泌尿、生殖系统（071555～071584）

071555 集束电极射频热毁损治疗肾上腺转移癌37例；071556 树突状细胞瘤内注射联合放疗对小鼠肾癌组织bcl-2和bax表达的影响；071557 KAI-1、Ki-67和HER-2／neu表达在T1～3 NoMo肾癌术后转移中的意义；071558 HIF-1α和HIF-2α在肾透明细胞癌中的表达及意义；071559 嗜铬细胞瘤围手术期诊疗的改进……[第一段]     

应用冷循环集束电极射频治疗晚期肝癌的疗效观察

[目的]观察冷循环集束电极射频治疗晚期肝癌的效果。[方法]冷循环集束电极射频治疗38例晚期肝癌，术后每月复查CT观察病变区液化坏死和病灶缩小情况以及增强扫描是否强化、患者生存质量及AFP变化。[结果]术后1个月CT显示全部病灶均出现部分液化坏死及CT扫描不强化，3个月后CT扫描5例患者肿瘤完全坏死。其余大部分坏死。全部患者术后1个月KPS评分均提高10分以上。随访AFP变化与肿瘤毁损情况一致。术后CT复查病灶液化坏死范围大或病灶缩小明显的病例AFP下降显著。[结论]冷循环集束电极射频治疗是一种安全、有效、耐受性好的晚期肝癌治疗技术。初步结果显示该治疗能够提高患者生存质量、延长生存期，值得深入研究并推广。     

经皮射频毁损治疗肝脏肿瘤的近期疗效观察

目的：观察经皮射频毁损治疗肝脏肿瘤的近期疗效,探讨其最佳适应证和治疗相关因素。方法：应用RF2000型射频治疗仪、LeVeen多弹头射频电极,超声引导下经皮穿刺毁损,对60例肝脏肿瘤患者（87个肿瘤）进行了72次治疗,分别观察其毁损范围、AFP水平、肝功能反应、并发症等。结果：原发性肝癌肿瘤直径小于5cm者1次性完全毁损61.11%（11/18）,3例2次治疗1例完全毁损范围扩大,均未完全毁损;肿瘤直径5-10cm者31例2例1次性完全毁损（6.45%）,其余均大部或部分毁损,2次治疗6例毁损范围扩大,均未完全毁损;直径大于10cm者11例1次治疗仅部分毁损,2次治疗2例仍有较大肿瘤组织残余。转移癌均为多发,肿瘤结节2-8个不等,1次治疗均未完全毁损,1例2次治疗效果不明显。术后复查,38例原发性肝癌（PHC）AFP升高者,15例AFP明显降低（39.47%）,肿瘤直径小于5cm者AFP下降率为76.92%（10/13）,5例完全阴转（38.46%）。所有患者均出现轻度的肝功能损害;并发自限性腹腔出血2例,胆漏、气胸各1例;3例肝硬化明显、且毁损范围较大者并发中、少量腹水,内科治疗均恢复。结论：经皮射频毁损治疗肝脏肿瘤是一安全有效的治疗方法,直径小于5cm的PHC或转移癌多可完全毁损,直径大于5cm者分次治疗,能明显减小肿瘤体积。     

射频消融联合TACE治疗肝癌肾上腺转移

目的 探讨射频消融联合TACE治疗肝癌肾上腺转移的可行性、治疗效果及并发症。方法 回顾分析2006年7月—2010年3月,13例在我院行经射频消融联合TACE治疗的肝癌肾上腺转移患者,所有患者均经病理证实,其中2例为胆管细胞癌,10例为肝细胞癌,1例为混合细胞癌,均先行肝及肾上腺病灶的TACE术,其后8~18日行肾上腺肿瘤射频消融术。术后增强CT或MR复查病灶。结果 在治疗过程中患者耐受良好,无严重并发症发生,13例病例中有9例即70%(9/13)的患者病灶完全坏死,2例即15%(2/13)的患者病灶进展。病灶小于5 cm的患者8例中,7例即87%(7/8)的患者病灶完全坏死。并发症情况如下:1例患者发生术中高血压(220/115 mmHg),1例右肾上腺转移瘤的患者临近病灶的肝脏部分被消融,1例出现少量血气胸。结论 射频消融联合TACE治疗肝癌肾上腺转移瘤,是较为有效的治疗方法,安全性及患者的耐受情况良好,明显减少射频消融术后出血,消融范围充分、明确。     

