经皮射频消融或联合肝动脉、门静脉栓塞化疗治疗原发性及复发性小肝癌

目的探讨经皮射频消融或联合肝动脉、门静脉栓塞化疗治疗原发性及复发性小肝癌的价值. 方法 2001年9月～2004年9月,采用经皮射频消融(percutaneous radiofrequency ablation,PRFA)方法治疗原发性小肝癌(肿瘤直径≤5 cm)11例和复发性小肝癌(肿瘤直径≤3 cm)13例,其中4例原发性肝癌和8例复发性肝癌结合肝动脉及门静脉栓塞化疗.结果在11例原发性小肝癌中,6例肿瘤直径≤3 cm者,MRI或CT提示瘤灶完全凝固性坏死;5例肿瘤直径3～5 cm者,MRI或CT提示4例肿瘤完全凝固性坏死.1、1.5、2年累积生存率分别为100%、85.71%、68.57%.在13例复发性小肝癌中,单发组(7例)MRI或CT提示瘤灶完全凝固性坏死;多发组(6例)共15个瘤灶,MRI或CT提示12个瘤灶完全凝固性坏死.1、1.5、2年累积生存率分别为88.89%、77.78%、64.81%. 结论 PRFA为原发性及复发性小肝癌的治疗提供了一种新的手段,对肿瘤直径超过3 cm以及复发性肝癌结合肝动脉、门静脉栓塞化疗有助于提高肿瘤坏死率,减少复发率,有效提高生存率.     

射频消融术后联合肝动脉化疗栓塞治疗肝癌的28例临床观察

目的　探讨射频消融术后联合肝动脉化疗栓塞对肝癌的治疗效果。方法　 2 8例肝癌患者共 33个瘤灶 ,中等大小肿瘤 (3～ 5cm) 9个 ,大肿瘤 (>5 .1cm) 2 4个。射频消融术后 2～ 8周行肝动脉化疗栓塞术。治疗效果采用术后 1月增强CT扫描和临床随访评估。结果　RFA术后CT扫描见治疗区仍有残留癌灶。TACE后CT扫描见大部分残留癌灶碘油沉积良好。 2 0例患者AFP转阴或明显下降。 2 5例临床随访 ,累计生存率 >1年 88.0 % ,>2年 72 .0 %。结论　射频消融术后联合肝动脉化疗栓塞是一治疗肝癌的有效方法。     

经皮肝穿刺冷循环射频消融治疗肝癌疗效分析

目的观察经皮肝穿刺冷循环射频消融术（Cool-tipRFA）对肝癌的热消融作用,探讨其适应证。方法在局麻下及B超引导下,射频电极经皮穿刺入肝癌瘤体内,对其进行消融。结果28例患者的38个瘤体中：直径≤3cm的26个瘤体,24个获得完全热消融,热消融率为91．9％;直径为3～5cm的7个瘤体中5个瘤体获得完全热消融,热消融率为71．4％;直径为5～8cm的5个瘤体中2个瘤体获得完全热消融,热消融率为40％。无明显术后并发症发生。术后6月、1年、2年及3年生存率分别为96．4％,89．3％,78．6％及60．7％。结论经皮肝穿刺冷循环射频消融术对直径≤5cm的肝癌疗效可靠,是一种安全、有效治疗肝癌的方法。     

射频联合无水酒精注射治疗肝脏恶性肿瘤

目的　探讨经皮肝穿刺射频热凝联合无水酒精注射治疗肝癌的意义、适应证和疗效评价标准。方法　对共 78个肿瘤结节 ,共进行约 6 0次射频联合无水酒精注射治疗。病人治疗后每个月进行血清标记物检测和B型超声检查。结果　肿瘤结节直径≤ 5cm ,甲胎蛋白定量升高者 ,治疗后甲胎蛋白正常占 72 .0 % (31 / 4 3) ,明显下降占 2 7.9% (1 2 / 4 3)。肿瘤结节直径 >5cm 2例 ,治疗后甲胎蛋白也明显下降 ,2例AFP阴性B型超声复查肿瘤缩小。无手术死亡。结论　经皮肝穿刺射频热凝联合无水酒精注射作为肿瘤治疗的一种方法 ,可应用于肝癌切除术后局部复发转移病例     

