射频消融治疗肝肿瘤315例报告

目的总结1999年6月至2003年8月用射频消融（radiofrequency ablation，RFA）治疗315例肝肿瘤病人的病例资料，探索RFA治疗肝肿瘤近远期疗效。方法采用了一次定位、多点穿刺，RFA联合肝动脉栓塞（TAE）、选择性门静脉栓塞（SPVE）治疗直径5～13cm的大肝癌，及经皮经肺经膈肌RFA治疗膈顶部肝癌。结果总并发症发生率为5．1％，无一例住院期间死亡。AFP阳性的169例肝癌病人中，RFA后有124例（73．6％）明显降低，其中有95例（56．2％）转阴。半年生存率为89．5％，1年生存率为80．1％，18个月生存率为61．4％，24个月生存率为48．3％，〉36个月生存率为35．6％。结论采用TAE、SPVE及RFA一次定位多点穿刺法治疗无手术切除指征的中晚期（含大肝癌）的病人，疗效明显，总并发症发生率低。     

一次定位多点穿刺法在射频消融治疗大肝癌中的应用

目的 探讨一次定位多点穿刺技术在射频消融(radio—frequency ablation，RFA)治疗大肝癌中的应用及疗效。方法 采用一次定位多点穿刺技术对53例大肝癌病人70个病灶进行RFA治疗；肿瘤直径平均6．9(5～lo)cm；治疗前后检查肝功、增强CT、彩超以肝穿活检；观察RFA治疗次数、治疗后的并发症以及肿瘤完全坏死率，并随访病人的生存情况。结果 53例病人的70个病灶共行RFA治疗81次，平均1．53次。RFA治疗后经6个月以上的增强CT复查，肿瘤完全坏死率为72．9％。53例中有12～18个月随访结果的48(90．5％)例，1年生存率为70．8％(35／48)。结论 一次定位多点穿刺法用于RFA治疗大肝癌是一种微创、安全且疗效显著的方法。     

单发直径≤3 cm肝肿瘤No-touch射频消融治疗的安全性及近期疗效分析(附50例报告)

目的探讨No-touch射频消融术(radiofrequency ablation,RFA)治疗直径≤3 cm单发肝肿瘤的安全性和疗效。方法 2015年9月至2017年6月采用cooltip电极对直径小于3 cm单发肝肿瘤50例病人进行No-touch RFA治疗。其中,治疗原发性肝癌49例(初发31例、复发18例),转移性肝癌1例。肿瘤平均直径1.8 cm,治疗前、后检查肝功能、增强CT扫描、磁共振检查、超声造影以及细针肝穿刺活检。观察RFA治疗时间、次数和术后住院时间,RFA治疗后的并发症以及肿瘤完全毁损率,并随访病人的生存情况。结果 50例病人共行No-touch RFA治疗51次,其中1例病人1个月内连续治疗2次。每例平均为1.02次;每次治疗时间平均为8.2 min;术后平均住院时间为3.2 d。Notouch RFA治疗后1个月内复查CT或磁共振,单次治疗后的肿瘤完全毁损率为98.0%,甲胎蛋白(AFP)阳性的22例病人在No-touch RFA治疗后6~12个月内有14例转阴,5例明显下降。50例病人随访时间从2015年9月开始至2017年6月止,其总体生存率为100%,术后总体无瘤生存率为90.0%(45/50)。结论 No-touch RFA对直径小于3 cm的单发肝肿瘤的治疗是一种微创、安全有效的方法。     

