经皮射频消融术治疗原发性单发小肝癌效果观察

目的探讨CT引导下经皮射频消融(RFA)治疗原发性单发小肝癌的临床疗效。方法收集我院2009年4月～2012年1月肿块直径≤3 cm单发小肝癌在CT引导下行RFA治疗31例,术后定期随访,做出疗效评价。结果 31个病灶消融术后1个月复查,完全消融25个(80.6%),不完全消融6个(19.4%),随访中病灶稳定17个(54.8%),病灶进展14个(45.2%),重复RFA后获得较为满意的治疗效果。患者均未出现严重不良反应及并发症。结论 RFA治疗原发性单发小肝癌疗效确切、安全性高、并发症低,近期生存率高。     

射频消融治疗肝细胞癌的预后因素及研究新进展

随着医学诊疗水平的提高,射频消融在治疗原发性肝癌的临床应用和基础研究方面都取得飞速进展,发挥着越来越重要的作用:(1)射频消融治疗原发性肝癌的10年总生存率为27.3%-46.1%,对于肿瘤单发且最大径≤3 cm的HCC患者, 10年总生存率可达74%,生存结果与手术切除相似;(2)射频消融联合其他治疗等可以扩大消融治疗的适应证,使患者生存获益;(3)建立预测射频消融治疗原发性肝癌的预后模型,可指导制定治疗和随访策略,为临床个体化诊疗提供重要依据.     

当前对原发性肝癌治疗的新认识

在全球常见的癌症中,原发性肝癌(HCC)发病率排名第五位,是第三大由癌症而致死的常见原因[1]。外科手术切除(HR)、局部消融治疗和肝移植(LT)被认为是有治愈可能的措施。但据估计,手术切除或射频消融(RFA)仅对10%的肝癌患者有明显疗效,且这部分患者的肿瘤直径≤3 cm[2];据报道,直到上世纪90年代中期,肝移植患者5年生存率仅为30%～40%。因此HCC的治疗措施并不是     

射频消融治疗肝癌115例报告

目的总结2001年4月至2005年4月用射频消融(RFA)治疗肝癌病人的病例资料,探索RFA治疗肝癌的疗效及并发症防治。方法经皮、经腹腔镜、开腹手术三种途径,采用B超、CT定位,多点穿刺行RFA治疗115例(原发性肝癌85例,转移性肝癌30例)肝癌患者,肿瘤直径1~8cm,其中3~5cm45例(39.1%),5~8cm42例(36.5%);数目1~6个。结果并发症发生率为11.3%,住院期间死亡2例。AFP阳性的60例肝癌病人中,RFA治疗后有46例(76.6%)明显降低,其中有35例(58.3%)转阴。1年生存率为78.2%,2年生存率为56.5%,>3年生存率为36.5%。结论采用不同径路、多点穿刺行RFA治疗无手术切除指征的肝癌、术后复发及转移性肝癌等临床治疗较困难的病例,疗效明显,并发症发生率低。     