原发性肝癌术后复发行经皮肝穿刺新型射频治疗的疗效分析

目的观察原发性肝癌术后复发行经皮肝穿刺新型射频治疗的疗效,探讨新型射频在治疗原发性肝癌术后复发的应用。方法在B超引导下,将射频电极针经皮穿刺入肝肿瘤内,对其进行原位毁损消融。结果28例患者共34个病灶中：直径≤3cm的23个瘤体,21个完全毁损,热毁损率为91．3％;直径为3～5cm的11个瘤体中8个瘤体获得完全毁损,热毁损率为72．7％。术后无严重并发症发生。术后6、12个月无瘤生存率分别为75％、53．6％;术后6、12、18个月生存率分别为100％,96．4％,92．9％。结论经皮肝穿刺射频消融术对于原发性肝癌术后复发疗效可靠,是一种安全、有效治疗肝癌术后复发的方法。     

经皮肝穿射频治疗肝癌的临床研究

目的　探讨经皮肝穿集束电极射频治疗肝癌的价值及适应证。方法　在 B超、CT、腹腔镜等引导下 ,使用RF2 0 0 0射频仪 ,对 38例肝癌患者共 4 6个结节进行集束电极射频治疗。比较治疗前后肝功能、AFP、瘤体血供及大小的变化。结果　术后 7d肝功能恢复正常 ,6 9.2 %的 AFP阳性病例术后 7d即出现 AFP下降 ,其中 4 2 .3%术后 30 d降至正常范围 (P<0 .0 5 )。彩色 B超及 CT复查显示 ,瘤体直径 <5 cm者 ,其术后 1～ 6月内瘤体血供消失 ,体积缩小甚至消失。瘤体直径≥ 5cm者 ,术后 1～ 6月内部分病例瘤体血供减少、体积缩小。结论　经皮肝穿集束电极射频治疗肝癌疗效确切、简便安全     

腹腔镜加强型射频消融治疗直径》5cm肝血管瘤的临床疗效分析

目的 探讨腹腔镜加强型射频消融术治疗直径〉5 cm肝血管瘤的疗效和技术要点.方法 22例肝血管瘤（直径〉5 cm）应用最新的加强型射频消融电极[StarBurst（R） Xli-enhanced RFA]进行腹腔镜射频治疗,采用腹腔镜超声定位穿刺血管瘤主要供血区域,逐步法张开电极,改变射频电极位置,治疗范围以覆盖整个瘤体及周边0.5～1 cm正常肝组织为标准.结果 22例均安全地完成腹腔镜射频消融术,单个病灶射频消融时间为（81.9±18.5） min,手术时间为（96.5±15.4） min,出血量为（74.7±32.8） ml.术后2例出现明显血红蛋白尿,未发生腹腔出血、胃肠道损伤、膈肌损伤及肝衰竭等并发症.术后1个月螺旋CT增强扫描证实,瘤体完全消融率达95.5%.术后无症状再发,复查B超见病灶明显缩小,血供完全消失,定期复查B超未见血管瘤复发.结论 腹腔镜加强型射频消融术治疗直径〉5 cm肝血管瘤是安全有效的治疗方法,可进一步扩大射频消融术的手术指征.     