RF2000型及RF3000型射频治疗仪疗效的实验对比

目的　实验研究RF2 0 0 0型及RF30 0 0型射频治疗仪治疗效果的区别。方法　将正常小猪 12头随机分为两组 ,A组用RF2 0 0 0型射频治疗仪行集束电极热毁损治疗 ,B组RF30 0 0型射频治疗仪行集束电极热毁损治疗 ,C组为离体猪肝 6个 ,用RF2 0 0 0型射频治疗仪行集束电极热毁损治疗 ,D组为离体猪肝 6个 ,用RF30 0 0型射频治疗仪行集束电极热毁损治疗 ,治疗后分别统计。结果　A组的治疗时间为 8± 1 3min ,坏死直径 4 7± 0 9cm ,最大使用能量 90W ;B组的治疗时间为 6± 1 8min ,坏死直径 4 5± 0 6cm ,最大使用能量15 0W ;C组离体猪肝的治疗时间为 6± 1 4min ,坏死直径 5 5± 0 7cm ,最大使用能量 4 0W ,D组离体猪肝的治疗时间为 4± 1 0min ,坏死直径 5 1± 0 3cm ,最大使用能量 6 0W。结论　RF2 0 0 0型及RF30 0 0型射频治疗仪治疗时 ,除治疗时间有差异外 ,其他无明显差异。     

射频加热联合放疗治疗颈部淋巴结转移癌

目的:观察射频加热联合放疗治疗颈部淋巴结转移癌的临床疗效,以期为此类患者的诊疗提供参考.方法:分析2015年至2016年在我院接受治疗的颈部淋巴结转移癌患者的临床资料.依据治疗方案不同将患者分为观察组(射频热疗+放疗)41例及对照组(放疗)40例.对比两组短期治疗有效率、肿瘤标志物改变及治疗后复发情况.结果:观察组患者治疗有效率显著高于对照组患者(χ2=4.313,P=0.038).治疗后,两组患者外周血CEA、CYFRA21-1及SCC-Ag水平均显著降低(P<0.05),但观察组患者低于对照组(P<0.05).观察组患者治疗后6个月颈部淋巴结转移癌复发率显著低于对照组(4.88%,2/41 vs 19.44%,7/36;Log-rank χ2=3.995,P=0.046).结论:在颈部淋巴结转移癌的放射治疗中,联合使用射频加热治疗可显著提高疗效,值得临床推广.     

集束电极射频治疗肺癌手术并发症及其处理

目的 探讨集束电极射频热凝固治疗肺癌的手术并发症及其发生的原因、处理方法和预防措施。方法 肺癌54例，62个病灶，CT引导下经皮肺穿刺将射频电极插入肺癌病灶行热凝固治疗。术中及术后密切观察，对并发症发生者予以积极处理。结果 54例患者的术中并发症：咳嗽ll例，气胸9例，血压下降7例，贴电极处皮肤灼伤4例，穿刺点持续渗血2例，呃逆2例及寒战l例，经处理后均不需中断手术。术后的常见并发症为发热，l例出现术后气胸。结论 集束电极射频热凝固治疗术中最常见并发症为咳嗽，最严重并发症为气胸：术后常出现发热。应采取积极的防治措施，才能保证手术的顺利进行。     

高温射频消融治疗周围型肺部恶性肿瘤

目的CT引导经皮肺穿刺高温射频消融治疗89例周围型肺部恶性肿瘤的近期疗效观察.方法集束聚能刀高温射频消融治疗89例周围型肺部恶性肿瘤,包括原发性周围型肺癌65例,肺转移癌24例,共计226个肿瘤.结果胸部CT或X线平片复查,肿瘤经射频消融治疗后绝大多数病例的肿瘤在3个月左右明显缩小(CR+PR,82.0%).术后并发症包括气胸32例、少量血胸3例和局部疼痛15例.结论高温射频消融治疗周围型肺部恶性肿瘤,近期疗效确切,严重并发症少,是一种较为安全有效的治疗方法.     

