗传修饰主要包括组蛋白乙酰化和DNA甲基化,组蛋白乙酰化和DNA低甲基化可促进基因表达,反之,则可抑制基因表达。在肝细胞癌的发生发展过程中,抑癌基因的甲基化特别是高甲基化起着重要作用,与肝细胞癌的形成有密切关系。另外,肝炎病毒等对抑癌基因的甲基化也起一定的调节作用。肝癌的表观遗传学研究对肝癌的早期诊断和病情预后的监测及其防治具有重要意义。     

骨桥蛋白与肝癌

肝癌转移是导致肝癌治疗失败的主要原因。骨桥蛋白能促进细胞的趋化、粘附和迁移等,参与肿瘤转移的过程。骨桥蛋白在肝癌转移中起重要作用,但是骨桥蛋白促进肝癌转移的确切机制尚未阐明。此文综述骨桥蛋白与肝癌的相关文献。     

几种不同治疗手段对原发性肝癌的疗效比较研究

目的对原发性肝癌儿种不同治疗手段疗效进行比较分析,为临床合理化治疗方案的确定提供参考与帮助.方法我院1999年6月至2003年6月收治原发性肝癌病例中80例分为A组:单纯手术组;B组:手术切除 植入式肝动脉化疗泵化疗组;C组:单纯肿瘤内注射无水酒精组;D组:股动脉穿刺介入治疗组.对不同治疗手段疗效进行比较分析.结果治疗后A、B、C、D四组1年生存率分别为60.13%、71.26%、43.15%、42.78%,2年生存率分别为46.52%、51.38%,26.64%,25.83%.A、B组术后1年复发率分别为60.33%,49.28%,术后2年复发率分别为76.59%,61.24%.结论对原发性肝癌的治疗以手术切除病灶加化疗的综合治疗效果最佳,单纯手术切除较荷瘤的其他治疗手段效果好,但对无法手术切除的病例肿瘤局部用药的治疗手段仍具有一定的控制效果.