经皮射频消融治疗邻近膈顶较大肝癌

目的探讨经皮射频消融(RFA)治疗邻近膈顶的较大肝癌的价值。方法回顾性分析接受超声引导下经皮RFA治疗的176例邻近膈顶较大病灶原发性肝癌患者(近膈组)及157例非邻近膈顶的较大病灶原发性肝癌患者(对照组)的资料。分析比较2组间患者年龄、性别、消融情况、早期灭活率、复发率、肿瘤新生率、并发症发生率及生存率的差异。结果近膈组RFA治疗中膈下注射生理盐水的比例高于对照组(P=0.016),局部复发率高于对照组(P=0.028)。2组患者年龄、性别、病灶最大径、RFA治疗所用消融仪及电极针、肿瘤早期灭活率、肿瘤新生率、并发症发生率差异均无统计学意义(P均0.05),RFA治疗后1、2、3、4、5年的生存率差异无统计学意义(P=0.203)。结论邻近膈顶的较大肝癌更易复发,超声引导下经皮RFA治疗应采取膈下注射生理盐水等个体化治疗方案及策略。     

肝动脉化疗栓塞联合CT引导射频消融治疗肝尾状叶原发性肝癌

目的探讨经肝动脉化疗栓塞(TACE)联合CT引导射频消融(RFA)治疗肝尾状叶原发性肝癌的疗效及安全性。方法回顾性分析肝尾状叶原发性肝癌患者16例,均先行TACE治疗,再行CT引导下RFA治疗,随访患者的手术并发症、无瘤生存时间及总生存时间。结果 15例患者实现完全消融,完全消融率为93.75%(15/16)。完全消融患者的无瘤生存时间为19.35个月。16例患者的总生存时间为44.62个月,1、3、5年的总生存率分别为88.23%、66.65%及33.18%。结论 TACE联合RFA治疗肝尾状叶原发性肝癌安全、有效。     

经肝动脉化疗栓塞联合射频消融术对中晚期原发性肝癌的近期疗效分析

目的探讨经肝动脉化疗栓塞(TACE)联合经皮肝穿刺射频消融术(RFA)治疗中晚期原发性肝癌(PHC)的临床疗效和安全性。方法将125例中晚期PHC患者按治疗方法不同分为TACE组(40例)、RFA组(38例)及TACE+RFA组(47例),观察3组近期疗效和并发症发生情况;采用Kaplan-Meier法计算复发率、生存率及中位生存期,比较采用Log-Rank时序检验。结果 TACE+RFA组总有效率为74.5%,明显高于TACE组的52.5%和RFA组的47.4%(P0.05);TACE+RFA组1、2年复发率分别为17.0%、31.9%,均明显低于TACE组(37.5%、57.5%)和RFA组(42.1%、60.5%)(P0.05);TACE+RFA组1、2年生存率分别为89.4%、70.2%,均明显高于TACE组(70.0%、47.5%)和RFA组(68.4%、44.7%)(P0.05);且TACE+RFA组中位生存期(26个月)明显长于TACE组(21个月)和RFA组(19个月)(P0.05)。结论 TACE联合RFA可有效治疗中晚期PHC,减少术后复发率并提高生存率,延长患者生存期,其疗效优于单纯TACE或单纯RFA治疗。     

肝癌射频消融后肝脓肿的发生率及危险因素分析

目的探讨肝癌射频消融(RFA)后肝脓肿形成的发生率及危险因素。方法回顾性分析2000年1月—2016年6月接受RFA治疗的1 643例肝癌患者的资料,包括原发性肝细胞癌(HCC)942例、胆管细胞癌(CCC)31例、转移性肝癌(MLC)670例,采用Logistic回归对影响因素进行分析。结果肝癌RFA治疗后肝脓肿发生率为0.79%(13/1 643)。单因素分析显示,糖尿病史、肝功能Child-Pugh分级、手术史及肿瘤位置与肝癌RFA治疗后肝脓肿形成相关(P均0.05);多因素分析显示,糖尿病史、手术史及肿瘤位置为肝癌RFA治疗后肝脓肿形成的独立危险因素。结论糖尿病史、手术史、肿瘤位置是影响肝癌RFA治疗后肝脓肿形成的重要因素。     

