肝癌的冷冻治疗

冷冻疗法己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；冷冻比手术更适宜治疗肝多发性肿瘤。冷冻联合肝动脉化疗栓塞（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〈5cm，尤其〈3cm的肝癌，数目不超过3个，可以手术中冷冻或经皮冷冻。②〉5cm的肝癌，先作TACE，再给予经皮冷冻。③〉5cm，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。     

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。     

肝癌治疗进展和展望

根据WHO(1983)等报告，肝细胞癌(HCC)世界每年发病估计不少于一百万新患者。肝细胞癌是最常见的人类致死性恶性肿瘤之一，其死亡指数(mortality index)为0.94(RustgiV 1987报告)。Anonymous(1987)指出HCC常见于30岁到50岁。     

原发性肝癌治疗进展

原发性肝癌（以下简称“肝癌”）是我国最常见的恶性肿瘤之一，近年来肝癌治疗的研究取得很大进步，新技术、新方法不断涌现，使得肝癌治疗效果得到明显改观。     

华蟾素注射液治疗中晚期肝癌临床研究进展

原发性肝癌是世界范围内高发的恶性肿瘤之一,其死亡率排名第三,每年有约50万新发患者,其中50％发生在中国。手术切除是治疗肝癌的首选方式,但由于肝癌发病特点,大多数患者确诊时已失去手术机会,此时以肝动脉化疗栓塞术为基础的综合介入治疗方法成为主要的治疗手段,然而,中晚期肝癌患者,受肝脏肿瘤负荷、肝功能、门脉癌栓的影响,部分患者存在肝脏介入术禁忌症,因此中医中药治疗中晚期肝癌凸显独特优势。     

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.     

Outcome of MR-guided percutaneous cryoablation for hepatocellular carcinoma

Purpose

To assess the mid-term results of MR-guided percutaneous cryoablation for small hepatocellular carcinoma (HCC).

Methods

Using an argon-based cryoablation system, MR-guided percutaneous cryoablation was performed. The number of tumors was three or fewer. The maximum diameter of tumors was less than 5 cm when solitary and no more than 3 cm when multiple. The Kaplan–Meier method was used to calculate the survival of patients.

Results

Among 15 patients, 16 tumors were treated. The maximum tumor diameter ranged from 1.2 to 4.5 cm, with a mean of 2.5 ± 0.8 cm (mean ± standard deviation). The volume of iceballs measured on MR-images was greater than that of the tumors in all cases. The follow-up period ranged from 10 to 52 months, with a mean of 36.6 ± 12.1 months. One-year and 3-year overall survival were 93.8 and 79.3%, respectively. The complete ablation rate was 80.8% at 3 years. Immediate complications were pneumothorax, hemothorax, and pleural effusion. An ablation zone was not absorbed and content exuded from a scar of the probe tract 4 months after cryoablation in one patient.

Conclusion

MR-guided percutaneous cryoablation appears to be a feasible modality and potentially good option for the treatment of small HCC.

     

Outcomes of ultrasound-guided percutaneous argon-helium cryoablation of hepatocellular carcinoma

Purpose

To evaluate the efficacy and safety of ultrasound (US)-guided percutaneous argon-helium cryoablation for hepatocellular carcinoma (HCC) and determine appropriate indications.

Methods

We reviewed outcomes of 300 HCC patients who underwent US-guided percutaneous cryoablation.

Results

Overall, 223 tumors (mean diameter 7.2?±?2.8?cm) in 165 patients were incompletely ablated, while 185 tumors (mean diameter 5.6?±?0.8?cm, P?=?0.0001 vs. incomplete ablation) in 135 patients were completely ablated. Nineteen patients (6.3%) developed serious complications while in hospital, including cryoshock syndrome in six patients, hepatic bleeding in five, stress-induced gastric bleeding in four, liver abscess in one and intestinal fistulas in one. Two patients died because of liver failure. The median follow-up was 36.7?months (range 6–63?months). The local tumor recurrence rate was 31%, and was related to tumor size (P?=?0.029) and tumor location (P?=?0.037). The mean survival duration of patients with early, intermediate and advanced HCC (Barcelona Clinic Liver Cancer staging system) was 45.7?±?3.8, 28.4?±?1.2 and 17.7?±?0.6?months, respectively.

Conclusions

US-guided percutaneous cryoablation is a relatively safe and effective therapy for selected HCC patients.     