多电极射频治疗42例小肝癌疗效观察

目的:探讨多电极射频疗法对小肝癌的治疗效果.方法:应用直径3.5cm多电极射频针在B超引导下经肋间或肋下经肝实质刺入肿瘤组织中.射频针的十根电极呈“伞形”分布,一次烧灼后形成直径3.5m～3.9cm,高度为1.2cm～1.5cm的半球形毁损区,重复多次直至将肿瘤区域完全覆盖.结果:42例患者行多电极射频治疗,23例AFP阳性患者,术后2月内全部转阴.病灶内动静脉血流频谱均消失,5例患者行肝动脉造影,也证实肿瘤内血供消失.术后3月复查,肿瘤均有所缩小,最大达1/2.所有患者均存活超过3个月.结论:多电极射频治疗将来可代替手术切除成为小肝癌治疗的首选方法.     

射频消融治疗腹膜后和盆腔恶性肿瘤

[目的]探讨射频消融治疗腹膜后和盆腔恶性肿瘤的疗效和安全性.[方法]腹膜后和盆腔恶性肿瘤患者9例,均为单发病灶.其中原发性肾上腺梭形细胞瘤术后复发1例,软骨肉瘤术后腹膜后转移2例,肺癌、恶性胸腺瘤术后1例,胰腺癌腹膜后转移1例,直肠癌和子宫颈癌术后盆腔转移各1例.CT引导下进行射频消融术.[结果]腹膜后和盆腔肿块射频消融术共19次,平均2.1次.9例患者临床症状不同程度减轻或消失,临床缓解率100%.增强CT复查完全热凝固坏死4例,不完全坏死3例,部分坏死2例.患者术中较好地耐受治疗,术后未发生严重并发症.[结论]射频消融治疗腹膜后和盆腔恶性肿瘤安全,对直径小于6cm的肿瘤疗效确切.     

Radiofrequency ablation permits an effective treatment for colorectal liver metastasis.

BACKGROUND: Radiofrequency ablation (RFA) has become an important adjunct to modern liver surgery. However, scant knowledge on long-term outcome of RFA for colorectal liver metastasis is available, nowadays. METHODS: This is a prospective clinical study of patients with liver metastasis of colorectal cancer who were treated by RFA between April 1, 1998, and November 30, 2004. Forty-seven patients with 147 liver metastases were treated with RFA in a total of 70 interventions. A metastasis resection was not feasible in 80% of the interventions. All the patients were followed up at regular intervals with contrast-enhanced computed tomography (CT) and laboratory tests including carcinoembryonic antigen (CEA). RESULTS: No RFA-related mortality occurred. The median follow-up time after the diagnosis of liver metastasis was 33 months. The RFA-related morbidity was 7%. After the RFA, the expected median overall survival rate is, to date, 39 months. Overall survival rates at 1, 2 and 3 years were 88%, 80% and 57%, respectively. Local recurrence rates reached 8.8% overall and 1.6% for metastasis smaller than 3cm in diameter. No local recurrence occurred for metastasis smaller than 3cm in diameter if treated with the newest RFA device. CONCLUSIONS: Excellent local tumour control was achieved with radiofrequency ablation of small liver metastasis. The expected overall survival rate of patients with RFA for unresectable or non-resected colorectal liver metastasis improved in comparison with the survival rate reported following the natural course (best supportive care) or chemotherapy. The low local recurrence rate of metastases of less than 3cm challenges the results obtained by the more invasive treatment of conventional liver surgery.     