手术切除联合射频消融治疗多发性肝癌合并肝硬化

目的探讨手术切除联合射频消融(radiofrequencyablation,RFA)治疗多发性肝癌合并肝硬化的可行性及疗效。方法2003年8月~2006年1月我院收治多发性肝癌合并肝硬化18例,术前经超声、螺旋CT或MRI共发现瘤体46个,其中2个病灶10例,3个病灶6例,4个病灶2例,全麻下距瘤体2cm做包括瘤体的不规则肝段切除、次病灶RFA治疗。结果18例均顺利完成手术切除及RFA治疗。同时行胆囊切除术2例,脾切除及食管胃底周围血管离断术1例。手术切除时间(37.4±8.8)min;单个病灶RFA时间(25.6±8.9)min,总RFA时间(39.8±14.7)min;总手术时间(152.6±30.8)min;总术中出血量(465.6±171.0)ml。未出现腹腔出血、胃肠道损伤、膈肌损伤及肝功能衰竭等严重并发症。术后1个月螺旋CT增强扫描证实,18例手术切除边缘未见残余肿瘤组织,RFA治疗病灶均完全坏死。随访6~31个月,5例发现肝内新病灶,采用经皮RFA进行治疗,其中1例术后15个月死于肝内再复发及肺转移;2例分别于术后7、16个月死于肝功能衰竭。结论手术切除联合RFA治疗多发性肝癌合并肝硬化安全可行,近期治疗效果肯定,最大程度保存受损的肝功能,但应根据病灶的位置及肝功能的状况选择合适的病人进行治疗。     

肝动脉栓塞化疗联合微波消融与单纯手术切除对小肝癌疗效比较

目的对比肝动脉栓塞化疗(TACE)联合微波消融(MWA)与单纯手术切除对小肝癌的治疗效果。方法回顾性分析2008年1月至2013年1月共65例小肝癌病人临床资料。65例中30例行肝动脉栓塞化疗联合微波消融,35例单纯手术切除治疗。比较两组肿瘤治疗后的总并发症发生率,术后1、2、3年生存率和复发率等情况。结果肝动脉栓塞化疗联合微波消融组总并发症发生率为10.0%,低于手术组并发症发生率(31.4%),差异有统计学意义(x~2=4.389,P=0.036)。肝动脉栓塞化疗联合微波消融组术后1、2、3年复发率为6.7%、13.3%、23.3%,手术组术后1、2、3年复发率为11.4%、17.1%、31.4%,两组复发率比较差异无统计学意义(x~2=0.465,P=0.495)。肝动脉栓塞化疗联合微波消融组术后1、2、3年总生存率为93.3%、80.0%、60.0%,手术组术后1、2、3年总生存率为91.4%、77.1%、57.1%,两组的生存率比较差异无统计学意义(x~2=0.078,P=0.78)。结论肝动脉栓塞化疗联合微波消融的治疗效果确切,其术后并发症发生率较低,远期疗效与手术切除相近,可考虑作为小肝癌的首选治疗。     

肝癌射频消融治疗严重或少见并发症分析

目的分析射频消融(radiofrequency ablation,RFA)治疗肝癌的严重或少见并发症. 方法回顾分析2002年1月～2004年12月272例肝癌RFA治疗的严重或少见的并发症资料. 结果 272例肝癌行RFA 301次,严重或少见并发症10例,发生率为3.32% (10/301),其中2例导致死亡,病死率为0.66%(2/301).10例并发症包括:腹腔出血1例,感染2例(腹膜炎合并败血症1例,胆汁瘤继发肝脓疡1例),上消化道出血3例(其中1例为胆道出血),肝动静脉瘘1例,血气胸1例,食管胸膜瘘1例,肿瘤针道播散1例. 结论 RFA严重并发症依次为上消化道出血、感染、腹腔出血等.     

