彩色多普勒在肝血管瘤硬化治疗的应用

本文对６例临床确诊的肝血管瘤患者进行了超声引导下经皮经肝穿刺瘤体内注射无水乙醇的硬化治疗，治疗前后应用彩色多普勒检测瘤体内血流信号作为判断近期疗效的指标，并与中远期疗效进行比较。结果表明：术前６例患者瘤体内均探及脉冲性或脉冲与连续性低速血流信号；术后一周４例患者瘤体内血流信号消失，２例经再次硬化治疗后瘤体内血流信号消失。本研究表明，瘤体内血流信号消失可作为治疗有效的指征，彩色多普勒检测瘤体内血流信号，有助于肝血管瘤硬化治疗近期疗效的判断，指导临床治疗。     

超声引导下经皮穿刺留置中心静脉导管引流并反复无水乙醇硬化联合抗生素冲洗治疗单纯性肝脓肿

目的 探讨彩色多普勒超声引导下经皮穿刺留置中心静脉导管引流并反复无水乙醇硬化联合抗生素冲洗治疗单纯性肝脓肿的治疗方法和临床应用价值.方法 对65例单纯性肝囊肿患者进行彩色多普勒超声引导经皮穿刺留置中心静脉导管引流并反复无水乙醇硬化联合抗生素冲洗治疗.结果 所有患者均一次性穿刺成功,成功率为100%,术后均放置中心静脉导管,经引流管共注射无水乙醇及抗生素各670次,平均每次注射保留时间约6.3 min.随访0.5~2.0年,26个脓肿均治愈,治愈率为100%,均未出现出血与感染性休克等并发症.结论 彩色多普勒超声引导下经皮穿刺留置中心静脉导管引流并反复无水乙醇硬化联合抗生素冲洗治疗单纯性肝脓肿,成功率和治愈率高,并发症少.     

CDE在超声引导经皮肝穿多弹头射频治疗肝癌中的应用价值

目的 :探讨彩色多普勒能量图 (Color Doppler energy,CDE)在经皮肝穿多弹头射频治疗肝癌中的应用价值。方法 :对 35例肝癌患者行 6 5次射频治疗 ,应用彩色多普勒超声对治疗前后肿瘤的大小及血供改变进行对比观察。结果 :35例于治疗后一周 ,15例治疗后 30天 ,7例于治疗后半年进行 B超及 CT复查。 4 7个肿块术后不同程度缩小的 31个 (6 5 .9% ) ,血流信号消失的 35个 (81.4 % )。其中 1例 2 .3cm× 2 .1cm瘤体基本消失 ,2例发现新生病灶。结论 :CDE在超声引导经皮肝穿多弹头射频治疗肝癌中 ,在术前诊断、引导定位及术后疗效的评价方面均具有重要的应用价值     

超声导向射频联合无水酒精治疗小肝癌

目的探讨超声导向多电极射频联合瘤内无水酒精注射治疗小肝癌的治疗效果.方法应用超声导向208例直径＜5 cm的小肝癌患者采用射频联合瘤内无水酒精治疗,观察治疗前后肿瘤大小、血流、AFP水平及生存率变化.结果治疗后1～2周肿瘤内血流信号消失或减少率100%;3个月复查B超显示196例(94.2%)患者肿瘤缩小25%以上;其中6例患者瘤体完全消失,132例AFP阳性患者转阴104例,下降21例,有效率94.7%;1年、2年生存率为100%、94.3%.结论超声导向射频联合瘤内无水酒精注射是一种有效治疗小肝癌的新方法.     

经皮穿刺注射无水乙醇治疗高强度聚焦超声治疗后残留肝癌的疗效观察

目的探讨经皮穿刺注射无水乙醇治疗高强度聚焦超声(HIFU)后残留肝癌的疗效及其影响因素。方法对HIFU治疗肝癌术后的83例残留病灶进行无水乙醇注射(PEI)治疗。观察治疗前后患者临床症状、肿瘤标记物的变化,并用彩色多普勒血流显像(CDFI)定期随访肿瘤变化。结果79例患者临床症状明显改善。6个月和1、2年生存率分别为95.5%、82.5%、60.5%。CDFI随访,所有患者治疗区病灶回声增强,血供减少或消失,其中77例(92.8%)病灶体积缩小。51例AFP阳性患者中,46例(90.2%)AFP下降。结论HIFU联合无水乙醇能有效破坏肿瘤血供,灭活肿瘤,延长患者的生存期和提高生存质量,是肝癌非手术治疗的一种有效方法。     

