腹腔镜联合射频消融和125I粒子治疗晚期直肠癌并肝转移

目的探讨腹腔镜切除并联合应用射频消融和^125I粒子植入治疗晚期直肠癌合并肝转移的临床价值。方法对30例术前确诊为直肠癌，经CT发现肝脏有实性占位的患者术中行腹腔镜下直肠癌切除，经吻合器吻合肠段后，即行腹腔镜下肝转移瘤切除或射频消融，最后将^125I粒子植入盆腔及肝脏肿瘤部位。结果术中超声发现新病灶7个，所有患者均顺利行腹腔镜切除手术，无中转开腹及严重并发症。25个转移病灶位于肝脏右叶仅行腹腔镜下射频消融及^125I粒子植入，8个转移病灶行离体切除。随访12～25个月（平均22．3个月），有6例转移癌未见液化，行腹腔镜下二次射频。1年生存率为73％（22／30）。结论腹腔镜切除并联合应用RFA和^125I粒子植入治疗晚期直肠癌并肝转移癌具有微创、安全、疗效确切、术后恢复快等优点。     

腹腔镜肝切除联合射频消融及125I粒子植入治疗肝癌

目的探讨应用腹腔镜下肝切除联合射频消融及^125Ⅰ粒子植入治疗肝癌的疗效。方法26例肝癌患置，左肝叶肿藉12翻，右肝叶肿瘤11例，左右肝叶均有肿瘤3例。总病灶为34个，肿瘤直径2．8—13．0cm。所有患者均接受腹腔镜肿瘤切除、^125Ⅰ粒子植入和射频消融。结果所有患者均顺利行^125Ⅰ粒子植入、射频消融或腹腔镜肿瘤切除，无中转开腹，术中超声发现新病灶2个。8个病灶位于右后内叶仅行超声刀汽化及射频消融、^125Ⅰ粒子植入，28个边缘病灶行射频消融、腹腔镜肿瘤切除和^125Ⅰ粒子植入。随访12～25个月（平均22．3月），1年生存率为92．3％（24／26），治疗的36个病灶中有3个在切除部位复发。所有患者无严重并发症。结论联合应用^125Ⅰ粒子植入和射频消融、腹腔镜切除肝癌安全，微创，疗效确切，存活率高，复发少，术后恢复快。     

TACE联合微波消融及125I放射性粒子植入治疗小肝癌

目的:探讨经肝动脉化疗栓塞(TACE)联合微波消融(MWA)及~(125)I放射性粒子植入治疗小肝癌的安全性和疗效。方法:19例行TACE治疗小肝癌患者,术后1个月复查肝功能、AFP及上腹部CT平扫+增强扫描,根据检查结果联合MWA及~(125)I放射性粒子植入治疗,联合治疗3个月后再次复查肝功能、AFP及上腹部CT平扫+增强扫描,采用m RECIST标准评价其疗效。结果:19例患者共行TACE治疗19次,TACE术后1个月病灶完全缓解(CR)6例、部分缓解(PR)13例,完全缓解率31.5%,13例PR患者联合MWA或MWA+~(125)I放射性粒子治疗后3个月CR 10例、PR 3例。TACE术后1个月3例患者AFP值降至正常,联合治疗后3个月,全组16例患者AFP值降至正常,另3例患者AFP值较术前均明显下降。全部病例均未发生严重并发症。结论:TACE联合MWA及~(125)I放射性粒子植入治疗小肝癌能明显提高其疗效,并且具有创伤小、并发症少等优点。     

CT引导下组织间植入 125 I粒子治疗肺癌的临床应用

目的 探讨CT引导下组织间植入125I粒子治疗肺癌的临床价值. 方法 18例肺癌患者采用CT引导下125I放射性粒子植入.粒子植入之前采用三维治疗计划系统模拟布源,在螺旋CT引导下将125I粒子植入肿瘤组织内.术后2个月复查CT一次,随访6个月. 结果 全组18例18个病灶共植入粒子812粒,平均每个病灶植入粒子45.1粒.2个月后采用CT评价,完全缓解(CR)7例,部分缓解(PR)10例,无变化(NC)1例,总有效率(CR PR)为94%(17/18). 结论 经皮穿刺放射性粒子组织间永久植入治疗中晚期肺癌为一种近期疗效满意、微创、低毒的新方法,值得进一步临床应用,长期观察.     