射频消融术联合TACE治疗肝癌

目的探讨射频消融术（RFA）联合经导管肝动脉化疗栓塞术（TACE）对肝癌的治疗效果。方法对36例肝癌患者共48个病灶行CT引导下RFA治疗,病灶直径1.50～9.50cm。所有患者术前均接受过一次或多次TACE或TAE治疗,治疗术前术后均行CT、MRI等影像学检查,并定期随访。结果术后肿瘤完全损毁率为64.58%（31/48）,部分损毁率为22.92%（11/48）,复发率为12.50%（6/48）。术后相关肿瘤指标AFP和CEA均有不同程度下降。所有病例均未出现严重肝功能损害。结论 RFA是治疗原发性及转移性肝癌安全有效的手段,与TACE联合应用更有助于提高对肝癌的治疗效果。     

经皮经肝选择性门静脉栓塞化疗术在原发性肝癌合并门静脉癌栓治疗中的应用

目的探讨选择性门静脉栓塞化疗对原发性肝癌的治疗效果。方法对38例合并门静脉瘤栓的原发性肝癌患者在行肝动脉栓塞化疗（TAE）基础上,联合应用经皮经肝选择性门静脉栓塞化疗术（SPVE）。33例为块状型,5例为结节型,其中直径大于10cm24例,5～10cm11例,小于5cm3例,肿瘤位于肝右叶29例,肝左叶6例,左右叶3例。血清AFP检测＞400ug／L21例,在200ug／L～400ug／L之间6例,（一）／＜200ug／L11例。门静脉瘤栓位于右支19例,左支者7例,右支＋主干6例,左支＋主干2例,左右支＋主干4例。结果治疗后门静脉瘤栓消失和缩小率为68．4％,肿瘤缩小率为76．3％,AFP转阴14例,4例呈一过性转阴或下降,总有效率为85．7％。9例获二期手术切除,术后病理证实,门静脉癌栓坏死率100％。术后随访,1年,3年存活率分别为73．7％和18．4％,远比单纯TAE治疗组高。结论选择性门静脉栓塞化疗是治疗肝癌合门静脉癌栓的有效方法。     

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??Current indications and efficacy of radiofrequency ablation in the treatment of liver cancer ZHANG Jie??CHEN Min-shan. Department of Hepatobiliary Surgery??Cancer Center??Sun Yat-sen University??Guangzhou 510060??China
Corresponding author??CHEN Min-shan??E-mail??cms64@163.com
Abstract Radiofrequency ablation (RFA) has been accepted as one of the curative therapies for small liver cancer, following liver resection and transplantation with its development and clinical application in liver cancer over 20 years. The published experts’ statement in China has confirmed the impartment role of RFA in the treatment of liver cancer and defined that RFA can be used as a curative treatment for single tumor ≤5 cm or tumor number ≤3 and each ≤3 cm, and as a palliative or combined treatment for unresectable single tumor >5 cm or multiple tumors >3 cm. Laparoscopic RFA is superior to percutaneous RFA for tumors in unfavorable location. RFA combined with disconnection is an effective treatment for patients with liver cancer and portal hypertension. Combined with transcatheter arterial chemoembolization (TACE), RFA can improve its ablative region, complete ablation rate and prognosis.     

Clinical short-term results of radiofrequency ablation in primary and secondary liver tumors.

