超声引导经皮射频消融治疗肝癌的临床疗效分析

目的：探讨超声引导经皮射频消融治疗肝癌的临床疗效。方法对我院接受超声引导经皮射频消融治疗的56例原发性肝癌患者的临床资料进行分析。结果在术后1周,超声检查显示肝癌病灶为不均匀的回声增强,边界模糊,范围大于原病灶,内无血流信号,1个月后病灶表现为高回声,增强CT示病灶无强化。本组56例患者中8例患者的AFP在正常范围内,为14．29％（8/56）,术前及术后均＜10ng/ml,其余48例患者AFP值均不同程度地增高。结论超声引导下经皮射频消融治疗是一种安全有效的微创治疗法,值得临床推广。     

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。     

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。     

微波与射频消融治疗小肝癌的实验和临床研究的疗效分析

目的对使用改良后的微波(MW)消融与射频(RF)消融在活体猪肝脏和小肝癌(SHCC)病人中的前瞻性比较。方法在动物实验中,使用水冷轴探针或内部冷却电极在活体猪肝脏进行MW和RF消融。对两种消融方法的消融直径进行了比较。在临床研究中,42例小肝癌病人采用MW或RF治疗,在完全消融(CA)和肿瘤局部进展(LTP)方面进行了比较。结果 MW消融和RF消融在猪的肝脏和小肝癌的消融量分别为(33.3±15.6)cm3和(18.9±9.1)cm3、(109.3±58.3)cm3和(48.7±30.5)cm3,MW消融的消融范围更显著。MW消融和RF消融的CA率分别为95.5%(21/22)和95.0%(19/20)。在5.1个月的随访中,LTP率在MW消融组为18.2%(4/22),在RF消融组为15.0%(3/20)。结果使用改良后的MW消融比RF消融产生更大的消融范围,并且在肿瘤局部控制方面与射频消融疗效相似。MW消融对于治疗小肝癌是一种安全和前景良好的治疗方法。     

超声引导经皮射频消融治疗肝癌的探讨

目的 探讨超声引导在经皮穿刺射频消融技术治疗肝癌中的可行性与安全性。方法 应用超声对36例肝癌患进行穿刺引导，并实时检测射频消融的全过程。结果 36例患均在超声引导下顺利完成治疗，仅有1例术后肝包膜下出现小血肿。结论 准确的超声引导射频治疗肝癌术对提高疗效，减少并发症具有重要意义。     

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。     

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.     

肝动脉化疗栓塞联合射频消融治疗原发性 肝癌临床疗效观察

目的探讨肝动脉化疗栓塞(TACE)联合射频消融(RAF)治疗原发性肝癌(PHC)的临床疗效。方法选取东莞市人民医院自2012年1月至2017年1月收治的80例PHC患者为研究对象。采用随机数字表法将其分为A、B两组,每组各40例。A组给予TACE疗法治疗,B组在A组基础上联用RAF疗法。比较两组患者的临床疗效与肿瘤完全坏死率。结果 B组患者治疗总有效率为85.0%(34/40),显著高于A组的42.5%(17/40),两组间比较,差异有统计学意义(P<0.05)。B组患者肿瘤完全坏死率为85.0%(34/40),显著高于A组的25.0%(10/40),两组间比较,差异有统计学意义(P<0.05)。结论 TACE联合RAF治疗PHC的临床疗效显著,可有效提高肿瘤完全坏死率,临床应用价值较高。     

CT引导下经皮射频消融治疗较大原发性肝癌的临床应用

目的 探讨CT引导下经皮射频消融(RFA)治疗较大原发性肝癌的疗效.方法 对27例TACE治疗效果欠佳的较大原发性肝癌患者行CT引导下经皮RFA治疗,肿瘤大小5.4-11.0 cm,平均6.2 cm.单发病灶23例,2个病灶4例,共31个病灶.AFP阳性22例.术后通过增强CT及AFP检测评价疗效,所有病例随访2～20个月.结果 射频治疗后1个月随访显示,31个肿瘤中14个(45.2%)肿瘤完全坏死,内部及边缘无明显强化;17个肿瘤部分坏死.22例AFP阳性患者,AFP明显降低15例(68.2%),不变3例(13.6%),升高4例(18.2%).并发症中3例出现表皮烫伤,1例顽固性呃逆,1例肝内出血,1例肝脓肿,1例术后出现严重低蛋白血症,术后2个月死亡.患者中位生存期为9.8个月,1年累计生存率29%.结论 对于不可切除的较大原发性肝癌,RFA是较有效的局部介入治疗方法,合理应用RFA治疗,可提高患者生活质量并延长患者的生存时间.     