放射性125I粒子组织间植入治疗软组织肿瘤

目的评价放射性125I粒子组织间永久性植入治疗软组织肿瘤的疗效和安全性。方法对12例软组织肿瘤共15个病灶(2个原发灶,13个局部复发或转移灶)行125I粒子永久性植入治疗。单个病灶植入粒子60颗(7~80颗),粒子活度0.6mCi(0.5~0.8mCi),肿瘤匹配周边剂量(MPD)140~160Gy。术后行质量验证。2个病灶质量验证不满意加行补充外照射,剂量为30、60Gy,分次剂量2.0Gy。结果中位随访时间17个月(3~34个月)。疼痛缓解率83%(5/6)。术后2个月实际临床获益率(完全缓解CR 部分缓解PR 疾病稳定SD)为93%(14/15)。1年及2年局部控制率均为83%。1年生存率72.9%,2年生存率62.5%,中位生存时间32个月。3例远处转移。5例死亡:1例死于肺转移,4例死于全身多器官衰竭。1例植入粒子后皮肤破溃未愈合,其他患者未出现明显的毒副作用。结论放射性125I粒子植入术单独或联合外照射治疗软组织肿瘤尤其是复发和转移性软组织肿瘤有效,方法简单、易行、微创、安全。     

CT导向125I粒子植入治疗结直肠癌肝转移

目的 探讨CT导向下125I粒子植入治疗技术在结直肠癌肝转移瘤治疗中的意义.方法 2006年7月至2007年8月对15例结直肠癌肝转移患者采用CT引导下125I放射性粒子植入,粒子植入前采用治疗计划系统(treatment planning system,TPS)模拟布源或遵循Halarism的125I经验公式(mCi=Da×5),计算术中所需125I粒子的总活度及治疗粒子的数量.在螺旋CT导向下将125I放射性粒子植入肝转移瘤实质内及肿瘤边缘. 结果 治疗3个月后行肿瘤影像学评价,15例患者中完全缓解(complete remission,CR)2例,部分缓解(partial remission,PR)10例,稳定(no change,NC)3例.随访至今全组15例全部存活,随访时间最长20个月,最短6个月,近期平均生存期12个月.结论 CT导向下125I粒子植入是治疗直肠癌肝转移瘤的安全、微创、有效的方法 .     

CT引导下组织间植入 125 I粒子治疗肺癌的临床应用

目的探讨CT引导下组织间植入125I粒子治疗肺癌的临床价值。方法18例肺癌患者采用CT引导下125I放射性粒子植入。粒子植入之前采用三维治疗计划系统模拟布源,在螺旋CT引导下将125I粒子植入肿瘤组织内。术后2个月复查CT一次,随访6个月。结果全组18例18个病灶共植入粒子812粒,平均每个病灶植入粒子45.1粒。2个月后采用CT评价,完全缓解(CR)7例,部分缓解(PR)10例,无变化(NC)1例,总有效率(CR PR)为94%(17/18)。结论经皮穿刺放射性粒子组织间永久植入治疗中晚期肺癌为一种近期疗效满意、微创、低毒的新方法,值得进一步临床应用,长期观察。     

CT导向下放射性125I粒子近距离治疗晚期鼻咽癌的临床观察

目的探讨CT导向下经皮125I放射性粒子植入治疗鼻咽癌的临床疗效。方法对10例确诊鼻咽癌的患者行CT导向下经皮植入125I放射性粒子,分析治疗效果,研究其临床应用的可行性。结果 10例患者共植入粒子760颗。治疗后4周复查,CR 7例(70%),PR 2例(20%),总有效率达到90%,所有患者均未发生严重并发症。8周后复查,3例患者出现新病灶,分别补充植入60、30、40粒,1例患者死于肝转移。结论 CT导向下125I粒子植入治疗晚期鼻咽癌是一种安全、可靠、疗效较好的治疗方法。     