超声显像及多普勒技术在肝癌射频治疗中的应用

目的利用超声显像引导肝癌射频治疗,结合彩色及能量多普勒评价其治疗效果。方法对120例肝癌患者射频治疗前后1周肿瘤内血供及形态学变化进行观察,并对部分病例术后1个月进行超声检测。结果120例肝癌患者167个肿块术后瘤体缩小103个(61%),血流信号消失116个(79%),肝动脉峰值流速明显降低(89.5±36.0cm/svs63.6±26.0cm/sP<0.01)。1月后对39例患者复查,31例瘤体不同程度缩小,瘤体内无血流信号;3例再次出现血流信号。结论超声显像及多普勒技术不但能准确地引导肝癌射频治疗,而且对判断疗效及指导再次治疗具有重要意义。     

超声引导经皮穿刺无水乙醇注射治疗肝癌的临床应用价值

目的探讨超声引导经皮穿刺无水乙醇注射治疗肝癌的临床应用价值。方法对58例肝癌患者共70个结节在超声引导下细针穿刺经皮瘤内注射无水乙醇进行硬化治疗。肿瘤直径1～4cm、每个瘤体内注射2～6次、注射剂量6～60ml。结果58例在注射2～6次后，总有效率为56．40％。治疗后12个瘤灶消失；34个缩小；24个未增大。直径缩小或不变的肿瘤CT增强扫描动脉期无强化。原血清血甲胎蛋白（AFP）值升高者显著下降。经组织学检查的病灶证实完全坏死。注射过的瘤灶无局部复发。结论超声引导经皮穿刺无水乙醇注射治疗肝癌是一种简单易行、安全和较为有效的方法。     

彩色多普勒超声在选择性门静脉联合肝动脉栓塞治疗中晚期肝癌中的应用

目的　探讨彩色多普勒超声对经皮经肝选择性门静脉栓塞化疗 (SPVE)联合肝动脉栓塞 (TAE)治疗中晚期肝癌的应用价值。方法　彩超引导 65例不能手术的中晚期肝癌在TAE基础上行SPVE术 ,同时观察本组与单纯TAE对照组治疗前后的肿瘤血供变化、声像图特征及与临床疗效的关系。结果　①本组肿瘤血供消失和减少率 92 .3 % ,其中动脉血流消失和减少率 89.2 % ,门静脉血流消失和减少率 86.2 % ,对照组肿瘤动脉血流减少和消失率 63 .0 % ,瘤周和瘤内门静脉血流明显增加率 87.4% (P <0 .0 0 5 )。②随访结果表明 ,栓塞化疗后肿瘤动、静脉血供情况与临床疗效密切相关 ;观察肿瘤血供变化比肿瘤体积的变化更为准确。结论　彩超为观察肝癌血供状态提供重要依据 ,对指导治疗和判定疗效有着重要意义。     

转移性肝癌多弹头射频治疗的疗效观察及价值

目的：探讨超声引导经皮肝穿治疗转移性肝癌的疗效及价值。方法：对18例转移性肝癌22次射频治疗,观察治疗前后肿瘤大小。结果：18例于治疗后10天,16例60天、13例6个月、5例12个月进行B超及CT复查,结果：10天后80％病人瘤体缩小30％以上,6个月后瘤体缩小40％,5例已存活1年,90％的病人自觉症状改善,无手术死亡,结论：超声引导经皮穿刺射频治疗转移性肝癌杀伤肿瘤彻底,对机体损害小,疗效确切而满意,对临床有较高的应用价值。     

彩超引导下经皮肝穿刺瘤体内注射中药制剂治疗肝癌的近期疗效观察

目的观察经皮肝穿刺瘤体内注射中药制剂华蟾素注射液治疗肝癌的近期疗效,探讨其在临床应用的价值。方法28例肝癌病例分为瘤体内注射华蟾素(研究组18例)和瘤体内注射无水乙醇(对照组10例),治疗2月后观察疗效,统计治疗后瘤体的大小,回声改变及血流指数治疗前后变化。结果治疗后从临床症状、声像图改变及血流指数变化比较,治疗组效果优于对照组。结论瘤体内注射中药制剂华蟾素的疗效有较好的效果及临床适用性。     