Bilateral adrenal leiomyosarcoma treated with multiple local therapies

A 62-year-old woman presented with right flank pain, and computed tomography (CT) showed bilateral adrenal tumors (right, 8 cm; left, 4 cm). There were no abnormal findings on physical examination, and adrenal hormone levels in serum and urine were within normal limits. Radiological studies showed a right adrenal tumor with intratumoral hemorrhage, a cystic tumor in the left adrenal gland, and no sign of distant metastasis. Because laboratory tests showed normal levels of adrenal hormones, we considered the tumors to be nonfunctioning adrenal tumors. The right adrenal tumor was surgically removed because it was thought to be malignant, and histological examination revealed that it was a leiomyosarcoma. Postoperative CT showed a pleural metastasis in the right chest wall. The patient received combination chemotherapy with cyclophosphamide, vincristine, adriamycin, and dacarbazine. The metastasis was also treated with radiofrequency ablation (RFA). Because the left adrenal tumor grew rapidly despite two courses of the chemotherapy, it too was surgically removed. After the operation, metastasis in the right iliac bone was treated with RFA and radiotherapy. Positron emission tomography detected bilateral femoral metastases, and these were treated with radiotherapy in combination with a low dose of cisplatin. A liver metastasis and a small metastasis in the left kidney were treated with RFA and a metastasis in the pancreatic tail was removed surgically. Sixteen months after the right adrenalectomy, the patient died due to systemic spread of the disease. Multiple local treatments including RFA, radiotherapy, and resection were effective for the local control of metastatic lesions of adrenal leiomyosarcoma.     

射频消融治疗全肺切除术后转移癌:5例临床分析

目的:回顾性评价CT引导下经皮射频消融(radiofrequency ablation, RFA)治疗全肺切除术后转移癌的可行性、有效性和安全性。方法:2010年01月至2022年05月,5例单肺转移癌患者(5例男性,平均年龄59.6岁),共接受了8次RFA治疗。4例患者为原发肺癌术后转移癌,1例患者为肾盂输尿管肿瘤肺转移。其中2例患者因肿瘤局部复发而分别接受了2次和3次RFA。8个RFA治疗的肿瘤大小2.0～5.0 cm(平均3.0 cm)。根据RFA后立即进行的CT检查及临床随访结果评估RFA治疗全肺切除术后转移癌的可行性、有效性及安全性。结果:术后并发症包括气胸(37.5%)、胸痛(37.5%)以及以低热为主要表现的消融后综合征(25.0%)。没有一例患者在手术期间或RFA后30天内死亡。死亡病例存活期分别为3个月、25个月、33个月。1例首次RFA后38个月随诊仍然生存,1例术后3个月随诊仍然生存。结论:RFA可以在全肺切除术后提供局部肿瘤控制,并且可以重复射频。RFA治疗全肺切除术后转移癌安全、可行、有效。     

Endoscopic radiofrequency ablation for liver metastasis of colorectal cancer

The application of radiofrequency ablation (RFA) for liver metastasis of colorectal cancer has not yet acquired an established status in clinical cancer therapy research. Removing as much tumor tissue as possible is desirable, but some cases do not allow optimal surgical ablation due to general condition of the patient and tumor status. We introduced endoscopic RFA for liver cancer in 2003, and have applied the procedure to 6 cases with H1 or H2 liver metastases of colorectal cancer to which surgical ablation could not be applied due to the poor general health of patients. Mean tumor diameter was 22.9 mm, and mean number of tumors per patient was 1.2. Tumor location was: S4, n = 2; S5, n = 1; S4, n = 1; S7, n = 2; and S8, n = 1. Mean frequency of session was 3.0. No complications occurred in any cases, and no reoperations were required. Although no recurrence of tumors in the vicinity of ablation was observed, 2 cases of each lung metastasis and intrahepatic recurrence were identified. Intrahepatic recurrence underwent hepatic arterial infusion (HAI) chemotherapy for simultaneous metastatic hepatic tumors (H2) prior to RFA, and relapses occurred in the metastatic focus where the efficacy of HAI was observed. At this point, 2 deaths were reported, 1 each from cancer and other diseases, and mean duration of survival after the procedure was 451.2 days. These results indicate that endoscopic RFA with good local control should be an available treatment for cases involving colorectal cancer with metastasis to the liver in which surgical ablation is difficult to apply.     

