开放式磁共振引导肝癌的冷冻消融治疗疗效分析

目的 探讨在开放式磁共振(MRI)监视下、采用经皮穿刺方法 进行肝癌的冷冻消融治疗的疗效.方法 对60例HCC的肝肿瘤进行了冷冻消融治疗.采用新奥博为0.3-T开放式MRI系统,冷冻探针通过实时监视被置于消融病灶中.评估其临床体征、症状和实验室检验结果 ,并对冷冻消融治疗的疗效进行分析.结果 MRI引导下经皮穿刺冷冻消融治疗能精确到达肿瘤、彻底消融的目的 ,有血清肝酶水平临床上的改变,没有引起严重的并发症.结论 MRI引导下经皮穿刺的肝脏肿瘤冷冻消融治疗是可行和安全的.MRI能够在手术期间引导冷冻消融治疗,以及用于评估冷冻消融治疗的效果.     

直径小于3cm肝癌的经皮射频微创治疗

[目的]初步总结采用经皮射频消融治疗肿瘤直径小于3cm小肝癌的疗效和经验。[方法]射频消融治疗肿瘤直径小于或等于3cm的小肝癌共53例，其中首次诊断为原发性肝癌30例，肝癌术后复发16例，肝转移癌7例，全部采用超声引导下经皮穿刺，单纯射频消融治疗31例，射频消融联合瘤内无水酒精注射术治疗22例。[结果]全组未见严重并发症，常见的术后反应为穿刺点疼痛，腹胀，低热，甲胎蛋白治疗后转阴者12例，下降但未完全转阴者5例，术后第1年出现复发者2例，第2年出现复发者1例，死亡1例，1年生存率为98.1%。[结论]经皮射频消融对小肝癌的治疗具有微创，简单，快速和重复性好的特点，是一种新的具有根治可能的微创治疗手段。     

开放式磁共振导航下经皮穿刺肝癌的冷冻消融治疗

目的:探讨在开放式磁共振(MRI)监视下、采用经皮穿刺方法进行肝癌冷冻消融治疗的可行性、疗效和安全性.方法:采用新奥博为0.3-T 开放式MRI系统对20例病人中的22个肝肿瘤进行冷冻消融治疗.冷冻探针通过实时监视被置于消融病灶中,冷冻消融术采取氩氦刀(Cryo-Hit),对临床体征、症状、实验室检验和影像学结果进行评估,并术后随访.结果:在MRI引导下经皮穿刺冷冻探针均成功置于病灶内,共对20例病人22个肝肿瘤进行了冷冻消融治疗(共24次治疗),手术期间MRI显示冰球扩展并包裹整个肿瘤,包裹肿瘤的冰球在MRI图像中呈现边缘清晰的信号暗区.使用一个冷冻探针形成最大的冰球为 5.0cm×2.5cm×2.5cm、使用4个冷冻探针形成的冰球最大为7.6cm×5.5cm×5.0cm.冷冻消融治疗有血清肝酶水平临床上的改变,没有引起严重的并发症.术后随访1-6月,肿瘤经影像检查体积缩小者5例,增大3例,无变化12例.手术切除肿瘤1例,病情进展死亡2例,死于消化道出血.结论:MRI引导下经皮穿刺的肝脏肿瘤冷冻消融治疗是可行和安全的.MRI能够在手术期间引导冷冻消融治疗,以及用于评估冷冻消融治疗的效果.     

TACE＋AHCS治疗原发性肝癌的临床研究

外科手术切除是治疗原发性肝癌的首选疗法,但是,患者确诊肿瘤时绝大多数失去手术根治的机会。微创治疗已成为肿瘤治疗中的重要组成部分。多年来肝动脉化疗栓塞（transcatheter arterial chemoembolization,TACE）是非手术治疗原发性肝癌的首选方法,取得了一定的疗效。但肿瘤完全坏死率较低。一种新型超低温介入冷冻消融治疗肿瘤的微创手术系统氩氦刀冷冻消融（argon—heliumcryosur-gerysystem,AHCS）,由于其独特的优点,目前已广泛用于原发性肝癌的治疗。TACE与AHCS联合治疗,可以优势互补,进一步提高疗效。     