Microwave coagulation therapy for hepatocellular carcinoma

The efficacy and safety of microwave coagulation therapy (MCT) in patients with hepatocellular carcinoma (HCC) and impaired hepatic reserve were studied. Preoperative background factors, postoperative results, and prognostic factors were compared in 51 patients who underwent hepatic resection (HR group) and 38 patients who underwent microwave coagulation therapy (MCT group). Before surgery, measures of hepatic function, including level of albumin (P = 0.0072), prothrombin time (P < 0.0001), hepaplastin test (P = 0.0088), and the radioactivity of technetium‐99m galactosyl‐human serum albumin 15 min in the liver after injection divided by that in both liver and heart (P < 0.0001) were significantly lower in the MCT group than in the HR group. The indocyanine green dye retention rate at 15 min was significantly greater (P < 0.0001) in the MCT group than in the HR group, and a significant difference was noted in Child‐Pugh grade between the groups (P < 0.0001). Operative time (P = 0.0014) and blood loss during surgery (P = 0.0005) were significantly lower in the MCT group than in the HR group. In contrast, no significant differences were recognized between the groups in the changes in postoperative liver function, or in the rates of morbidity, mortality, local recurrence, and survival. Moreover, the type of treatment (HR or MCT) was not a prognostic factor. The results indicate that MCT can be used safely as an alternative to hepatic resection in patients with poor liver function without reducing the efficacy of local control.     

质子刀放射治疗肝细胞癌的研究进展

随着对正常组织耐受能力的研究的不断深入和放疗技术的发展,针对大部分肝细胞癌（HCC）患者伴有的肝硬化,肿瘤体积大、多发且伴有血管浸润,甚至出现门静脉癌栓等现状,放射治疗便成为HCC降级治疗及辅助治疗的重要手段。其中质子刀（PBT）作为一种较新型的放疗方法取得了较为显著的临床效果。介绍了PBT治疗HCC的生物学特性及其临床疗效和毒性副作用。前期的研究结果表明PBT对于局部照射剂量具有良好的控制作用,可降低对健康肝细胞及周围正常组织的毒性。但目前的临床研究显示PBT应用于HCC也存在着一些禁忌证,值得进一步界定。     

分子靶向药物治疗肝细胞癌的研究进展

肝细胞癌(HCC)严重威胁着人类的生命健康。在临床治疗中,HCC治疗策略的选择越来越备受关注,随着对HCC发病机制的不断研究及分子生物学技术的飞速发展,分子靶向抗肿瘤药物治疗晚期HCC成为研究热点,并在临床实践中取得了显著疗效。回顾了近几年HCC分子靶向治疗药物最新临床应用研究进展及出现的相关问题,并针对其治疗策略的未来焦点进行展望,为应用研究和临床治疗HCC提供新的方向和参考。     

晚期肝细胞癌靶向治疗及个性化治疗的现状

随着精准医疗理念的普及,在晚期肝细胞癌系统性治疗领域,新技术驱动的个性化治疗逐渐流行,晚期肝细胞癌靶向治疗也迎来了新的发展契机。本文就晚期肝细胞癌靶向治疗的现状与过去、新技术驱动的个性化治疗的发展与未来进行综述,着重介绍以sorafenib为代表的分子靶向药的发展历程,以及二代测序、人源肿瘤组织异种移植模型等新技术在个性化精准治疗中的应用。     

靶向药物治疗肝细胞癌的最新进展

靶向药物对于肝细胞癌的治疗效果在临床上已经被广泛证实。随着科学技术的发展,越来越多的靶向药物相继出现。近期,瑞格菲尼、ramucirumab等靶向药物在相应的临床实验中也表现出了相当的潜力。更多的二线候选药物,比如c-Met抑制剂tivantinib与cabozantinib、VEGFR-2抑制剂ramuciruma临床试验正在进行。总结了近几年靶向药物治疗肝细胞癌的试验数据及最新进展,为下一步临床试验及治疗提供参考意见。     

Current status of hepatic resection for hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most common tumors worldwide. For this disease, a variety of therapeutic measures have been applied, including hepatic resections, total hepatectomy followed by allografting, transarterial chemoembolization, and percutaneous tumor ablative therapy by ethanol, microwave coagulation, and radiofrequency ablation. This article focuses on the current status of hepatic resections for HCC.     

原发性肝细胞癌介入治疗的现状与进展

临床对原发性肝细胞癌(HCC)的治疗已取得了长足进步,其中以介入放射学为主的综合治疗在整个治疗中占据重要地位.HCC的介入治疗方法主要包括以肝动脉化疗栓塞(TACE)为代表的血管内介入治疗和以局部消融为主的非血管介入治疗,而介入结合靶向治疗更进一步丰富了HCC介入治疗的内涵.本文将分别从HCC介入治疗的不同方法、原理、...