超声引导下无水酒精、醋酸、热生理盐水、激光、射频及肝动脉化疗栓塞局部综合介入疗法治疗5～8 cm肝癌的疗效分析

目的 探讨超声引导下经皮瘤内注射酒精(PEI)、醋酸(PAI)、热生理盐水(PHSI)、间质性激光动力学疗法(IPDT)、射频消融(RFA)及肝动脉化疗栓塞(TACE)联合酒精或射频或激光局部综合介入疗法对5～8 cm肝癌患者的治疗疗效.方法 选择1992-2005年经上述6种介入方法治疗的肝癌患者204例,其中分别以酒精治疗66例、醋酸20例、热生理盐水20例、激光24例、射频30例、综合介入治疗44例,并与同期56例肝癌手术治疗患者的生存率和复发率进行比较. 结果 (1)6种方法介入治疗及手术治疗患者1、3、5年累计生存率比较均以外科手术组最高(91.9%、58.9%、35.7%);6种方法介入治疗患者1年生存率由高至低依次为酒精组(86.4%)、激光和射频组(83.3%)、综合治疗组(81.8%)、醋酸组(80.0%)、热生理盐水组(35.0%);3年生存率由高至低依次为醋酸组(55.0%)、综合治疗组(52.3%)、激光组(50.0%)、酒精组(48.5%)、射频组(46.7%)、热生理盐水组(20.0%);5年生存率由高至低依次为射频组(30.0%)、激光组(29.2%)、酒精组(25.8%)、醋酸组(25.0%)、综合治疗组(25.0%)、热生理盐水组(5.0%);热生理盐水组患者1、3、5年生存率最低且与其他治疗组比较差异有非常显著性 (P＜0.01),其余6组患者1、3、5年生存率比较差异均无统计学意义(P＞0.05);(2)热生理盐水组患者肝癌病灶局部复发率(75.0%)显著高于其余6组(P均＜0.05),手术治疗组(8.9%)与醋酸组(20.0%)局部复发率比较差异无统计学意义(P＞0.05),而显著低于其他5组(P均＜0.05);(3)各组治疗部位以外肝癌病灶复发率为62.5%～80.0%,组间比较差异无统计学意义 (P＞0.05).结论 除热生理盐水外,酒精、醋酸、激光、射频和局部综合介入治疗可作为无法切除大肝癌的治疗选择,若肿瘤血供丰富首选局部介入综合疗法;综合治疗,术后严密监测,及时补充治疗是提高疗效的关键.     

肝癌射频消融术后超声造影引导下无水乙醇治疗肝癌的临床价值

目的：研究与常规超声引导相比较,超声造影(CEUS)引导下无水乙醇治疗射频消融术(RFA)后残存的肝癌有无优越性。方法：61例原发性肝癌的患者RFA术后行无水乙醇注射进行补充治疗,根据引导方式不同分为治疗组和对照组,治疗组运用超声造影引导方式,对照组采用常规超声引导方式,术后1个月对治疗病灶进行超声造影及增强CT的评价。结果：治疗组30个病灶,28个病灶达到完全灭活,2个病灶存有残存活性区达到部分灭活。对照组31个病灶,22个病灶达到完全灭活,9个病灶达到部分灭活。两者有统计学差异,(P＜0.05)。结论：运用超声造影引导可以有效的提高肝癌RFA术后无水乙醇治疗肝癌的疗效。     

瘤内无水酒精注射治疗肝癌切除术后复发的疗效及预后因素分析

目的：研究经皮瘤内酒精注射（pereutaneous ethanol injection，PEI）治疗原发性肝癌术后复发病灶的疗效，分析影响预后的因素。方法：原发性肝癌术后复发患者行PEI治疗，部分患者合用射频毁损治疗（radiofrequency ablation，RFA）、肝动脉化疗栓塞治疗（transcatheter arterial chemoembolization，TACE）。采用寿命表法分析患者复发后的生存期，并分析影响患者生存期的因素。结果：58例术后复发患者治疗后1、3、5年生存率分别为96.6％、59．2％、29．3％，中位生存期为42．5个月。单因素分析显示Child-Pugh分级B级为疗效差的影响因素，合用RFA有助于提高疗效；多因素分析显示Child-Pugh分级为独立的预后因素。结论：酒精注射治疗复发性肝癌可取得较好疗效。     