肝移植治疗原发性肝细胞癌的进展

肝移植已经成为治疗肝癌的重要手段.选择合适的病人是一个重要的问题,国际通行的是米兰标准,我国一般公认的适应证主要包括:合并有肝硬变失代偿、不能接受肝切除治疗的小肝癌患者和肿瘤多发且波及左右两叶、肝功能严重损害、行切除术后肿瘤容易复发或出现肝功能衰竭者.血管侵犯,细胞分化程度等因素可以影响治疗的预后.围手术期辅助治疗(经皮肝动脉化学栓塞、经皮无水酒精瘤内注射、射频消融,氩氦刀治疗)对于提高肝移植的疗效有一定的意义.     

开放式磁共振导航下经皮穿刺肝癌的冷冻消融治疗

目的：探讨在开放式磁共振（MRI）监视下、采用经皮穿刺方法进行肝癌冷冻消融治疗的可行性、疗效和安全性。方法：采用新奥博为0．3-T开放式MRI系统对20例病人中的22个肝肿瘤进行冷冻消融治疗。冷冻探针通过实时监视被置于消融病灶中,冷冻消融术采取氩氦刀（Cryo—Hit）,对临床体征、症状、实验室检验和影像学结果进行评估,并术后随访。结果：在MRI引导下经皮穿刺冷冻探针均成功置于病灶内,共对20例病人22个肝肿瘤进行了冷冻消融治疗（共24次治疗）,手术期间MRI显示冰球扩展并包裹整个肿瘤,包裹肿瘤的冰球在MRI图像中呈现边缘清晰的信号暗区。使用一个冷冻探针形成最大的冰球为5．0cm×2．5cm×2．5cm、使用4个冷冻探针形成的冰球最大为7．6cm×5．5cm×5．0cm。冷冻消融治疗有血清肝酶水平临床上的改变,没有引起严重的并发症。术后随访1—6月,肿瘤经影像检查体积缩小者5例,增大3例,无变化12例。手术切除肿瘤1例,病情进展死亡2例,死于消化道出血。结论：MRI引导下经皮穿刺的肝脏肿瘤冷冻消融治疗是可行和安全的。MRI能够在手术期间引导冷冻消融治疗,以及用于评估冷冻消融治疗的效果。     

射频凝固电极在肝癌切除或消融治疗中的应用

目的评价射频凝固电极消融技术在肝切除术中应用的可行性、安全性及疗效。方法采用射频凝固电极射频消融技术进行肝癌切除手术共16例,其中腹腔镜下射频消融后肝切除术9例,腔镜下射频消融6例（共13个瘤体,平均最大肿瘤直径3．0-4-1．0em）,小切口腹腔镜辅助右肝V、Ⅷ段肝癌切除1例。观察术后并发症情况,肿瘤复发情况。结果16例均顺利完成肝癌切除或消融治疗。未出现严重并发症。肝癌消融灶完全坏死率为92．3％。随访8～20个月（平均14个月）,于术后3、6个月各发现1例肝脏出现新病灶,1例消融部位肿瘤残留。肝癌切除患者未出现新病灶。死亡1例。结论腹腔镜下手术或开腹术中射频凝固电极消融技术在肝癌切除或消融治疗中应用安全可行,效果好。选择远离肝门区肿瘤进行治疗时效果更佳。     

放射介入联合射频治疗肝癌进展

原发性肝癌是常见的恶性肿瘤,由于起病隐匿,患者就诊时大多已到中晚期,加之常常合并肝硬化,切除率不到5%～20%,且手术切除病例的一年生存率仅为28%,对不能手术切除的中晚期肝癌治疗方法虽然很多,但其疗效均难以令人满意,目前肯定疗效的非手术疗法中首选经肝动脉化疗及栓塞治疗[1],以肝癌血供为理论基础,以经肿瘤供血动脉直接给药和栓塞和栓塞为主要手段的介入治疗是肝动脉的伸入治疗建立在可靠和合理的科学基础上,肝动脉化疗栓塞术使一些不能手术的大肝癌变小,而得以切除,成为二期手术前的有效措施,目前80%以上的肝癌患者受益于介入治疗随着医学影像技术的进展,经皮穿刺导入激光、微波、高强度超声聚焦、射频消融等方法不断涌现,尤其是射频消融操作简单,痛苦小,效果直观可靠,近年备受关注[2、3],参考国内外文献,本人对放射介入及射频治疗法进展加以总结,并比较各自特点,现综述如下.     