肾脏多极射频消融的初步研究

目的 研究多极射频对正常肾组织和肾肿瘤组织的消融效果，探讨腹腔镜下行肾脏射频消融的可行性。方法 采用WE7568多极射频肿瘤消融仪。动物实验中，比较B超和腹腔镜引导下多极射频肾组织消融技术的优劣。并于治疗后1、14、30和90d行B超、CT及病理组织学检查。比较“干”与“湿”、离体与在体射频消融实验结果。肾肿瘤患者5例，肿瘤平均直径3．2cm，经开放手术游离肾脏，射频消融肿瘤后切除，行病理检查。结果 离体条件下肾脏射频消融破坏灶的范围大于在体破坏灶。间质内注射高渗盐水可以增大破坏灶范围。操作中可采用由浅入深推进的方法形成完整楔形治疗灶。病理急性期表现为凝固坏死，慢性期为纤维化和钙化。CT显示治疗灶密度增高且不被造影剂强化，B超显示治疗灶回声增强。近期和远期并发症有血尿和肾盂积水。结论 射频消融术治疗4cm以下的肾脏小肿瘤具有简单、安全、有效和微创的优点。位于上极、前侧和内侧的肾肿瘤，可采用腹腔镜辅助下肾脏穿刺射频消融术。     

腹腔镜辅助射频消融术治疗特殊部位肝癌的研究

目的:探讨腹腔镜辅助射频消融术治疗特殊部位肝癌的可行性、安全性及优势,并评估其疗效.方法:为35例肝癌患者、42枚特殊部位肝肿瘤行腹腔镜辅助射频消融术(laparoscopic radiofrequency ablation,LRFA).其中原发性肝癌29例,转移性肝癌6例.32例曾行介入栓塞治疗.单发肿瘤30例,直径...     

经皮肝穿刺射频热凝治疗肝脏恶性肿瘤

目的 探讨经皮肝穿刺射频热凝治疗肝癌的意义。适应证和疗效评价标准。方法 1999年10月-2000年10月,100例肝脏恶性肿瘤患者进行了B超引导经皮肝穿刺射频热凝治疗。患者治疗后每个月进行血清肿瘤标记物检测、B超检查,治疗后1个月复查MRI。结果 患者肝功能ChildA级67例,ChildB级29例,ChildC级4例,原发性肝癌76例,转移性肝癌24例,小肝癌（未手术,肿瘤直径≤5cm)甲胎蛋白阳性者治疗后甲胎蛋白转阴占75.0%(21/28),明显下降占21.4%(6/28)。B超复查肿瘤缩小、MRI或CT提示≤5cm肿瘤完全凝固性坏死率85.9%(61/71)。结论 经皮肝穿刺射频热凝（PRFA）作为肿瘤透热治疗的一种方法,对于小肝癌尤其是无手术指征,或有手术指征但位于肝中央区,临近腔静脉或肝门区的小肝癌,是一种微创、时间短、安全方便、疗效可靠的新方法,对于大肝癌,PRFA可与肝动脉介入化疗栓塞联合应用,提高疗效。     

CT引导下经皮冷热交替复合式冷冻消融治疗肝脏恶性肿瘤近期效果及其安全性

目的 观察CT引导下复合式冷冻消融治疗肝脏恶性肿瘤的近期效果及其安全性。方法 回顾性分析45例接受CT引导下经皮冷热交替复合式冷冻消融（康博刀）治疗的肝脏恶性肿瘤患者,包括原发性肝细胞癌（HCC）20例、肝转移癌25例;共治疗50个病灶,对18例20个（16例1个病灶、2例2个）病灶行根治性消融,对27例30个（25例1个、1例2个、1例3个）病灶行姑息性消融,记录术中及术后不良反应。于术后1、3和6个月复查腹部增强CT或MR,参照改良实体瘤疗效评价标准（mRECIST）判断疗效。结果 45例均顺利完成消融治疗,其中37例采用单针、8例采用双针进行消融。6例术中及术后肝周少量积血或积液,1例术中局部皮肤轻度冻伤,术后8例轻度恶心,均自行或经对症处理后恢复。20个根治性消融病灶术后1个月均达完全缓解（CR）,术后3、6个月均为19个（19/20,95.00%） CR、1个（1/20,5.00）疾病进展（PD）;30个姑息性消融病灶术后1个月25个（25/30,83.33%）部分缓解（PR）、5个（5/30,16.67%）疾病稳定（SD）,术后3个月22个（22/30,73.33%） PR、7个（7/30,23.33%） SD、1个（1/30,3.33%） PD,术后6个月17个（17/30,56.67%） PR、7个（7/30,23.33%） SD、6个（6/30,20.00%） PD。结论 CT引导下复合式冷冻消融治疗肝脏恶性肿瘤近期疗效及安全性均较好。     