Radiofrequency ablation of liver cancer

The development of image-guided percutaneous techniques for local tumor ablation has been one of the major advances in the treatment of liver malignancies. Over the past two decades, several methods for chemical or thermal tumor destruction have been clinically tested. Among these methods, radiofrequency (RF) ablation is currently established as the primary ablative modality at most institutions. RF ablation is accepted as the best therapeutic choice for patients with early stage hepatocellular carcinoma (HCC) when liver transplantation or surgical resection is not suitable options. In addition, RF ablation is emerging as a viable alternative to surgery for inoperable patients with limited hepatic metastatic disease, especially from colorectal cancer. Several series have shown that RF ablation can result in complete tumor eradication in properly selected candidates, and have provided indirect evidence that the treatment improves survival. In this article, we review technique, indications, and clinical results of percutaneous RF ablation in the treatment of HCC and colorectal hepatic metastases.     

经肝动脉插管栓塞化疗原发性肝癌的临床观察

目的:了解原发性肝癌的经肝动脉插管栓塞化疗的方法,探讨经肝动脉插管栓塞化疗原发性肝癌的临床疗效。方法:对28例原发性肝癌患者临床使用经肝动脉插管栓塞化疗的临床资料进行回顾性分析,比较其AFP,AST,γ-GT及TBiL等指标的变化,统计其生存率及平均生存时间等临床疗效。结果:患者治疗前和治疗后1个月的AFP,AST,γ-GT及TBiL指标相比存在显著统计差异,P<0.05。结论:使用经肝动脉插管栓塞化疗对原发性肝癌进行治疗,其近期疗效比较稳定,副作用小,患者生存率高,平均生存时间比较长,是一种比较实用的治疗方法。     

MR-guided laser thermal ablation of primary and secondary liver tumours

AIM: To test the hypothesis that magnetic resonance (MR)-guided hepatic tumour ablation is (i) safe and feasible, (ii) is associated with favourable patient survival, and (iii) decreases viable tumour. MATERIALS AND METHODS: One hundred and twenty-five MR-guided laser thermal ablations (LTA) were performed on 35 patients with hepatocellular carcinoma (HCC, n=19), hepatic metastases (n=11, mainly colorectal) and carcinoid liver tumours (n=5). RESULTS: Mean overall survival was 14.8 months (HCCs 14.6 months, metastases 15.2 months). Near real-time T1-weighted colourized thermal maps correlated moderately with follow-up gadolinium-enhanced MR imaging in predicting ablated tumour area (Pearson correlation coefficient=0.5). There was a significant difference in percentage enhancing pre- and post-LTA (Wilcoxon signed ranks test=0.0001). An average of 50.7% of tumour was ablated by each treatment. In patients with multiple liver tumours ablated tumours grew significantly less than untreated tumours (108%compared with 196% growth, follow-up period 5.8 months, WSRTp=0.07). CONCLUSION: MR- guided LTA of primary and secondary liver tumours is safe, feasible, and significantly decreased amount of enhancing or viable tumour. MR-guided LTA produces a better survival in patients with HCC than would be expected in untreated patients, and has a mean survival in patients with metastases at least equal to the longest median survival in untreated patients.     

原发性肝癌并发胆结石

目的：观察研究原发性肝癌（ＰＨＣ）并发胆结石发生率及其发生机理，方法：采用腹部Ｂ超和ＣＴ影像学检查确定ＰＨＣ患者并发胆结石，结果：并发胆结石发生率：ＰＨＣ组２２％（３６／１５２）和继发性肝癌（ＭＨＣ）组４．５％（２／４４）比较有明显差异。Ｐ〈０．０５，ＰＨＣ组和肝硬化（ＬＣ）组２５％（１４／５６）比较无明显差异，结论：并发胆结石，ＰＨＣ组远无高于ＭＨＣ组，其原因可能与两组在门脉高压和肝功能损害存在     

原发性肝癌超声显像后方回声增强效应临床观察

原发性肝癌是临床最常见的恶性肿瘤之一,早期发现及诊断尤为重要,约有90%肝癌来自肝硬化[1],但肝硬化肝脏实质回声常增强,超声表现因其肿瘤细胞分化程度及内部成分改变而不同,寻找肝癌的超声特异性表现尤为重要。我们在临床工作中发现一些肝癌病灶后方常常伴有后方回声效应,本文通过回顾性分析82例患者,101个病灶的超声表     

Radiofrequency ablation in the management of liver metastases from breast cancer

OBJECTIVE: Systemic chemotherapy remains the standard treatment for patients with breast cancer hepatic metastases. Resection of metastases has survival advantages in a small percentage of selected patients. Radiofrequency ablation has been used in small numbers of selected patients. This small series was undertaken to review our experience with radiofrequency ablation in the management of patients with breast cancer hepatic metastases. CONCLUSION: Radiofrequency ablation of breast cancer hepatic metastases is safe and may be used to control hepatic deposits in patients with stable or no extrahepatic disease.     

Radiological contribution to the treatment of primary and secondary liver tumors

The prognosis of patients with primary and secondary liver tumors has been improved recently by more aggressive operative, chemotherapeutic and embolization treatments. In a personal series of 40 patients with liver metastases from colorectal cancer, regional intra-arterial chemotherapy was superior to systemic intravenous treatment, with a tumor remission rate of 66% in comparison to 48% of the cases. But the benefit of intra-arterial chemotherapy is still questionable considering the higher complication rate and the absence of prognostic data of the procedure.