彩超引导下微波凝固治疗配合肝动脉栓塞化疗治疗原发性肝癌

目的:研究彩超引导下经皮肝穿刺微波凝固治疗配合肝动脉化疗栓塞术治疗原发性肝癌的疗效.方法:对48例肝癌进行肝动脉化疗栓塞术和经皮肝穿刺微波凝固治疗(治疗组),与42例单纯肝动脉化疗栓塞术组(对照组)比较疗效.结果:治疗组的临床疗效、AFP值、累计生存率均明显优于对照组.结论:彩超引导下经皮肝穿刺微波凝固治疗配合肝动脉化疗栓塞术为一种肝癌治疗的较好方法.     

肝癌双介入治疗的护理

肝癌的介入栓塞术（TACE）临床已广泛应用。超声引导经皮肝穿刺微波治疗肝癌,是近几年来国际上新开展的治疗恶性肿瘤的方法。微波治疗是在肿瘤内直接插入针状微波电极,通电后微波电极末端的微波辐射器产生热效应导致肿瘤组织凝固性坏死,从而达到对肿瘤的治疗目的。超声引导经皮肝穿刺微波治疗肝癌具有热效率高、操作相对简单、安全可靠、凝固性坏死范围稳定、疗效好等特点。     

结直肠癌局限性肝转移的治疗

[目的]探讨结直肠癌局限性肝转移多种治疗方法的价值。[方法]对我院1987年-2000年收治的原发癌根治术后的引例结直肠癌局限性肝转移患者进行回顾性研究。[结果]原发癌加肝转移灶切除患者1、3、5年生存率分别为85.7％、46.9％、32.1％,而肝转移灶未治疗的患者分别为26.7％、0、0,两者的差异均有显著性（P<0.05）;肝转移灶微波固化和无水酒精注射及肝脏区域化疗合并组患者1、3、5年生存率分别为 74.2％、42.9％、19.2％,其与肝转移灶切除组的差异均无显著性（P>0.05）,与肝转移灶未治疗组的1、3年生存率差异有显著性（P<0.05）。[结论]1结直肠癌局限性肝转移患者,应尽可能彻底切除原发癌和肝转移灶,肝转移灶微波固化和无水酒精注射及肝脏区域化疗是其治疗的重要补充。     

Carcinome hépatocellulaire : résection ou transplantation hépatique ?

Hepatocellular carcinoma is the most common hepatic cancer and the frequency of its incidence is increasing. It develops from liver cirrhosis in 90% of the cases. Curative treatment is possible in cases of limited hepatic extension and absence of metastasis. Liver transplantation treats both the cancer and the underlying cirrhotic liver. However, the scarcity of liver transplants makes it necessary to select liver transplant candidates. Liver resection and radioablation are curative treatments that can be considered during the time on the waiting list for transplants. Liver resection is the treatment of choice for the minority of patients who developed hepatocellular carcinoma without an underlying pathologic liver.     

Liver-directed therapies in colorectal cancer

The liver is the most common site of metastatic colorectal cancer (CRC) and the status of this organ is an important determinant of overall survival in patients with advanced disease. Complete resection of hepatic CRC metastases can provide a long-term cure for some patients, but the majority of liver metastases are not amenable to such surgery. Furthermore, most patients after curative resection ultimately suffer from recurrence, and the majority of such failures occur in the liver. Various ablative techniques can achieve local control of tumor after incomplete resection or for palliation. Tumor ablation currently has a secondary therapeutic role, as there is no evidence that it can achieve long-term survival comparable to surgical resection. Regional chemotherapy delivers tumoricidal agents in a selective fashion, minimizing systemic toxicity and damage to normal liver cells. Chemotherapy agents delivered through the hepatic artery can extend time to liver recurrence after curative resection and may prolong survival both in the adjuvant setting and when given to patients with unresectable disease. Molecular-based therapies, such as gene delivery and oncolytic viruses, provide promise for curative outcomes in patients with advanced disease.     