No-touch射频消融术治疗小肝癌的安全性和短期疗效

目的:探讨No-touch射频消融术治疗小肝癌患者的安全性和短期疗效。方法:本研究共纳入65例信阳市中心医院小肝癌患者，23例采用No-touch射频消融术治疗，42例采用常规射频消融术（radiofrequency ablation，RFA）治疗。比较和分析治疗并发症和无瘤生存率。结果:两组间基线混杂因素无显著差异。No-touch射频消融术的消融体积显著高于常规射频消融术（P=0.043），但两种技术的剩余肝脏体积和治疗并发症相同（分别为P=0.670和P=1.000）。Kaplan-Meier生存曲线显示:No-touch射频消融组的总体生存率显著高于常规组（P=0.048）。结论:No-touch射频消融术比传统射频消融术具有更高的短期总体生存率，而与传统射频消融术一样安全。     

Radiofrequency ablation and percutaneous ethanol injection in patients with small hepatocellular carcinoma: a comparative study

BACKGROUND: Radiofrequency ablation (RFA) is a novel thermal ablation technique to achieve coagulative necrosis of hepatocellular carcinoma. A study was conducted to compare the antitumor effect and adverse effect of RFA with those of percutaneous ethanol injection (PEI) in patients with solitary small hepatocellular carcinoma. METHODS: The study population consisted of 119 consecutive patients with solitary hepatocellular carcinoma smaller than 3 cm in diameter. Among these, 23 patients were treated with RFA and the remaining 96 patients were treated with PEI. The antitumor effects of both treatments were assessed by contrast-enhanced computed tomography 1 month after treatment. RESULTS: Complete tumor necrosis was achieved in 23 patients (100%) of the RFA group and 90 patients (94%) of the PEI group (p = 0.48) and local recurrence rates at 1 year were 15% in the RFA group and 14% in the PEI group (p = 0.80). RFA required an average of 1.5 sessions to achieve complete necrosis, whereas PEI required an average of 4.0 sessions. As a consequence, the hospital stay in the RFA group (median 10 days) was significantly shorter than that in the PEI group (median 17 days). There were no serious adverse effects or complications except for one case of cholangitis in the PEI group, although deterioration of serum transaminase after RFA was significantly more severe than that after PEI. CONCLUSION: RFA achieved complete tumor necrosis for small hepatocellular carcinoma with fewer treatment sessions compared with PEI. There were no serious complications.     

Radiofrequency versus microwave ablation for intraoperative treatment of colorectal liver metastases

IntroductionIntraoperative radiofrequency ablation (RFA) and the newer technique of microwave ablation (MWA) can both be of additional value in parenchyma preserving surgical treatment of colorectal liver metastases (CRLM). MWA is less influenced by the heat-sink effect of surrounding vessels and can generate more heat in less time but RFA is still widely used. True comparing studies are scarce.MethodsThis single centre retrospective cohort study analyzed patients who underwent ultrasound guided intraoperative ablation as a part of the surgical treatment of CRLM between 2013 and 2018. In September 2015, MWA was substituted for RFA. Outcomes included unsuccessful ablation rates at 1-year postoperative, 30-days major complication rates, progression free survival (PFS) and overall survival (OS). Logistic regression models were used for univariable and multivariable analyses to identify predictors of unsuccessful ablation.ResultsForty-one patients underwent RFA of 98 lesions (median 2) and 79 patients underwent MWA of 193 lesions (median 2). The median diameter of the ablated lesions was 9 mm for both RFA and MWA. Unsuccessful ablation was observed in 7 metastases (7.1%) after RFA and 14 metastases (7.3%) after MWA (p = 1.000). Complications requiring re-intervention were observed after 8 procedures, 2 complications in the RFA group (4.9%) versus 6 complications in the MWA group (7.6%, p = 0.714), of which 6 were liver-related. Ninety-day mortality did not occur. Ablation technique was not associated with unsuccessful ablations. CRLM size was associated with unsuccessful ablation in the per lesion analysis (p < 0.001).ConclusionIntraoperative RFA and MWA were equally effective for treatment of small CRLM.     