放射性125I粒子组织间植入治疗软组织肿瘤

目的 评价放射性125I粒子组织间永久性植入治疗软组织肿瘤的疗效和安全性. 方法 对12例软组织肿瘤共15个病灶(2个原发灶,13个局部复发或转移灶)行125I粒子永久性植入治疗.单个病灶植入粒子60颗(7～80颗),粒子活度0.6 mCi(0.5～0.8 mCi),肿瘤匹配周边剂量(MPD)140～160 Gy.术后行质量验证.2个病灶质量验证不满意加行补充外照射,剂量为30、60 Gy,分次剂量2.0 Gy. 结果 中位随访时间17个月(3～34个月).疼痛缓解率83%(5/6).术后2个月实际临床获益率(完全缓解CR 部分缓解PR 疾病稳定SD)为93%(14/15).1年及2年局部控制率均为83%.1年生存率72.9%,2年生存率62.5%,中位生存时间32个月.3例远处转移.5例死亡1例死于肺转移,4例死于全身多器官衰竭.1例植入粒子后皮肤破溃未愈合,其他患者未出现明显的毒副作用. 结论 放射性125I粒子植入术单独或联合外照射治疗软组织肿瘤尤其是复发和转移性软组织肿瘤有效,方法简单、易行、微创、安全.     

125I 放射性粒子治疗原发性肝癌的疗效研究

目的：评价125I放射性粒子植入治疗原发性肝癌的临床疗效。 方法：回顾性分析2009年6月—2012年8月84例接受125I放射性粒子植入治疗肝癌患者的临床资料。 结果：84例患者共植入粒子3 630粒,其中肿瘤≤3.5 cm患者平均17粒;肿瘤>3.5 cm患者平均46粒,所有患者均一次性植入成功。患者植入治疗后疼痛明显减轻或消失,达完全缓解（CR）者为40例,部分缓解（PR）36例,疾病稳定（SD）8例,总有效率（CR+PR）为90.5%。术后随访3~45个月,患者平均生存率期为16.5个月,1、2年生存率分别为64.3%、31.0%。 结论：125I放射性粒子瘤内植入治疗原发性肝癌疗效确切,可作为治疗难治性、复发性、转移性肝癌的一种重要选择。     

大鼠肝组织冷冻和射频灭活治疗对肺形态学和功能影响的比较实验研究

目的 比较大鼠肝组织冷冻或射频治疗后对肺形态学和功能的影响.方法 SD大鼠随机分成A(n=47)、B(n=32)两组,A组给予冷冻治疗,-196℃液氮浸泡冷冻,治疗时间15～20 s;B组给予射频治疗,功率15 W,时间60～90 s.按预定时间处死.术前、术后1、3、6、24 h ELASA检测血TNF-α,IL-8;同时观察肺组织学表现和早期死亡率.结果 术后,A组血TNF-α,IL-8浓度1 h显著升高,3 h达峰值;B组仅轻微的升高(A与B组相比:P＜0.01).A组光镜下可见肺组织间隔明显增厚,充血,水肿,灶性肺实质出血,大量的中性粒细胞,巨噬细胞浸润;而B组肺部仅有少量的炎细胞浸润.另外,术后48 h内死亡率,A组为25.5%;B组仅为5.4%,差异显著(P＜0.05).结论 相同条件下,冷冻治疗引起了急性肺损伤、高死亡率等并发症,而射频治疗影响轻微.在一定条件下,射频是相对安全的.     