射频消融术治疗肺部恶性肿瘤的临床观察

目的观察射频消融术（RFA）治疗肺部恶性肿瘤的临床疗效和安全性。方法对25例肺部肿瘤患者的31个肿瘤行局麻下CT引导经皮射频消融术,术后通过影像学、生存质量、并发症、疾病进展时间等方面评价RFA的治疗价值。结果31个肿瘤均顺利完成了射频消融热毁损肿瘤,其中3个肿瘤进行了2次重叠消融,3例患者失访。31个肿瘤经治疗后病灶完全毁损率达71.43％。完全毁损病灶治疗后6个月内未见复发;而部分毁损病灶治疗后1个月复发率为87.50％,3个月后复发率达到了100％,需行二次射频治疗。胸痛、发热、咳嗽咳痰是患者术后的主要并发症,且均在可耐受范围。患者治疗后各项生存质量评分均有明显变化（t分别=11.43、-4.06、-8.72、-10.89、-3.72、-8.97,P均＜0.05）。病灶完全毁损和病灶部分毁损患者的无进展生存期比较,差异有统计学意义（t=2.10,P＜0.05）。所有患者的1年生存率为60.00％,2年生存率为40.00％。结论射频消融治疗肺部恶性肿瘤近期疗效确切、安全,不良反应能耐受,可明显提高肺癌患者的生存质量。     

Percutaneous image-guided radiofrequency ablation in the therapeutic management of hepatocellular carcinoma

Owing to surveillance programs for detection of hepatocellular carcinoma (HCC) in patients with cirrhosis, more tumors are being detected at an early, asymptomatic stage. Percutaneous ablation is considered the best treatment option for patients with Child-Pugh class A or B cirrhosis and a single, nodular-type HCC smaller than 5 cm or as many as three HCC lesions, each smaller than 3 cm, when surgical resection or liver transplantation is not suitable. Radiofrequency ablation (RFA) has emerged as the most powerful method for percutaneous treatment of early-stage HCC. Recent studies have shown that RFA can achieve more effective local tumor control than ethanol injection and with fewer treatment sessions. In a randomized trial, local recurrence-free survival rates were significantly higher in patients who received RFA than in those treated by ethanol injection, and treatment allocation was confirmed as an independent prognostic factor by multivariate analysis. Due to advances in radiofrequency technology, RFA also has been used to treat patients with more advanced tumors. Preliminary reports have shown that RFA performed after balloon catheter occlusion of the hepatic artery, transarterial embolization, or chemoembolization results in increased volumes of coagulation necrosis, thus enabling successful destruction of large HCC lesions. This report reviews the current status of percutaneous, image-guided RFA in the therapeutic management of HCC.     

Therapeutic response evaluation of malignant hepatic masses treated by interventional procedures with contrast-enhanced agent detection imaging.

OBJECTIVE: To assess the usefulness of microbubble contrast-enhanced agent detection imaging in evaluating the therapeutic response of malignant hepatic masses to treatment with interventional procedures. METHODS: Fifty-eight patients with 68 hepatocellular carcinomas and 6 metastases who were treated with interventional procedures were evaluated with SH U 508A-enhanced agent detection imaging and helical computed tomography. Helical computed tomography was also performed to help establish the outcome of therapy with unenhanced computed tomography 2 weeks after transcatheter arterial chemoembolization and with dynamic contrast-enhanced computed tomography 1 day after radio frequency ablation or percutaneous ethanol injection. The studies were reviewed separately and randomly, and the sensitivity and specificity of agent detection imaging for detection of viable tumor residue were determined by follow-up imaging performed at least 3 months later. RESULTS: Follow-up computed tomography or magnetic resonance imaging revealed complete tumor responses in 44 (59.5%) of 74 cases after the therapeutic procedures. The sensitivity of agent detection imaging was 94.7% after transcatheter arterial chemoembolization and 72.7% after radio frequency ablation and percutaneous ethanol injection. The specificity of agent detection imaging for the detection of residual tumors was 80% after transcatheter arterial chemoembolization and 79.2% after radio frequency ablation and percutaneous ethanol injection. The false-positive rate for agent detection imaging in cases of radio frequency ablation or percutaneous ethanol injection was 20.8% (5 of 24), resulting from reactive hyperemia or vascularity within the safety margin. In the assessment of the therapeutic effects, the concordance of contrast-enhanced agent detection imaging with helical computed tomography was statistically significant after transcatheter arterial chemoembolization (P < .00001) and radio frequency ablation or percutaneous ethanol injection (P < .02). CONCLUSIONS: Contrast-enhanced agent detection imaging proved useful and as effective as helical computed tomography for evaluating the therapeutic effects of interventional therapeutic procedures for malignant hepatic masses.     