Local progression after radiofrequency ablation for pulmonary metastases

BACKGROUND:

Local treatment for pulmonary metastases is considered to be a reasonable treatment option in patients with oligometastatic disease. Percutaneous radio frequency ablation (RFA) has been reported as an alternative to surgery. Results of RFA for local control of pulmonary metastases were evaluated.

METHODS:

All consecutive patients treated with RFA for pulmonary metastases (2004‐2009) were included. RFA was performed percutaneously under computed tomographic guidance. Follow‐up was scheduled at 1, 3, and 6 months after treatment and every 6 months thereafter. Major outcome parameters were local and any‐site progression, complications, and survival.

RESULTS:

Ninety pulmonary metastases were treated, in 46 patients at 65 sessions. Many patients had recurrent metastases after previous surgery (n = 36 of 46). Pneumothorax occurred in 34% (chest drain in 25%) and major complications in 6%. After median follow‐up of 22 months (range, 2‐65 months), 25 local progressions occurred after RFA; the 2‐year local progression rate per lesion was 35%. Overall survival at 3 years was 69%.

CONCLUSIONS:

Notwithstanding its relatively low morbidity, follow‐up after RFA for pulmonary metastases shows a considerable rate of local progression. The role of local ablation techniques for long‐term disease control in oligometastatic disease is discussed. Cancer 2011. © 2011 American Cancer Society.     

Microwave ablation is as effective as radiofrequency ablation for very-early-stage hepatocellular carcinoma

Background: Percutaneous radiofrequency ablation (RFA) is a first-line treatment for very-early-stage hepatocellular carcinoma (HCC), whereas the efficacy of percutaneous microwave ablation (MWA) for very-early-stage HCC remains unclear. The purpose of this study was to clarify this issue by comparing the safety and efficacy of percutaneous MWA with percutaneous RFA in treating very-early-stage HCC. Methods: Clinical data of 460 patients who were diagnosed with very-early-stage HCC and treated with percutane-ous MWA or RFA between January 2007 and July 2012 at the Eastern Hepatobiliary Surgery Hospital, The Second Mili-tary Medical University, in Shanghai, China were retrospectively analyzed. Of these 460 patients, 159 received RFA, 301 received MWA. Overall survival (OS), recurrence-free survival (RFS), local tumor progression (LTP), complete ablation, and complication occurrence rates were compared between the two groups, and the prognostic factors associated with survival were analyzed. Results: No significant differences were observed between the two groups in terms of the 1-, 3-, or 5-year OS rates (99.3%, 90.4%, and 78.3% for MWA vs. 98.7%, 86.8%, and 73.3% for RFA, respectively;P= 0.331). Furthermore, no signif-icant differences were observed between the two groups in terms of the corresponding RFS rates (94.4%, 71.8%, and 46.9% for MWA vs. 89.9%, 67.3%, and 54.9% for RFA, respectively;P= 0.309), the LTP rates (9.6% vs. 10.1%,P= 0.883), the complete ablation rates (98.3% vs. 98.1%,P= 0.860), or the occurrence rates of major complications (0.7% vs. 0.6%,P= 0.691). By multivariate analysis, LTP, antiviral therapy, and treatment of recurrence were independent risk fac-tors for OS (P < 0.001), and the alpha-fetoprotein level was an independent prognostic factor for RFS (P= 0.002). Conclusions: MWA is as safe and effective as RFA in treating very-early-stage HCC, supporting MWA as a first-line treatment option for this disease.