BACKGROUND: Radiofrequency ablation (RFA) is emerging as a new therapeutic method for management of solid tumors. We report here our experience in the use of this technique for management of primary and secondary unresectable liver cancers. METHODS: Thirty-five patients with liver cancers were considered not suitable for curative resection at presentation: 8 with primary hepatocellular carcinoma ([HCC] 6 HCC and 2 fibrolamellar); 27 with metastatic liver cancer (17 colorectal carcinoma and 10 others). They were treated either with radiofrequency heat ablation (Radionics Europe N.V., Wettdren, Belgium) alone percutaneously and/or intraoperatively or in conjunction with surgical resections. The quality of RFA was based on the subjective feeling of whether the tumor was completely destroyed or not. The effectiveness of RFA was assessed according to clinical findings, radiographic images, and tumor markers at follow-up. RESULTS: In 8 primary liver cases, 4 patients with a high level of alpha fetoprotein (AFP) benefited from the RFA with a 83.3% to 99.7% reduction of AFP. One with fibrolamellar hepatocellular carcinoma died 2 months after an incomplete percutaneous RFA from recurrence. The rest all had stable disease at the time of follow-up (mean 10.4 months). In patients with colorectal liver metastases, there were 4 deaths: 1 patient died postoperatively on the 30th day from a severe chest infection having shown a considerable reduction of carcinoembryonic antigen level (CEA, 8 versus 36 microg/L); 3 died from local and systemic disease, 1 at 12 months and 2 at 1 month, having had an incomplete RFA. The others had stable disease at follow-up (mean 7.6 months). Five patients underwent liver resections successfully with the application of RFA for residual lesions in the remaining contralateral lobe. In 10 patients with other liver tumors, 7 patients had stable disease at follow-up (mean 13.4 months); 1 patient had evidence of local and systemic recurrence 10 months after surgical resections with the intraoperative RFA and 2 patients died of systemic recurrence of disease 3 and 6 months after RFA alone. Two patients had liver resections in conjunction with the intraoperative RFA. The mean follow-up in our series was 8.5 months. CONCLUSION: Radiofrequency heat ablation is useful as a primary treatment for unresectable liver cancers. The procedure can be used to treat the small residual tumor load in the contralateral lobe following liver resection in those considered unresectable at the first presentation. This new therapeutic strategy seems to increase surgical resectability in patients judged unresectable.     

Ultrasound-guided radiofrequency thermal ablation of liver tumors: Percutaneous, laparoscopic, and open surgical approaches

Only 10% to 20% of patients with primary and colorectal metastatic liver tumors are candidates for curative surgical resection. Even after curative treatment, tumors recur commonly in the liver. As a less invasive therapy, radiofrequency thermal ablation (RFA) of primary, metastatic, and recurrent liver tumors was performed under percutaneous, laparoscopic, or open intraoperative ultrasound guidance. The safety and local control efficacy of RFA were investigated. RFA was performed mostly in patients with unresectable hepatomas or metastatic liver tumors. Patients with large tumors, major vessel or bile duct invasion, limited extrahepatic metastases, or liver dysfunction were not excluded. An RFA system with a 15-gauge electrode-cannula with four-pronged retractable needles was used. All patients were followed for more than 8 months to assess morbidity and mortality, and to determine tumor recurrence. Sixty RFA operations were performed in 46 patients: 11 patients underwent repeat RFA once or twice. A total of 204 tumors were treated: 70 hepatomas and 134 metastatic tumors. Tumor size ranged from 5 mm to 180 mm (mean 36 mm). RFA was performed in 29 operations for 81 tumors percutaneously, in seven operations for 14 tumors laparoscopically, and in 24 operations for 109 tumors by open surgery. Combined colorectal resection was carried out in five operations and combined hepatic resection was carried out in three operations. There was one death (1.7%) from liver failure, and there were three major complications (5%): one case of bile leakage and two biliary strictures due to thermal injury. There were no intra-abdominal infectious or bleeding complications. The length of hospital stay ranged from 0 to 2, 1 to 3, and 4 to 7 days for percutaneous, laparoscopic, and open surgical RFA, respectively. During a mean follow-up period of 20.5 months, local tumor recurrence at the RFA site was diagnosed in 18 (8.8%) of 204 tumors. The risk factors for local recurrence included large tumor size and major vessel invasion: recurrence rates for tumors less than 4 cm, 4 to 10 cm, and greater than 10 cm, and for those with vessel invasion were 3.3%, 14.7%) 50%) and 47.8%) respectively. Ten of 18 tumors recurring locally were retreated by RFA, and eight of them showed no further recurrence. Ultrasound-guided RFA is a relatively safe, well-tolerated, and versatile treatment option that offers excellent local control of primary and metastatic liver tumors. The appropriate use of percutaneous, laparoscopic, and open surgical RFA is beneficial in the management of patients with liver tumors in a variety of situations.     