射频消融治疗中晚期肝癌的可行性

目的 通过经皮射频消融(RFA)对临床多见的中晚期肝癌治疗方案策略性应用,探讨RFA治疗的可行性.方法 655例非手术适应证的肝细胞癌(HCC)患者行经皮RFA治疗,以其中随访资料完整的中晚期癌92例136个病灶(直径≤7.0cm)为研究对象.RFA前行超声造影(CEUS)检查51例(55.4％);采用优化方案策略行规范化治疗67例(72.8％),规范化方案包括根据CEUS筛选适应证、界定浸润范围以制定根治消融方案,及根据数学方案计算行多灶重叠覆盖消融、2～3支双极针立体定位布针适形消融、血供丰富肝癌采用彩色多普勒超声或CEUS引导经皮阻断荷瘤动脉或经动脉插管化疗栓塞后行RFA.另25例常规RFA治疗.所有患者在RFA后均经西医及中医中药保肝治疗.RFA后1个月用增强CT判断肿瘤早期灭活率,其后每3个月用CT并结合甲胎蛋白检查评价疗效.早期灭活率、局部复发率的比较用x2检验或Fisher精确法检验,生存率计算采用KaplanMeier方法及Log-rank检验.结果 肿瘤早期灭活率为90.4％(123/136),严重并发症2例(2.2％),无相关死亡病例.随访3 ～ 134个月,局部复发率16.9％ (23/136),1、3、5年总生存率分别为83.3％、48.3％、21.9％,中位生存期35个月.分层分析显示,Child-Pugh A级、应用CEUS及采用规范化治疗患者的早期灭活率均明显提高,分别为98.3％、98.％、97.0％;肿瘤直径≤3.0 cm、应用CEUS及规范化治疗患者的局部复发率均减低,分别为5.9％、11.8％、16.4％,与相应对照组比较,差异均有统计学意义(P＜ 0.05).Child-Pugh A级、肿瘤直径≤3.0 cm、应用CEUS及规范化治疗患者的5年生存率更高(P＜ 0.05).结论 证实对直径≤7.0 cm、无主脉管癌栓的中晚期HCC行RFA治疗是可行的治疗方法,尤需重视采取规范化治疗以降低复发率.     

影像引导射频消融治疗较大肝癌的现状及前景

肝癌在中国的发病率较高,需要有效的治疗手段.近年来影像引导经皮射频消融(radiofrequency ablation,RFA)作为非手术治疗因其安全有效、对肝功能损伤小等优点已被广泛适用于治疗小肝癌,甚至可以与手术相媲美.然而,3.0 cm的肿瘤往往易发生肿瘤残留复发而影响疗效.随着基础研究的开展和消融技术的进步,为RFA治疗较大肿瘤提供了更多机会.成功消融较大肝肿瘤的重要因素包括消融的技术设备、肿瘤的生物学特征及操作者手法经验等方面的结合.本文将根据这三个重要方面探讨较大肝肿瘤的治疗现状及前景.     

手术切除与射频消融治疗小肝癌的疗效比较

目的比较小肝癌手术切除与射频消融（RFA）初治后疗效及复发情况。方法收集吉林大学白求恩第一医院2002年1月至2008年12月接受手术或RFA初治的97例小肝癌患者资料,并对治疗后满2年的患者进行随访,共随访到63例,手术和RFA治疗分别为34和29例,回顾性分析两种方法治疗小肝癌患者的预后复发情况。计量资料采用χ2检验,利用Cox回归分析比较影响患者复发相关的危险因素,并应用Log-rank进行两种无瘤生存率检验。结果手术与射频消融治疗小肝癌3个月、1、2 a复发率分别15%、38%、64%,21%、35%、45%,两者差异无统计学意义。初治后复发与治疗方法、性别、年龄、Child-Pugh分级、肿瘤大小、结节数目、是否合并有肝硬化、甲胎蛋白水平相关性差异无统计学意义,两者无瘤生存率差异无统计学意义。结论 RFA与肝癌切除术在治疗小肝癌取得相近的治疗效果,RFA有望成为替代手术治疗的一种理想的治疗方法。     

超声引导经皮微波固化治疗肝癌临床研究分析

超声引导经皮微波固化疗法（PMCT）是近年来一种新的肝癌治疗手段,主要适用于不适合手术治疗包括不能手术切除、手术切除困难或不能耐受手术的早期肝癌患者,肝内肿瘤不超过3个,肿瘤直径≤5cm,且无血管内或远处转移灶,肝功能为 Child A 级或 B 级。对于中晚期肝癌患者,微波也可作为一种有效减小肿瘤的手段,以达到减轻痛苦、延缓发展,延长生存时间的目的。近年来,微波固化已成为继手术、放化疗、生物治疗及射频消融后又一种有效治疗肝癌的治疗方法。近年来研究表明,微波固化以其创伤小、简便可靠、疗效显著等优势在肿瘤临床治疗中得到了普遍的推广。现就微波固化在肝癌治疗方面研究进展作一综述。     

