温控射频消融治疗VX2肝癌实验研究

目的 探索不同温度控制条件下射频消融(RFA)治疗兔VX2肝癌后靶区内肿瘤细胞凋亡及增殖变化.方法 采用开腹组织块法构建兔VX2肝癌模型,随机分为对照组(n=6,未行RFA)和实验组A组(n=24,射频针温度50～70℃)、B组(n=24,射频针温度70～90℃)、C组(n=24,射频针温度90～110℃).实验组分别接受CT引导下不同温控RFA,靶区由消融中心向外周依次分为针道区、消融区和交界区;采用苏木精-伊红(HE)染色观察肿瘤及周围肝组织病理学变化,脱氧核糖核苷酸末端转移酶介导的缺口末端标记法(TUNEL)和增殖细胞核抗原(PCNA)免疫组化法检测各区带肿瘤细胞凋亡及增殖情况.结果 RFA后实验组各组各区带6个时间点(术后即刻,1、3、7、14、21 d)标本肿瘤细胞凋亡指数(AI)和增殖指数(PI)与对照组比较,均有统计学差异(P＜0.05);B、C组区带各时间点AI均高于A组(P＜0.05),B、C组间无明显差异(P＞0.05);术后7、14、21 d时B、C组消融区和交界区PI均低于A组(P＜0.05),且术后21 d时C组PI低于B组(P＜0.05).结论 RFA温控在50～110℃能达到基本灭活针道区兔VX2肝癌细胞的作用,选择90～110℃温控更利于彻底控制肿瘤.     

射频消融亚致死性温度对肝癌干细胞的影响

目的 研究亚致死温度射频消融(RFA)对肝癌干细胞(LCSC)产生及其相关转录因子表达的影响.方法 利用小鼠Hep1-6肝癌细胞株和肝细胞癌(HCC)患者临床样品,检测LCSC相关标志物和转录因子的表达.结果 不同温度分别刺激Hep1-6细胞后发现,45℃是不能诱导细胞死亡的亚致死性温度.流式细胞仪(FCM)检测显示45℃处理可引起CD13+、CD44+、CD90+、CD133+ Hep1-6细胞水平明显上调,提示45℃温度导致Hep1-6细胞中以上各型LCSC产生增加;实时定量聚合酶链反应(RT-qPCR)检测显示45℃温度导致CD13、CD90、CD133 mRNA水平明显上调.CD13 mRNA水平在5例HCC患者复发肝癌组织中均明显上调,CD133 mRNA在4例复发肝癌中上调,CD90 mRNA仅在1例复发肝癌中上调;FCM检测显示CD13+ LCSC水平在4例复发肝癌中明显上调,CD133+ LCSC水平仅在1例复发肝癌中上调,提示CD13+ LCSC水平上调与45℃温度关系更密切.RT-qPCR检测显示4例CD13+ LCSC上调的复发肝癌患者13个LCSC相关转录因子中Sox2、Stat1明显上调,FCM检测显示45℃处理Hep1-6细胞后Sox2、Stat1 mRNA明显上调.用Sox2、Stat1 siRNA分别沉默了Sox2、Stat1基因,表明Sox2 、Stat1均参与了45℃温度诱导的CD13+ LCSC产生.结论 RFA治疗中45℃亚致死性温度所致CD13+ LCSC水平增高与Sox2、Stat1表达有关.该结果对肝癌复发研究有一定借鉴意义.     

异丙酚辅助射频消融治疗肝癌的临床研究

目的：探讨应用异丙酚作镇静麻醉辅助经皮肝穿刺射频消融（PRFA）治疗肝脏肿瘤的可行性，评价其效果和安全性。方法：将27例行PRFA治疗的肝癌病人辅以异丙酚静脉麻醉，记录患者体温、脉搏、呼吸、血压、氧饱和度、治疗时间及不良反应等。以25例未用异丙酚的PRFA患者作为对照组。结果：本组治疗中与治疗前比较，体温升高，脉搏及呼吸频率在治疗5min时最快（P〈0．01），其余时段虽有增快但无统计学意义；收缩压与舒张压在治疗5min时升高，其余时段降低，无统计学意义；血氧饱和度在静注异丙酚5、25min时呈下降趋势（P〈0．01）。异丙酚组患者的疼痛、大汗及恶心／呕吐显著低于对照组（P〈0．01-〈0．05），未发生明显不良反应。结论：应用异丙酚麻醉辅助PRFA，可明显减轻病人的痛苦，提高PRFA治疗的依从性和彻底性。     