腹腔镜下射频消融治疗肝细胞肝癌

目的 评价分析腹腔镜下射频消融(radiofrequency ablation,RFA)治疗原发性肝癌的安全及疗效性.方法 回顾性研究分析2008年5月至2010年7月中日友好医院应用腹腔镜下RFA治疗原发性肝癌78例,全部病例均在腹腔镜超声引导下至少一个病灶穿刺活检确诊为肝细胞肝癌.其中男41例,女37例,年龄31～87岁(中位年龄57岁).统计分析肿瘤坏死情况、肿瘤局部复发对总生存率的影响.结果 78例患者中位随访16个月.肿瘤直径、是否邻近大血管、周围是否有卫星灶及是否联合经导管肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)是影响肿瘤复发的主要因素.直径＜3 cm的肿瘤完全消融率90.5％(38/42),明显比＞3 ～5 cm的肿瘤消融率71.4％ (20/28)高,二者比较差异有统计学意义(x2 =4.291,P=0.038).肿瘤未邻近大血管组的肿瘤消融率91.9％ (61/67),高于肿瘤邻近大血管组的消融率63.6％ (7/11),二者相比差异有统计学意义(x2 =6.351,P=0.012).RFA组和联合TACE组的肿瘤消融率分别为75.0％和88.9％,两者相比,差异无统计学意义(x2=1.567,P=0.211).RFA治疗后平均总生存期(48.7±2.4)个月,术后1、2、3、4、5年的总生存率分别为86.1％、76.9％、60.3％、51.8％、33.1％.结论 RFA是肝脏恶性肿瘤安全、有效的治疗手段,而腹腔镜下RFA,能够更好的判断肿瘤大小、数目以及肿瘤与周围血管的关系,使穿刺更加准确,从而获得更好的远期疗效.     

腹腔镜下一期行结直肠癌切除与多电极射频治疗肝转移癌

目的探讨腹腔镜下行乙状结肠、直肠癌切除,同时多电极射频治疗肝转移癌方法的临床价值。方法对6例术前确诊为乙状结肠、直肠癌,经CT发现肝脏有实性占位的患者,行腹腔镜下乙状结肠、直肠癌切除,吻合器吻合肠段后,再在腹腔镜直视下行肝脏肿瘤穿刺病理学检查,确诊为肝转移癌后,即经皮多电极针穿刺进入肝肿瘤进行射频消融治疗。结果6例患者治疗中未发生严重并发症,术后肠道功能恢复时间24～72h。术后3个月CT复查发现肿瘤明显液化并完全坏死;存活4例,其中1例又再做肝移植至今;2例死于全身衰竭。结论腹腔镜下应用多电极射频消融治疗乙状结肠、直肠癌伴肝转移癌是安全有效的,避免了二期手术的创伤和不良预后。     

Transcatheter arterial chemoembolization with or without radiofrequency ablation in the management of patients with advanced hepatic malignancy

Transcatheter arterial chemoembolization (TACE) is efficacious against hepatic malignancies by rendering tumors ischemic while delivering high-dose chemotherapy. The added benefit of radiofrequency ablation (RFA) has not been determined. We sought to review our experience with TACE with or without RFA in the treatment of hepatocellular carcinoma and colorectal liver metastases in patients not amenable to resection. TACE and RFA were undertaken in 13 patients with hepatocellular carcinoma (n = 7) or colorectal liver metastases (n = 6). Concurrently 24 patients underwent TACE alone for hepatocellular carcinoma (n = 15) or colorectal liver metastases (n = 9). Patients undergoing TACE with or without RFA were similar in age, gender, and diagnosis. Overall follow-up was 9.1 months +/- 7.1. One-year survival was greater in patients undergoing TACE with RFA than with TACE alone (100% vs 67%, P = 0.04). Mean survival was longer after TACE with RFA compared with TACE alone (25.3 months +/- 15.9 vs 11.4 months +/- 7.3, P < 0.05). No patients suffered significant complications. The addition of RFA to TACE improves survival in patients with unresectable primary or metastatic hepatic malignancies. RFA with TACE should be in the armamentarium of surgeons caring for patients with malignant liver lesions.     

Laparoscopic radiofrequency ablation of neuroendocrine liver metastases: a 10-year experience evaluating predictors of survival