超声引导经皮集束电极射频消融冶疗中小肝癌

目的：探讨超声引导经皮集束电极射频消融(RFA)治疗中小肝癌(直径≤5cm)的疗效。方法：利用RF-2000^TM肿癌射频治疗系统，在B超引导下对29例中小肝癌患者34个肿块进行经皮肝穿刺射频热凝冶疗，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93．3％(28／30)的肿块血供消失(另4个直径≤3cm的肿块治疗前即无血供)，且94．1％(32／34)的肿块呈完全凝固性坏死。对有血供的2个肿块再次进行了RFA治疗。随防6月～3年，29例中现存活25例，半年生存率100％。存活的25例中，已有6例生存半年，7例生存1年，7例生存2年，5例生存3年。结论：集束电极RFA治疗中小肝癌创伤小，安全，疗效可靠。     

超声引导射频消融治疗老年肝癌的效果及肿瘤残留的危险因素

目的探讨超声引导射频消融(RFA)治疗老年肝癌(HCC)的疗效及肿瘤残留的危险因素。方法接受超声引导RFA治疗的老年HCC患者315例。治疗后1个月评价疗效。采用单因素分析和多元Logistic回归分析法分析与RFA治疗后肿瘤残留有关的危险因素。结果患者的肿瘤完全消融率为90.16%;病灶的完全消融率为91.27%。单因素分析发现靠近肝内大血管和胆囊、肿瘤最大直径>5 cm及联合其他局部治疗影响患者RFA治疗后肿瘤残留(P<0.05)。靠近肝内大血管、肿瘤直径>5 cm及未联合局部治疗是患者RFA治疗后肿瘤残留的危险因素。结论超声引导RFA治疗获得了良好的治疗效果,靠近肝内大血管、肿瘤直径>5 cm及未联合局部治疗是患者RFA治疗后肿瘤残留的危险因素。     

Radiofrequency ablation versus surgical resection as primary treatment of hepatocellular carcinoma meeting the Milan criteria: a systematic review

Background and Aim: Surgery is the standard treatment option for hepatocellular carcinoma (HCC) meeting the Milan criteria, defined as single HCC ≤ 5 cm in maximum diameter or up to three nodules ≤ 3 cm. However, favorable survival outcomes have also been reported for these HCCs following radiofrequency ablation (RFA). Methods: We performed a systematic review to compare the results of hepatic resection and percutaneous RFA as a primary treatment option of HCC meeting the Milan criteria. Studies were identified by searching MEDLINE on PubMed, the Cochrane Library database and CANCERLIT using appropriate key words. Results: In all six identified observational studies, there were no statistically significant differences in overall survival rates between the two treatment modalities. The results of two randomized trials are controversial, while the power of these randomized trials is too limited to reach a reliable conclusion. In practice, the choice of treatment between surgery and RFA largely depends on the relationship between the local recurrence and perioperative mortality rates of HCC patients. Following RFA, local recurrence rates are low when a minimal safety margin ≥ 4–5 mm is achieved. A previous simulation study of overall survival for very early stage HCC, defined as an asymptomatic solitary small HCC ≤ 2 cm, showed that primary RFA with a 9% local recurrence rate is comparable to surgical resection with a 3% operative mortality rate. Conclusion: Acquisition of a sufficient safety margin seems to be a critical factor before recommending wider application of RFA as primary treatment for HCCs that meet the Milan criteria.     