Development of severe lactic acidosis during radio frequency ablation conducted for the treatment of hepatocellular carcinomata in a patient with liver cirrhosis

A 60-year-old male with liver cirrhosis (Child-Pugh class B) underwent laparotomic radio frequency ablation for the treatment of a solitary hepatocellular carcinoma (-4.5 cm in diameter). Severe lactic acidosis (base excess < -12 mEq.l-1, lactate > 150 mg.dl-1) developed during the intraoperative period, when neither his hemodynamics nor arterial oxygenation was significantly impaired. The blood loss was small (-200 g), and the serum hemoglobin level was maintained -10 g.dl-1 during the procedure. There was no evidence for impairment of either peripheral perfusion or renal function. In addition, there was no evidence for development of either splanchnic ischemia or diabetic ketoacidosis. Thus, the acidosis appeared to be caused by significant impairment of liver function possibly resulting from the ablation (total ablation time = -60 min). The core temperature increased rapidly (-1.5 degrees C/60 hr) immediately after the ablation was started, suggesting that a large amount of heat was produced in the ablated area and/or that the vicinity of the ablated area was richly supplied by blood flow. As a result, intact liver cells in the vicinity of the tumor probably suffered from thermal injuries. In conclusion, depending on preoperative liver function, ablated area, and/or blood flow in the vicinity of ablated area, the ablation may become significantly invasive.     

1.5T磁共振导向下射频消融治疗肝转移癌的可行性

目的探讨1．5TMR引导下射频消融（RFA）治疗肝转移癌的可行性。方法收集34例肝转移癌患者,采用MR兼容多极射频针,于1．5TMR引导下行RFA。术后1个月行1．5T或3．0T肝脏MR平扫＋动态增强扫描,之后每2-3个月复查1次;随访3-37个月,平均（14．33±9．81）个月。结果34例患者共消融98个病灶,其中完全消融86个（86／98,87．76％）,不完全消融12个（12／98,12．24％）。MRI上射频电极针呈低信号。T2WI中消融灶呈低信号,周围可见薄层高信号环绕;T1WI中消融灶呈环样高信号,中央瘤灶呈相对低信号。结论1．5TMR引导下RFA治疗肝转移癌安全、有效,具有一定临床应用价值。     

Radiofrequency thermal ablation of liver tumors

The basic principle of radiofrequency ablation is that the deposit of electromagnetic energy in a tumor causes heat ("cooks the tumor") and thereby destroys it. In the liver, this ablation may be performed percutaneously (by needles) or surgically (laparotomy, laparoscopy). Guidance by an imaging technique is necessary: ultrasound, CT or magnetic resonance imaging. The principal hepatic indications are hepatocellular carcinoma and hepatic metastases smaller than <5 cm. There is no associated mortality and only slight morbidity, due principally to hemorrhage, infection or stenosis of the bile ducts. Results show a 5-year survival rate of 40% for hepatocellular carcinoma and 22% for metastases.     