经皮射频消融治疗肝癌

经皮射频消融治疗肝癌是当今最新的介入导向治疗方法之一，具有微创、安全、并发症少、近期疗效确定等特点，广泛用于治疗各种原发性及继发性肝癌。本文就该技术的适应证和禁忌证、术前准备、技术概况、实验与临床研究、随访观察、并发症及展望做一综述。     

射频消融治疗肝细胞肝癌

肝细胞肝癌(hepatoeellular carcinoma,HCC)是一种常见的恶性肿瘤,由于HCC恶性程度高、发展迅速,加上患者多有肝硬化基础、肝功能储备差,HCC有多发和肝内播散倾向,病灶邻近大血管、胆管等因素,仅5％～15％的患者可以接受根治性切除术。因此动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)、热疗、冷冻治疗、经皮无水酒精注射(percutaneous ethanol iniection,PEI)等非手术疗法在HCC治疗中占据重要地位。作为热疗的一种,射频消融(radiofrequency abhtion,RFA)近年来发展迅速,并在临床上取得较好疗效,现综述如下。     

膈顶部原发性肝癌的射频消融

目的 探讨膈顶部原发性肝癌射频消融(RFA)的治疗转归.方法 2006年2月至2008年3月,共有251例原发性肝癌患者接受了超声引导下的经皮RFA,其中42例56个肿瘤位于膈顶部,定义为A组.另有209例368个肿瘤位于非膈顶部,定义为B组.结果 初次RFA后,A、B两组的完全消融率、局部复发率及并发症发生率分别为85.7%比86.6%;9.5%比11.5%和7.1%比4.7%.差异均无统计学意义(P>0.05).将B组按肿瘤具体部位进一步分为肝实质内、包膜下、空腔脏器旁以及肝门部肿瘤,再与A组比较,显示上述5个不同部位肿瘤完全消融率两组间差异有统计学意义(P<0.05).膈顶部和非膈顶部直径<3 cm,3～5 cm和>5 cm肿瘤的完全消融率分别为90.2%,76.9%,50%和96.6%.78.1%.69.2%,两组同等直径范围肿瘤的完全消融率差异无统计学意义(P>0.05).A、B两组1年无复发生存率分别为62.3%和59.2%,总生存率分别为90.O%和92.O%.2年无复发生存率分别为56.6%和52.4%,总生存率分别为82.7%和84.2%.A、B两组1、2年无复发生存率和总体生存率之间差异无统计学意义(P>0.05).结论 尽管膈顶部肿瘤位置的特殊性影响着RFA后疾病转归,但与其他部位肿瘤相比,膈顶部肿瘤在治疗效果、治疗风险、局部复发以及生存预后方面均不逊色,膈顶部肿瘤并非RFA的禁忌证.     

肝癌射频和微波热消融治疗的肿瘤免疫学进展

射频消融(radiofrequency ablation,RFA)和微波消融(mi- crowave ablation,MWA)是肝癌的微创治疗方法,取得了很好的临床疗效。小肝癌患者射频消融与手术治疗随机对照研究的存活率和复发率无显著性差异,同样能达到根治性治疗效果,Ⅰa期小肝癌的近期疗效尚优于手术切除。射频和微波消融对比研究表明,两种治疗方法的主要临床疗效指标和并发症等均无明显差异。射频和微波消融治疗不仅能直接使肿瘤细胞凝固坏死,原位彻底灭活肝癌组织,而且还能提高肿瘤局部和外周血中免疫细胞数量及其抗肿瘤功能,现就它们在肝癌治疗中的有关肿瘤免疫学方面进展做以介绍。     