射频消融与无水酒精注射治疗术后复发肝细胞癌患者的疗效比较

目的对比肝细胞癌（HCC）术后复发肿瘤病灶经射频消融（RFA）与无水酒精（PEI）注射治疗的疗效,以期为临床治疗HCC肿瘤复发提供参考。方法回顾性分析2007年8月至2010年1月HCC术后单一病灶复发患者175例,分为PEI治疗101例与RFA治疗74例。所有病例治疗前后均行常规彩超和超声造影/增强CT检查,观察比较治疗次数、病灶完全灭活率及治疗并发症发生率,记录患者治疗后1、2、3年生存率。计量资料采用t检验,计数资料采用χ2检验。结果 HCC术后复发病灶,平均每例的PEI治疗次数多于RFA（P〈0.05）,PEI和RFA治疗并发症的发生率比较差异无统计学意义（P〉0.05）;肿瘤直径〈2.0 cm的HCC术后复发病灶组中,PEI和RFA治疗病灶完全灭活率比较差异无统计学意义（P〉0.05）,而2.0～5.0 cm HCC术后复发病灶组,PEI治疗病灶完全灭活率低于RFA,差异均有统计学意义（P〈0.05）。HCC术后复发病灶直径〈2.0 cm组中,PEI和RFA治疗术后1、2、3年生存率分别为89.1%和90.2%、69.1%和70.7%、49.1%和53.7%,两种治疗方式术后生存率比较差异无统计学意义（P〉0.05）。而2.0～5.0cm组中,PEI和RFA治疗术后1、2、3年生存率分别为63.0%和84.8%、43.5%和66.7%、21.7%和45.5%,两种治疗方式术后生存率比较差异均有统计学意义（P〈0.05）。结论肿瘤直径小于2.0 cm HCC术后复发病灶的RFA和PEI局部消融治疗,患者术后的生存率无明显差异,而肿瘤直径2.0～5.0 cm时,RFA治疗后生存期优于PEI。     

Role of radiofrequency ablation in the treatment of small hepatocellular carcinoma

Radiofrequency ablation (RFA), one of the most advanced loco-regional ablative therapeutic methods, is widely utilized in the treatment of hepatocellular carcinoma (HCC). Because of its minimal invasiveness and high efficacy, RFA has been regarded as a curative therapy as alternative to surgical resection and liver transplantation. It brings new hope and a new treatment pattern for small HCC. In this article, we summarize the important role of RFA in the treatment of small HCC according to our clinical experience over six years. The prognosis of small HCC after RFA is comparable to that of surgical resection but with higher safety, less complications, wider applicability, and good long-term survival. RFA will play a more and more important role in the clinical treatment of small HCC.     

Comparing the outcomes of radiofrequency ablation and surgery in patients with a single small hepatocellular carcinoma and well-preserved hepatic function

GOALS: To compare the efficacy of radiofrequency ablation (RFA) and surgical resection in a group of patients with a Child-Pugh score of 5 and a single HCC less than 4 cm in diameter. BACKGROUND: Radiofrequency ablation (RFA) has become a popular method for treatment of hepatocellular carcinoma (HCC) and has been applied as an alternative primary therapy to surgical resection. STUDY: We compared outcomes for 148 patients treated with RFA (n = 55) and those treated surgically (n = 93). RESULTS: The rate of local recurrence among patients in the RFA group was significantly higher than in the surgery group (P = 0.005), while the incidence of remote recurrence was similar between the two groups (P = 0.30). The cumulative 1- and 3-year overall survival rates (P = 0.24) and the cumulative 1- and 3-year recurrence-free survival rates (P = 0.54) were not significantly different between the two groups. CONCLUSIONS: Despite a higher rate of local recurrence, RFA was found to be as effective as surgical resection for the treatment of single small HCC in patients with well-preserved liver function, in terms of the incidence of remote recurrence and the patients' likelihood of achieving overall and/or recurrence-free survival.     