Palliative techniques for hepatic cancer

Primary and secondary hepatic malignancies are a leading cause of death. Only a minority of patients with liver cancer are candidates for curative surgical resection. Palliative treatments for unresectable hepatic malignancies should minimize tumor-related symptoms and extend overall survival. Systemic chemotherapy is only modestly effective at both ameliorating symptoms and improving survival. This review focuses on the liver-directed therapy options for patients with advanced unresectable liver malignancies.     

Liver-directed therapies for patients with primary liver cancer and hepatic metastases

Opinion statement Liver cancer, whether primary or metastatic, is a major cause of death throughout the world. The surgical management of these diseases varies according to the extent of disease and the overall health of the patient. Surgical resection of hepatic disease remains the only chance for cure. However, a large proportion of patients with liver cancer are unable to undergo a complete surgical resection. These patients are often treated with liver-directed therapies. Although not as effective as surgical resection, these approaches can help to improve the survival of patients. In patients with primary liver cancer, underlying liver disease often prohibits surgical intervention. However, survival advantages have been gained with the application of percutaneous alcohol injection and radiofrequency ablation (RFA). In patients with hepatic metastases, the number of metastases is often what prevents surgical resection. In these patients, RFA, cryoablation, and hepatic artery infusional therapy have all aided in prolonging survival. As chemotherapeutic agents improve and targeted therapies are developed, more patients will be able to undergo surgical management of their liver cancer, primary or metastatic.     

Microwave coagulation therapy for liver metastases from colorectal cancer

Hepatic resection has gained acceptance as the most effective therapy for liver metastases from colorectal cancer. Microwave coagulation therapy (MCT) and radiofrequency ablation as well as resection are also reported as effective therapies. We analyzed the prognosis of 52 patients with liver metastases from colorectal cancer treated with MCT as the first radical therapy. A total of 4 percutaneous MCT's (3 cases with interruption of hepatic blood flow), 23 MCT's with laparotomy, and 25 with hepatic resection + MCT with laparotomy were performed. Thirty-three MCT's performed as a second therapy for recurrence in the liver were also analyzed. Clinical risk scoring as reported by Fong, et al was used in our cases. The indication for percutaneous MCT with interruption of hepatic blood flow is solitary tumor less than 20 mm in diameter. The 5-year survival rate for the 4 percutaneous MCT's, 23 MCT's with laparotomy, and 25 hepatic resection + MCT's with laparotomy and 68 hepatic resections were 20, 24 and 24%, respectively. No significant difference was found among them. The 5-year survival rate for the 17 MCT's and 12 hepatic resections with recurrence in the liver were 20% and 24%, respectively. There was no significant difference found between them. The 5-year survival rate for the 28 CRS3 was 17%, almost equal to the rate, 20%, reported by Fong, et al for hepatic resections only. MCT is effective therapy for liver metastases from colorectal cancer, recurrence in the liver, and hepatic resections.     

经皮微波热凝治疗肝癌的疗效观察

目的 经皮微波肝穿刺对肝癌进行热凝损毁,观察其对肝癌的作用疗效。方法 52例患者在局麻或硬膜外麻醉下,使用2450MHz微波微型穿刺天线,在B超引导下直接经皮穿刺进入肝癌瘤体内,对其进行热凝固。结果 52例患者的97个瘤体中,直径均＜3cm的肿块61个（62．9％）能1次手术热凝损毁,其中57个（93．4％）经CT或MRI检查,并随访6－12个月,提示瘤体热损毁后未见复发;3－5cm的肿块36个（37．1％）,分2次手术,术后6个月CT或MRI检查提示,27个热凝损毁（75．0％）,9个大部分热凝损毁（25．0％）。经皮微波热凝治疗（PMCT）的患者均未见明显的副作用和其他并发症。结论 PMCT治疗肝癌,尤其对直径＜3cm的瘤体疗效可靠,对＞3．5cm或＜5cm的瘤体仍具有大部分或完全热损毁的作用。     