多电极射频消融治疗肝癌研究进展

对于不能手术切除的原发或继发性肝癌,目前常用的治疗方法有肝动脉栓塞化疗、经皮无水酒精注射、微波、激光、冷冻以及组织间高剂量率内照射和立体定向放射治疗等。本文介绍一种介入治疗肝癌的新方法-经皮多电极射频消融〔1〕(Percutaneousradiofrequencyablatio,PRFA) ,对其治疗肝癌的工作原理、实验研究、临床应用、适应证、并发证和疗效观察作一综述。1　工作原理射频消融(radiofrequencyablatio ,RFA)治疗肿瘤的原理与激光、微波及高强度超声治疗肿瘤相同,均是一种热损毁的方法。其依据是肿瘤细胞对热的耐受能力比正常细胞差〔2〕,…     

肝癌射频消融后的影像学评价

射频消融术(RFA)是肝癌综合治疗中的一项重要手段,尤其是对小肝癌的治疗,临床疗效较好。由于RFA治疗范围的局限,术后常有肿瘤病灶的残存或出现复发。因此,准确地评价RFA术后疗效非常重要。本文综述了不同影像手段对RFA治疗肝癌的疗效评价,同时讨论不同评价方法的优劣,以冀为采取合理的影像手段,做出正确的临床处理提供参考。     

经皮集束电极射频消融治疗小肝癌

目的 探讨经皮集束电极射频消融(radiofrequency ablation,RFA)对小肝癌(直径≤3cm)的治疗效果。方法利用RF-2000TM肿瘤射频治疗系统,在B超引导下对21例小肝癌患者24个肿块进行经皮肝穿刺射频热凝治疗,并用B超及CT检查以了解RFA治疗效果,随访观察其复发和生存情况。结果 RFA治疗后100％(20/20)的肿块血供消失(另4个治疗前即无血供),且2,4个肿块呈完全凝固性坏死(100％)。随访6月-3年,21侧中存活19例,半年生存率100％。存活的19例中,已有5例生存半年,4例生存1年,6例生存2年,4例生存3年。结论 集束电极RFA治疗小肝癌创伤小,安全,疗效可靠。     

腹腔镜射频消融治疗原发性肝癌的研究

目的：评价腹腔镜射频消融（RFA）治疗原发性肝癌的可行性、安全性及疗效。方法：51例原发性肝癌在全麻下行腹腔镜RFA治疗,共72个瘤体,平均最大肿瘤直径（3．4±1．0）cm。合并肝硬化49例、慢性结石性胆囊炎5例,糖尿病4例,凝血功能障碍10例。结果：51例均顺利完成腹腔镜RFA治疗,12例行腹腔镜胆囊切除术。未出现严重并发症。肿瘤完全坏死率为95．8％。随访12～58个月（平均35个月）,6例发现肝内新病灶,11例射频治疗部位复发,再次采用经皮RFA治疗9例,12例死于肿瘤复发或肝功能衰竭。结论：腹腔镜RFA治疗原发性肝癌安全可行,治疗效果可靠,但应选择瘤体位于肝脏表面或临近胆囊而且不宜手术切除的病例进行治疗。     

重复射频消融治疗原发性肝癌的临床疗效观察

目的评价经皮肝穿刺重复射频消融治疗原发性肝癌的临床疗效。方法将88例原发性肝癌患者按单次射频消融及重复射频消融的方法分为2组,观察每组肿瘤完全消融率、肿瘤复发率及不良反应的发生情况。结果2组均未发生出血、胆漏等严重的不良反应。单次射频消融组肿瘤的完全消融率为62．5％,重复射频消融组为87．5％,2组间比较差异有统计学意义（P〈O．05）;单次射频消融组肿瘤的复发率为20．0％,重复射频消融组为4．2％,2组间比较差异有统计学意义（P〈O．05）。结论重复射频消融可有效提高原发性肝癌的临床治疗效果。     

Ultrasound-guided percutaneous thermal ablation of hepatocellular carcinoma using microwave and radiofrequency ablation