经导管栓塞联合射频消融对兔VX2肝肿瘤的干预效果

目的 探讨经导管动脉栓塞术（TAE）联合射频消融（RFA）对兔VX2肝肿瘤的干预效果。方法 将兔VX2肝肿瘤模型分为4组,每组15只。对TACE+RFA组于TACE治疗15 min后行RFA,TAE+RFA组TAE治疗15 min后行RFA,RFA组仅给予RFA,TACE组仅给予TACE。分别于术前1天及术后3、7天检测血清天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）,术后7天检测肿瘤生长率、肿瘤坏死率及Suzuki评分;术后1、3、7天采用免疫组织化学法检测坏死区或凝固区周围肝组织热休克蛋白70（HSP70）表达,计算肝细胞凋亡指数及增殖指数。结果 TACE+RFA组术后3、7天血清ALT、AST水平均高于其他3组（P均<0.05）。术后7天,TACE+RFA组Suzuki评分高于其他3组,TACE+RFA组、TAE+RFA组肿瘤生长率低于RFA组和TACE组、肿瘤坏死率高于RFA组和TACE组（P均<0.05）。4组术后1、3、7天坏死区或凝固区周围肝组织HSP70表达均逐渐升高,TACE+RFA组术后1、3、7天均高于其他3组,术后1、3天TAE+RFA组均高于TACE组和RFA组（P均<0.05）。4组术后1、3、7天坏死区或凝固区周围肝细胞凋亡指数均逐渐降低,TACE+RFA组术后1、3、7天均高于其他3组,TACE组术后1、3天均高于TAE+RFA组、RFA组（P均<0.05）。4组术后3天肝细胞增殖指数均高于术后1、7天,TAE+RFA组术后1、3、7天均高于其他3组,RFA组术后1、3天均高于TACE+RFA组和TACE组（P均<0.05）。结论 TACE+RFA、TAE+RFA抑制兔VX2肝肿瘤生长效果优于单独应用TACE、RFA;TAE+RFA对肝损伤更小,促进肝细胞增殖、抑制其凋亡的效果更好。     

超声造影评价射频治疗肝细胞癌疗效

目的探讨超声造影在肝细胞癌射频治疗术后疗效评估中的临床应用价值。方法对21例因单发病灶肝细胞癌接受射频治疗后患者，应用超声对比剂SonoVue与低机械指数实时造影技术进行超声造影成像，观察病灶坏死范围，并结合增强CT、MRI与血清甲胎蛋白水平评定有无肿瘤复发或局部残留。结果21个病灶超声造影后，毁损灶最大平均直径约（4．7±0．3）cm。17例毁损灶较原病灶增大；8例原病灶旁或病灶周边有动脉期强化灶，提示肿瘤局部复发，1例复发灶位于肝脏膈顶部而未发现。结论超声造影可显示射频治疗后毁损灶的范围，对术后肿瘤消融不全或局部复发的诊断具有较高敏感性。     

腹腔镜结直肠癌切除术联合射频消融治疗肝转移癌

目的 探讨腹腔镜结直肠癌切除术+同期RFA治疗肝转移癌的临床价值.方法 2001年12月至2006年7月成都市第三人民医院对22例结直肠癌合并同时性肝转移的患者施行腹腔镜结直肠癌切除术+同期RFA治疗肝转移癌,术后通过增强CT检查评价消融灶固化效果.采用X2检验分析疗效.结果 本组22例患者中8例肝转移癌为多发,16例有合并症.对31个肝转移癌进行RFA治疗,未发生相关并发症;术后平均住院时间为(14±5)d,无手术死亡.5例因消融不完全进行重复RFA,4例消融灶复发(2例重复RFA);6例死亡(2例死于消融灶复发).消融灶复发率为18%(4/22),病死率为27%(6/22).肝转移癌直径≥2.0 cm者RFA后消融灶复发率高于直径＜2.0 cm者(x2=5.867,P＜0.05).结论 腹腔镜结直肠癌切除术+同期RFA治疗肝转移癌,为多发性肝转移癌、合并基础疾病、高龄、手术耐受差和肿瘤切除困难的结直肠癌患者提供了治疗的机会.