BACKGROUND: A decade ago we reported the first use of laparoscopic radiofrequency thermal ablation (RFA) for the treatment of neuroendocrine hepatic metastases. This study analyzes our 10-year experience and determines characteristics predictive of survival. METHODS: Eighty RFA sessions were performed in 63 patients with neuroendocrine hepatic metastases in a prospective trial. All patients had unresectable disease with computed tomography (CT) documented lesion and/or symptom progression. Perioperative morbidity, symptom relief, disease progression, and long-term survival were analyzed. Data are expressed as mean +/- standard error of the mean (SEM). RESULTS: There were 22 women and 41 men, age 54.4 +/- 1.5 years followed for 2.8 +/- 0.3 years (range, 0.1 to 7.8). Tumor types included 36 carcinoid, 18 pancreatic islet cell, and 9 medullary thyroid cancer. RFA was performed 1.6 +/- 0.3 years after the diagnosis of liver metastases. Number of lesions treated was 6 +/- 0.5 (range, 1 to 16). Forty-nine patients underwent 1 ablation session, and 14 (22%) had repeat sessions caused by disease progression. Mean hospital stay was 1.1 days. Perioperative morbidity was 5%, with no 30-day mortality. Fifty-seven percent of patients exhibited symptoms. One week postoperatively 92% of these reported at least partial symptom relief, and 70% had significant or complete relief. Duration of symptom control was 11 +/- 2.3 months. CT follow-up demonstrated 6.3% local tumor recurrence. Larger dominant liver tumor size and male gender adversely impacted survival (P < .05). Median survival times were 11.0 years postdiagnosis of primary tumor, 5.5 years postdiagnosis of neuroendocrine hepatic metastases, and 3.9 years post-1st RFA. Survival for patients undergoing repeat ablation sessions was not significantly lower. CONCLUSIONS: This study represents the largest series of neuroendocrine hepatic metastases treated by RFA. In this group of patients with aggressive neuroendocrine tumor metastases and limited treatment options, RFA provides effective local control with prompt symptomatic improvement.     

Radiofrequency ablation of primary and metastatic liver tumors: a critical review of the literature

BACKGROUND: Surgical resection is the treatment of choice for hepatic tumors; however, for various reasons, the vast majority of patients are not operative candidates. As a result, several local ablative therapies have emerged as alternatives to resection or as adjuncts in total oncologic care. Presently, the most widely employed liver-directed treatment is radiofrequency thermal ablation. METHODS: To define the current status of radiofrequency ablation (RFA), the authors reviewed available safety and efficacy data from select studies on RFA. A MEDLINE search was performed using the keywords "tumor type" + "radiofrequency ablation" + "survival." Only those studies containing long-term survival data on greater than 50 patients were included in this analysis. CONCLUSIONS: Although RFA has been readily adopted into treatment paradigms, more rigorous trials are needed to solidify its place in the armamentarium of therapeutic strategies for hepatic malignancy.     

125I粒子永久性植入组织间放射治疗肝癌

目的:探讨125I组织间放射治疗肝癌的疗效.方法:选择肝癌患者84例,随机分为对照组(A组)与治疗组(B组),A组42例行手术治疗(根治手术或姑息手术)和化疗;B组42例,除施行A组的治疗方案外,另行术中永久植入125I粒子.结果:术前、术后1 w及3个月内血象虽有显著差异,但均在正常范围内,免疫指标前后变化无统计学意义.A组:12个月、24个月、36个月局部复发率分别为41.7%、50.0%和59.5%;12个月、24个月、36个月局部生存率分别为81.3%、63.4%和47.6%.B组:12个月、24个月、36个月局部复发率分别为0、6.7%和11.9%;生存率分别为94.7%、87.5%和78.4%,两组的局部复发率及生存率有显著性差异(P<0.05).结论:125I组织间放射治疗肝癌方法简单、安全,近期疗效确切,是治疗癌症的理想方法之一.     

Hepato-pericardial fistula following radiofrequency ablation (RFA) for liver metastasis: a case report and review of the literature