AIM: To investigate the therapeutic efficacy of thermal ablation for treatment of hepatocellular carcinoma (HCC) using microwave and radiofrequency (RF) energy application. MATERIALS AND METHODS: A total of 190 nodules in 97 patients (84 male, 13 female; mean age 53.4 years, range 24-74 years) with HCC were treated with microwave or RF ablation in the last 4 years. The applicators were introduced into the tumours under conscious analgesic sedation by intravenous administration of fentanyl citrate and droperidol and local anaesthesia in both thermal ablation procedures. The patients were then followed up with contrast-enhanced computed tomography (CT) to evaluate treatment response. Survival was analysed using the Kaplan-Meier method. RESULTS: Complete ablation was obtained in 92.6% (176/190) nodules. The complete ablation rates were 94.6% (106/112) in microwave ablation and 89.7% (70/78) in RF ablation. The complete ablation rates in tumours/=4.0 cm were 93.1, 93.8 and 86.4%, respectively. Local recurrence was found in 9.5% nodules and the rates in tumours/=4.0 cm in diameter were 3.4, 9.9 and 31.8%, respectively. In the follow-up period, 7.1% nodules ablated by microwave and 12.8% by RF presented local recurrence. The 1, 2 and 3-year distant recurrence-free survivals were 47.2, 34.9 and 31.0%, respectively. Estimated mean survival was 32 months, and 1, 2 and 3-year cumulative survivals were 75.6, 58.5, and 50.0%, respectively. One and 2 years survivals of Child-Pugh class A, B and C patients were 83.8 and 70.4%, 78.2 and 53.2%, 36.3 and 27.3%, respectively. CONCLUSION: Thermal ablation therapy by means of microwave and RF energy application is an effective and safe therapeutic technique for hepatocellular carcinoma. Large tumours can be completely ablated, but have a significantly higher risk of local recurrence at follow-up.     

超声引导下射频消融治疗肝癌安全性与疗效分析

目的探讨超声引导下射频消融方法治疗肝癌的安全性与临床效果。方法选取我院2010年7月-2013年7月收治的35例肝癌患者,共61个病灶实施超声引导下经皮射频消融治疗,观察患者并发症情况及肿瘤消融情况,对比分析治疗前后的甲胎蛋白值、肿瘤大小及瘤体内的血供情况。结果所有病灶均消融成功,无严重并发症发生。经过4-15个月随访,复发13例,均给予再次射频消融。结论经皮射频消融治疗肝癌是一种安全、有效的热消融治疗技术,值得临床推广应用。     

The efficacy of intraperitoneal saline infusion for percutaneous radiofrequency ablation for hepatocellular carcinoma

Objective

To evaluated the efficacy and safety of radiofrequency ablation (RFA) with intraperitoneal saline infusion.

Background

Ultrasound-guided RFA is not always feasible due to the tumor location, possible adjacent tissue damage or poor sonographic identification.

Patients and methods

Ultrasound-guided RFA with intraperitoneal saline infusion was performed in 116 patients between June 2001 and March 2008.

Results

The overall technical feasibility of the intraperitoneal saline infusions was 90.5% (105 patients). The purposes of the intraperitoneal saline infusion were achieved in 100 patients (86.2%) by visualizing the tumor located in hepatic dome (47 patients), prevent adjacent organ damage (42 patients) and withdrawing overlying omentum (10 patients). Complete ablation of tumor was accomplished in 102 patients (87.9%). Complications associated with the treatment occurred in seven patients (6.0%). There was no case of adverse event directly related to intraperitoneal saline infusion.

Conclusions

Intraperitoneal saline infusion is an effective and safe procedure that can be used to overcome the current limitations of ultrasound-guided RFA.     