Adjuvant chemotherapy with MVP-CAB (methotrexate, vincristine, cisplatinum, cyclophosphamide, adriamycin and bleomycin) for epithelial tumors of the upper urinary tract]

Surgery plus adjuvant chemotherapy using MVP-CAB (Day 1; methotrexate 20 mg/m2, vincristine 0.6 mg/m2, cyclophosphamide 500 mg/m2, adriamycin 20 mg/m2, and bleomycin 30 mg, Day 2; cisplatinum 50 mg/m2) was conducted in 12 patients with epithelial tumors of the upper urinary tract who had unfavorable prognostic factors (progressive disease which was pT2 or more, or transitional cell carcinoma of grade 2 and 3). The MVP-CAB regimen was as follows: A total of 3 cycles were given either before or after surgery. MVP-CAB was given at 3- to 4-week intervals before surgery, or after surgery if the patient had macroscopic residual lesions. For the patients with micrometastases detected after radical surgery, MVP-CAB was given every 1 to 2 months. The median survival period of the 10 patients who underwent radical surgery was 17 months (5-59 months). The three-year survival rate of these 10 patients (Kaplan-Meier method) was 100% in grade 2 (5 patients), 100% in progressive cancer greater than pT3 (6), and 80% in grade 3 (5). In two patients, residual macroscopic lesions after surgery were confirmed. One of them initially responded to MVP-CAB but died of cancer 21 months later, while the other one did not respond and died of cancer 8 months later. Two renal pelvis cancer patients for whom radical surgery was considered impossible due to distant metastases showed remarkable tumor reduction after MVP-CAB administration (one showed CR for liver metastases and the other showed PR for lymph node metastases).(ABSTRACT TRUNCATED AT 250 WORDS)     

Laparoscopic in situ ablation of liver cancer with cryotherapy and radiofrequency ablation

BACKGROUND: In situ ablation has potential for the treatment of patients with liver cancer either as a single-modality treatment or in combination with liver resection. METHODS: Laparoscopy and intraoperative ultrasonography was used to target cryotherapy and radiofrequency ablation. Thirty-eight patients with 146 liver lesions were treated between January 1995 and December 2000 using cryotherapy alone (nine patients), combined cryotherapy and radiofrequency (eight), radiofrequency alone (15) and in situ ablation with liver resection (six). Cancers treated were metastases from colorectal tumours (n = 25), hepatocellular carcinoma (n = 5), and neuro endocrine (n = 5), melanoma (n = 2) and renal cell (n = 1) metastases. Complications and survival after in situ ablation were compared with age- and disease-matched controls treated with systemic chemotherapy. RESULTS: The mean age was 61.6 years. At mean follow-up of 26.6 (range 3-62, median 26) months, 22 patients were alive. Survival was increased following in situ ablation compared with that in controls (P < 0.001). Local recurrence at the ablation site was noted in 12 of 44 lesions following cryotherapy and in 20 of 102 lesions after radiofrequency ablation, and new disease in the liver was found in six of 17 and six of 29 patients respectively. The complication rate was higher with cryotherapy than with radiofrequency ablation (four of 17 versus one of 29). Intraoperative ultrasonography identified 14 new hepatic lesions (10 per cent) not seen on preoperative imaging. CONCLUSION: Laparoscopic in situ ablation should include ultrasonography to stage the disease. In situ ablation appears to have a survival benefit and should be considered for the treatment of liver cancer in appropriate patients.     

经皮射频治疗肝海绵状血管瘤的疗效与安全性分析

目的评价经皮射频(percutaneous radiofrequency ablation, PRFA)微创治疗肝脏海绵状血管瘤(hepatic cavernous hemangiomas,HCHs)的有效性和安全性. 方法应用RF-2000射频仪和10电极LeVeen射频针在超声引导下施行PRFA治疗HCHs 26例39个病灶直径2.5～11.0 cm,其中直径＞3.0 cm者予分层多点或多次叠合消融.局部麻醉,配合全身镇痛处理. 结果 26例均成功实施PRFA.反应期2～5天,包括局部疼痛不适、发热、ALT升高等,无胆漏、出血等并发症.23例随访1～5年,平均2年8个月,经一次治疗完全缓解(CR)22例,部分缓解(PR)1例,缓解率(CR PR)100%;HCHs直径平均缩小68.8%(41.2%～81.5%). 结论在掌握好适应证和操作技巧的前提下,PRFA可发挥微创、安全、有效之优势,可作为治疗HCHs的一种理想选择方法.     