Introduction  Recent large-scale studies have demonstrated the efficiency and safety of radiofrequency ablation (RFA) for unresectable hepatic tumors. Nevertheless, severe side effects especially relating to non-target thermal injury have occurred after radiofrequency ablation. Case report  We observed the development of a hepato-pericardial fistula leading to pericardial empyema after RFA of a metastatic hepatic lesion. Concerning the genesis of the fistula, development from thermal damages in the diaphragm and pericardium as well as abscess formation in the liver is assumed. Treatment consisted of percutaneous drainage and flushing via remaining hepatic and pericardial catheters. Recovery was achieved conservatively after 2 months. To the best of our knowledge, a hepato-pericardial fistula as a complication of RFA has not been reported so far. The review of the literature revealed several cases of intrahepatic abscess formation after RFA as well as one case of pericardial empyema due to perforation of hepatic amoebic abscess. Two cases of pericardial tamponade after RFA are reported in the literature leading to death. Treatment via percutaneous drainage has been successful in this case and correlates with the successful treatment of abscess formation after RFA of metastatic pancreatic cancer. Other authors suggest pericardectomy or thoracotomy in the treatment of pericardial empyema. Conclusion  The management of hepatic abscess formation subsequent to RFA of metastatic hepatic malignancies is not well described. We regard the percutaneous drainage as treatment of pericardial empyema as well as hepatic abscess as less invasive and sufficient, as demonstrated in this case.     

Radiofrequency Ablation of Unresectable Primary and Metastatic Hepatic Malignancies: Results in 123 Patients

OBJECTIVE: To describe the safety and efficacy of radiofrequency ablation (RFA) to treat unresectable malignant hepatic tumors in 123 patients. BACKGROUND: The majority of patients with primary or metastatic malignancies confined to the liver are not candidates for resection because of tumor size, location, or multifocality or inadequate functional hepatic reserve. Local application of heat is tumoricidal; therefore, the authors investigated a novel RFA system to treat patients with unresectable hepatic cancer. PATIENTS AND METHODS: Patients with hepatic malignancies were entered into a prospective, nonrandomized trial. The liver tumors were treated percutaneously or during surgery under ultrasound guidance using a novel LeVeen monopolar array needle electrode and an RF 2000 generator. All patients were followed to assess complications, treatment response, and recurrence of malignant disease. RESULTS: RFA was used to treat 169 tumors (median diameter 3.4 cm, range 0.5 to 12 cm) in 123 patients. Primary liver cancer was treated in 48 patients (39.1%), and metastatic liver tumors were treated in 75 patients (60.9%). Percutaneous and intraoperative RFA was performed in 31 patients (35.2%) and 92 patients (74.8%), respectively. There were no treatment-related deaths, and the complication rate after RFA was 2.4%. All treated tumors were completely necrotic on imaging studies after completion of RFA treatments. With a median follow-up of 15 months, tumor has recurred in 3 of 169 treated lesions (1.8%), but metastatic disease has developed at other sites in 34 patients (27.6%). CONCLUSIONS: RFA is a safe, well-tolerated, and effective treatment to achieve tumor destruction in patients with unresectable hepatic malignancies. Because patients are at risk for the development of new metastatic disease after RFA, multimodality treatment approaches that include RFA should be investigated.     

经皮射频消融与肝切除治疗小肝癌的疗效比较meta分析

目的 利用meta分析的方法,评价经皮射频消融与手术切除治疗符合Milan标准的小肝癌的疗效.方法 选取发表于1990年1月至2010年2月的文献,对比分析经皮射频消融与手术切除两种方式治疗符合Milan标准的小肝癌疗效的临床随机对照试验研究,并应用meta分析方法评价总体生存率以及术后复发率等相关指标.结果 共有4篇前瞻性随机对照研究纳入此分析,包括539例患者,其中经皮射频消融治疗252例患者,手术切除治疗287例患者.经皮射频消融与手术切除治疗患者之间术后总体生存率的差异无统计学意义(P＞0.05);经皮射频消融术治疗患者术后2、3、4年无瘤生存率均低于手术切除,差异有统计学意义(P＜0.05).经皮射频消融术治疗患者术后肿瘤复发率高于手术切除,差异有统计学意义( OR:2.63,95％ CI:1.67～4.15,P=0.000).经皮射频消融术治疗患者术后并发症的发生率低于手术切除,差异有统计学意义( OR:0.14,95％CI:0.09～0.22,P=0.000).结论 对于符合Milan标准且适应手术切除和经皮射频消融治疗指征的小肝癌,经皮射频消融与手术切除治疗患者的术后总体生存率相似.经皮射频消融具有侵袭性小、术后并发症发生率低等优点,但是手术切除能够较好的预防术后肿瘤复发.对于不愿意行手术切除的患者,可推荐选择经皮射频消融治疗.