原发性肝癌外科治疗的理性思考

全球肝细胞癌（hepatocellular carcinoma,HCC）的发病率一直呈上升趋势,肝切除仍然是HCC患者的首选治疗。有临床症状肝癌患者的可切除率为20％～30％。大型肝切除术不输血是肝切除术的一个进展。原位肝移植应遵照米兰标准执行,并应把肝移植数量控制在肝切除数量的10％以下。HCC的微创治疗,包括经皮射频消融、经皮微波凝固治疗、冷冻治疗、高强度聚焦超声热疔等,一直在临床应用。芮静安提出的“120”肝外科技术适用于城市和农村的医院。未来,HCC患者治疗后的无瘤生存率将会提高。     

Ablation of hepatocellular carcinoma

Radiofrequency ablation (RFA) has gained a wide acceptance as a first-line therapeutic option for small hepatocellular carcinoma (HCC). For very early-stage HCC, despite a higher rate of local tumour progression, RFA is considered as a viable alternative to surgical resection owing to its comparable long-term survival, reduced morbidity, and greater preservation of hepatic parenchyma. For HCCs larger than 2 cm, RFA can contribute to near-curative therapy when combined with chemoembolization. RFA can be used as part of a multimodal treatment strategy for more advanced or recurrent cases, and could be a useful bridging therapy for patients who are waiting for liver transplantation. However, the use of RFA is still limited in treating large tumours and some tumours in high-risk locations. To overcome its current limitations, other ablation techniques are being developed and it is important to validate the role of other techniques for enhancing performance of ablation therapy for HCC.     

Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: Is resection still the treatment of choice?

If liver transplantation is not feasible, partial resection is considered the treatment of choice for hepatocellular carcinoma (HCC) in patients with cirrhosis. However, in some centers the first-line treatment for small, single, operable HCC is now radiofrequency ablation (RFA). In the current study, 218 patients with single HCC 相似文献   

Radiofrequency ablation or percutaneous ethanol injection for the treatment of liver tumors

The liver is a common location of both primary and secondary malignancies. For unresectable liver cancer, many local ablative therapies have been developed. These include e.g., percutaneous ethanol injection (PEI), percutaneous acetic acid injection, radiofrequency ablation (RFA), cryoablation, microwave ablation, laserinduced thermotherapy, and high-intensity focused ultrasound. RFA has recently gained interest and is the most widely applied thermoablative technique. RFA allows more effective tumor control in fewer treatment sessions compared with PEI, but with a higher rate of complications. However, there are certain circumstances where PEI therapy represents a better strategy to control liver tumors than RFA, especially in situations where RFA is difficult, for example when large vessels surround the tumor. In the context of hepatocellular carcinoma (HCC), both RFA and PEI are feasible and of benefit in non-operable patients. RFA seems superior to PEI in HCC 2 cm, and the combination of interventions may be of benefit in selected patients. Liver resection is superior to RFA for patients with HCC meeting the Milan criteria, but RFA can be employed in tumors ≤ 3 cm and where there is an increased expected operative mortality. In addition, some lines of evidence indicate that RFA and PEI can be employed as a bridge to liver transplantation. The use of RFA in colorectal liver metastases is currently limited to unresectable disease and for patients unfit for surgery. The aim of this article is to summarize the current status of RFA in the management of liver tumors and compare it to the cheap and readily available technique of PEI.     

Is radiofrequency ablation the treatment of choice for patients with small hepatocellular carcinoma?

Liver resection is widely considered the mainstay of curative therapy for small hepatocellular carcinoma (HCC). Radiofrequency ablation (RFA) was initially developed as a treatment for small HCC in patients with considerable cirrhosis and inadequate liver function reserve for liver resection. However, in some centers, RFA is now used for small HCC, as an alternative to liver resection or even as the preferred treatment. This Practice Point commentary discusses the findings and limitations of a retrospective cohort study by Livraghi et al. that analyzed the outcomes of a group of patients with small, single HCC who underwent treatment with RFA. The authors reported a low major complication rate and a local complete response rate similar to that after resection. This commentary highlights the issues to consider when interpreting and generalizing these results, in particular that these findings need to be interpreted in the light of studies that suggest a high rate of local recurrence and incomplete histopathological response after RFA of small HCC.