原发性肝癌外科治疗方式选择及术后肿瘤复发防治相关性研究

目的 比较原发性肝癌患者肝切除术和肝移植术的长期疗效,探讨肝脏功能良好的早期肝癌患者肝切除术后复发的影响因素.方法 选取原发性肝癌患者77例,其中70例肝切除患者,7例肝移植患者;采用SPSS 20.0统计学软件分析肝切除患者和肝移植患者的生存疗效及肝功能Child-Pugh A级患者的肝切除术后复发的影响因素.结果 肝移植组合并肝硬化患者比率显著高于肝切除组(P=0.015);肝切除组肝功能Child-Pugh分级与肝移植组肝功能Child-Pugh分级的差异具有统计学意义(P=0.008);肝移植组患者术前接受TACE治疗比率显著高于肝切除组(P=0.003).两组患者在性别、年龄、乙肝感染、肿瘤大小、肿瘤分化程度及术后辅助化疗等方面均无统计学差异(P>0.05);肝移植组患者的术后并发症发生率、术中出血量及术中输血率均显著高于肝切除组(P<0.001);但两组患者在围手术期医院死亡率、二次手术率方面比较无显著差异(P>0.05);肝移植组患者的无瘤生存率明显优于肝切除组(P=0.041);单因素分析结果显示:乙肝病毒感染、重度肝硬化、血小板<100×109/L、甲胎蛋白>100 ng/ml和肿瘤中低分化是影响Child-Pugh A级直径≤5 cm的单个小肝癌切除术后肿瘤复发的重要不良预后因素;多因素分析结果显示,重度肝硬化、血小板<100×109/L和肿瘤中低分化是影响Child-Pugh A级直径≤5cm的单个小肝癌切除术后肿瘤复发的独立危险因素.结论 肝移植术治疗重度肝硬化的单个小肝癌患者的疗效优于肝切除术,肝移植术可作为首选方法,非重度肝硬化可考虑肝切除术;因此,术前应对肝功能Child-Pugh A级的单个小肝癌患者进行肝硬化严重程度分级,依此选择合适的外科治疗方法.     

Multidisciplinary treatment of patients with hepatocellular carcinoma

Hepatocellular carcinoma is one of the most common malignancies in the world. When it is diagnosed, patients can choose from among several potentially curative treatments, such as surgical resection, transplantation, ablation therapy and transcatheter arterial chemoembolization. This review will give an overview of the present management of hepatocellular carcinoma. Liver transplantation is considered the best curative option, achieving a high rate of complete response, especially in patients with small hepatocellular carcinoma and good residual liver function. However, a shortage of donor livers restricts the availability of transplantation. In addition, only a minority of patients with hepatocellular carcinoma can be treated surgically, owing to impaired hepatic reserve, multiple intrahepatic lesions, extrahepatic lesions and the inability to obtain an optimal tumor-free margin. Therefore, for most patients, other types of interventions (transcatheter arterial chemoembolization, percutaneous ethanol injection and radiofrequency ablation) have been developed. Among them, two local ablative modalities, percutaneous ethanol injection and percutaneous radiofrequency ablation, have been accepted as the only potentially curative nonsurgical treatments for hepatocellular carcinoma. Radiofrequency ablation may become a standard nonsurgical treatment option for patients with early hepatocellular carcinoma.     

Multidisciplinary treatment of patients with hepatocellular carcinoma

Hepatocellular carcinoma is one of the most common malignancies in the world. When it is diagnosed, patients can choose from among several potentially curative treatments, such as surgical resection, transplantation, ablation therapy and transcatheter arterial chemoembolization. This review will give an overview of the present management of hepatocellular carcinoma. Liver transplantation is considered the best curative option, achieving a high rate of complete response, especially in patients with small hepatocellular carcinoma and good residual liver function. However, a shortage of donor livers restricts the availability of transplantation. In addition, only a minority of patients with hepatocellular carcinoma can be treated surgically, owing to impaired hepatic reserve, multiple intrahepatic lesions, extrahepatic lesions and the inability to obtain an optimal tumor-free margin. Therefore, for most patients, other types of interventions (transcatheter arterial chemoembolization, percutaneous ethanol injection and radiofrequency ablation) have been developed. Among them, two local ablative modalities, percutaneous ethanol injection and percutaneous radiofrequency ablation, have been accepted as the only potentially curative nonsurgical treatments for hepatocellular carcinoma. Radiofrequency ablation may become a standard nonsurgical treatment option for patients with early hepatocellular carcinoma.