Image-guided locoregional non-intravascular interventional treatments for hepatocellular carcinoma: Current status

Hepatocellular carcinoma (HCC) is one of the most deadly and frequent cancers worldwide, although great advancement in the treatment of this malignancy have been made within the past few decades. It continues to be a major health issue due to an increasing incidence and a poor prognosis. The majority of patients have their HCC diagnosed at an intermediate or advanced stage in theUSA or China. Curative therapy such as surgical resection or liver transplantation is not considered anoption of treatment at these stages.Transarterial chemoembolization (TACE), the most widely used locoregional therapeutic approach, used to be the mainstay of treatment for cases with unresectable cancer entities. However, for those patients with hypovascular tumors or impaired liver function reserve, TACE is a suboptimal treatment option. For example, embolization does not result in complete coverage of a hypovascular tumor, and may rather promotes postoperative tumor recurrence, or leave residual tumor, in these TACE-resistance patients. In addition, TACE carries a higher risk of hepatic decompensation in patients with poor liver function or reserve.Non-vascular interventional locoregional therapies for HCC include radiofrequency ablation (RFA), microwave ablation (MWA), high-intensity focused ultrasound (HIFU), laser-induced thermotherapy (LITT), cryosurgical ablation (CSA), irreversible Electroporation (IRE), percutaneous ethanol injection (PEI), and brachytherapy. Recent advancements in these techniques have significantly improved the treatment efficacy of HCC and expanded the population of patients who qualify for treatment. This review embraces the current status of imaging-guided locoregional non-intravascular interventional treatments for HCCs, with a primary focus on the clinical evaluation and assessment of the efficacy of combined therapies using these interventional techniques.     

超声引导射频治疗加无水酒精注射联合肝动脉栓塞治疗肝癌的临床研究

目的：探讨超声引导多方法联合动脉栓塞（TAE）治疗肝癌的临床价值。方法：在超声引导下对198例肝癌患者行多电极射频治疗加无水酒精瘤内注射联合TAE治疗，同时观察治疗组与单纯TAE对照组治疗前后的肿瘤血供变化，声像图特征等与临床疗效的关系。结果：治疗组术后瘤周及瘤内血流信号完全消失和减少率92．93％；肿瘤缩小率91．93％，AFP转阴率82．54％，术后随访年，2年累计生存率分别为87．31％、78．68％，远高于单纯TAE组的59．46％和31．53％。结论：超声引导多方法联合TAE技术是治疗肝癌的有效方法，超声为观察治疗前后肝癌血供状态，声像图变化及与临床疗效关系提供主要依据，对指导治疗，判定疗效有着重要意义。     

三种微创治疗方法序贯联合治疗块状型肝细胞癌

【目的】探讨序贯联合肝动脉化疗栓塞（TACE）与经皮瘤内注药、射频消融（RFA）治疗块状型肝细胞癌（HCC）的临床疗效。【方法】对26例块状型HCC患者,共计39个瘤灶,先行TACE术,根据术后复查情况序贯联合TACE、经皮瘤内注药和RFA继续治疗。观察患者术前、术后6个月各相关指标的变化。【结果]26例患者,共行TACE术59人次,经皮穿刺瘤内注药术31人次,RFA术28人次。术后6个月甲胎蛋白（AFP）较术前明显下降（P〈O．01）。术后3个月、6个月的肿瘤体积分别较术前明显缩小（P〈0．01）。术后3个月肿瘤完全坏死率为89．7％。术前、术后3个月、6个月的肝、肾功能和血常规均在正常范围。1、2、3年患者生存率分别为76．92％、61．54％、34．62％。【结论】序贯联合TACE与经皮瘤内注药、RFA是一种对块状型HCC有效和可行的治疗方法。     

TACE、PEI、PVC介入三联疗法治疗中晚期肝癌

目的研究TACE、PEI、PVC介入三联疗法治疗原发性肝癌的疗效。方法(1)TACESeldinger′s法,5F导管、高选择、造影到位后注入5Fu1g、MMC10mg、ADM或EADM50～60mg与40%碘化油10～20mL的混合乳化剂。隔1～1.5月可重复;(2)PEICT引导下18GPTC穿剌针穿入肿瘤碘油缺损区,注入无水酒精2～8mL或10～20mL,1～2次/周,4～6次为1疗程;(3)PVCPEI后1～2周,在B超引导下用18G中心静脉导管穿剌针到门静脉穿剌,留置中心静脉导管或植入药盒,1次注入MMC6～8mg,药泵持续5d灌注5Fu2.5～3g。可隔3～4周后重复给药。结果本组14例,病灶缩小率为71.4%,AFP下降占85.7%;半年生存率为78.6%,1年生存率为57.1%,2年生存率为28.6%。结论介入三联疗法对不能手术切除,尤其对门静脉癌栓或门静脉供血的肝癌有较好的疗效,具优势互补作用。