Percutaneous radiofrequency ablation of small hepatocellular carcinoma: long-term results

The aim of this study was to evaluate the effectiveness and the safety of percutaneous radiofrequency (RF) thermal ablation of hepatocellular carcinoma (HCC) in 88 patients with a long follow-up, and to compare conventional electrodes and expandable electrodes. Eighty-eight patients with 101 hepatocellular carcinoma nodules (≤ 3.5 cm in diameter) underwent RF thermal ablation by means of either conventional electrodes or an expandable electrode. Therapeutic efficacy was evaluated with dynamic contrast CT, serum α-feto protein level, US examination at the end of the treatment, and during follow-up. Complete necrosis was obtained in all tumor nodules in a mean number of 3.3 sessions (tumor treated by conventional electrodes) or 1.5 sessions (tumor treated by expandable electrode). The mean follow-up was 34 months; overall survival rate was 33 % at 5 years. Disease-free survival at 5 years was 3 %; local recurrence rate was 29 % in patients treated with conventional electrodes; 14 % in patients treated with the expandable electrode. Two major complications and 14 minor complications were observed. Radiofrequency thermal ablation in small HCC is very effective with a low percentage of major complications. The use of an expandable electrode substantially reduced the number of treatment sessions but did not modify the overall survival rate and the disease-free survival rate. Received: 7 January 2000 Revised: 19 July 2000 Accepted: 11 August 2000     

不同MR成像方式对肝细胞癌射频消融术后的评估

以射频消融为主的肝细胞癌消融治疗已经广泛应用于临床,但治疗后肿瘤残存和复发是影响疗效的主要问题,所以消融后的评估显得尤为重要.MRI具有多参数、多序列、任意平面成像及多种功能成像方式,使其对肿瘤消融术后的评估更具优势.因此,本文就MRI常规平扫、MRI增强、DWI、DKI、PWI及MRS在肝细胞癌射频消融术后评估中的应...     

无水酒精注射术联合射频消融术与单纯射频消融术治疗小肝癌的疗效比较

目的比较无水酒精注射术（PEI）联合射频消融术（RFA）治疗方案与单纯RFA治疗小肝癌的疗效。方法回顾分析我院2006年1月～2008年1月进行的68例小肝癌射频消融治疗患者的临床资料。68例中37例行PEI联合RFA术,31例行单纯RFA术。比较两组肿瘤完全消融率,复发率,复发时间,术后1、2、3年生存率等情况。结果 PEI联合RFA组肿瘤完全消融率91.89%,局部复发率10.81%,局部复发时间（14.22±3.48）月,1、2、3年的生存率分别为89.19%、81.08%和72.97%。单纯RFA组肿瘤完全消融率70.97%,局部复发率32.26%,局部复发时间（9.15±2.68）月,1、2、3年的生存率87.10%、77.42%和48.39%。PEI联合RFA组在肿瘤完全消融率、局部复发率、复发时间、术后3年生存率方面好于单纯RFA组。结论 PEI联合RFA治疗小肝癌疗效优于单纯RFA治疗,在小肝癌的治疗中有重要临床应用价值。     

Percutaneous radiofrequency ablation of hepatocellular carcinoma in the presence of portal vein thrombosis

Portal vein thrombosis (PVT) may not be an absolute contraindication for hepatic radiofrequency ablation (RFA). Although the data are sparse, PVT is commonly considered a contraindication to RFA. PVT has actually been described as a complication following RFA. RFA was used to treat a 3.9×2.9 cm primary hepatocellular carcinoma (HCC) in a patient with concomitant PVT without complication. RFA can be safely performed in this setting but further studies could clarify this issue.     

Radiofrequency ablation of hepatocellular carcinoma: Current status

Ablation therapy is one of the best curative treatment options for malignant liver tumors, and can be an alternative to resection. Radiofrequency ablation (RFA) of primary and secondary liver cancers can be performed safely using percutaneous, laparoscopic, or open surgical techniques, and RFA has markedly changed the treatment strategy for small hepatocellular carcinoma (HCC). Percutaneous RFA can achieve the same overall and disease-free survival as surgical resection for patients with small HCC. The use of a laparoscopic or open approach allows repeated placements of RFA electrodes at multiple sites to ablate larger tumors. RFA combined with transcatheter arterial chemoembolization will make the treatment of larger tumors a clinically viable treatment alternative. However, an accurate evaluation of treatment response is very important to secure successful RFA therapy. Since a sufficient safety margin (at least 0.5 cm) can prevent local tumor recurrences, an accurate evaluation of treatment response is very important to secure successful RFA therapy. To minimize complications of RFA, clinicians should be familiar with the imaging features of each type of complication. Appropriate management of complications is essential for successful RFA treatment.