超声引导经皮消融术治疗复发性肝癌

目的　评价超声引导经皮消融术对复发性肝癌的治疗作用。方法　对复发性肝细胞癌14 1例6 2 8个结节分别采用了经皮超声引导下微波、射频、酒精和沸腾蒸馏水消融治疗,观察局部、远期疗效和对肝功能的影响。结果　肿瘤完全消融率92 . 0 % (5 78/ 6 2 8) ,微波、射频、酒精和沸腾蒸馏水的完全消融率分别为96 3% (10 5 / 10 9)、92 . 9% (119/ 12 8)、91. 5 % (311/ 340 )和84. 3% (43/ 5 1)。本组治疗后局部复发率13 5 % (78/ 5 78) ,微波、射频、酒精和沸腾蒸馏水的局部复发率分别为11 .4 % (12 /10 5 )、13. 4 % (16 / 119)、11.9% (37/ 311)和30 . 2 % (13/ 4 3)。14 1例患者经2～6 6月随访,117例患者(81% )的肝功能无明显变化。1、3、5年累计生存率分别为75 %、5 3%、2 6 %。结论　经皮消融治疗复发性肝癌对肝功能损伤小,能有效控制局部病变发展和改善患者的预后。     

Radiofrequency ablation: a novel primary and adjunctive ablative technique for hepatic malignancies.

The majority of primary and metastatic tumors of the liver are not amenable to surgical resection at presentation. Radiofrequency ablation (RFA) is a new modality for local tumor destruction with minimal local and systemic complications. We prospectively reviewed the experience with RFA at a single institute as a primary or adjunctive ablative technique in the treatment of hepatic malignancies. Between November 1997 and December 1998, 30 patients with primary or metastatic hepatic lesions were treated with RFA at the John Wayne Cancer Institute and the Cancer Center at Century City Hospital. Pathology of the treated lesions included colorectal metastases (29 in 14 patients), neuroendocrine metastases (29 in 4 patients), noncolorectal metastases (29 in 9 patients), and hepatocellular carcinoma (6 in 3 patients). Twelve patients underwent RFA laparoscopically, 12 at celiotomy, and the remaining 6 patients had percutaneous ablation. RFA was the only procedure in 17 patients, whereas the remainder underwent a combination of RFA and other procedures including resection, cryosurgical ablation, and hepatic artery infusion pump placement. Median length of stay for all patients was 6 days (2 days for laparoscopic patients). A single complication of a delayed intrahepatic abscess was noted in this series (3%). There have been no deaths associated with RFA. At a median follow-up of 5 months, 16 patients remain disease free, and 10 are alive with disease. RFA is a safe and effective method of tumor ablation for hepatic malignancies. This technique can be performed laparoscopically, at celiotomy, or percutaneously and can be used as a primary technique or in conjunction with other interventional procedures.     

肝切除联合术中热消融治疗肝硬化背景下多灶性肝癌

目的探讨肝切除联合术中热消融治疗肝硬化背景下多灶性肝癌的有效性和安全性。方法回顾性分析63例接受肝切除联合术中热消融治疗肝硬化背景下多灶性肝癌患者的临床资料,分析患者的治疗效果及并发症。结果 63例患者共切除病灶85个,病灶平均最大直径(4.66±3.82)cm,热消融治疗病灶146个,病灶平均最大直径(1.48±0.66)cm。146个病灶完全消融率达100%(146/146),局部复发率4.11%(6/146)。患者1、2、3、4年无瘤生存率分别为54.82%、31.28%、12.03%、6.02%;1、3、5年累积生存率分别为83.51%、56.83%、45.20%。未出现治疗相关的死亡病例。肝切除相关严重并发症8例(8/63,12.70%)。未出现热消融相关严重并发症。结论肝切除联合术中热消融治疗肝硬化背景下多灶性肝癌安全、有效,扩大了肝切除术的适应证。