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.     

腹腔镜引导定位肝脏肿瘤射频消融治疗的临床观察

目的:探讨腹腔镜直视引导定位下肝癌射频热凝消融治疗(radio-ferquency ablation, RFA)的可行性.方法:在腹腔镜直视引导定位下分别对10例原发性肝癌和多发转移性肝癌进行一次性射频消融治疗.结果:10例患者28个瘤体中直径＜5 cm的20个肿瘤均获得一次性热凝损毁,其中18个瘤体完全缓解CR 90.0%(18/20),2个瘤体部分缓解PR 10.0%(2/20),近期疗效CR+PR为100.0%(20/20),1例术后15个月肝、肺转移复发;8个直径5～9 cm的瘤体近期疗效为CR+PR 100.0%(8/8),CR 50.0%(4/8),PR 50.0%(4/8),1例术后6个月发生肝门部转移及阻塞性黄疸而病情进展死亡,1例术后14个月因肝脏、肺脏广泛转移死亡.术后2周复查AFP、CEA和CA19-9等肿瘤标志均有不同程度的下降或转阴.所有患者均很好地耐受了射频消融治疗,无严重并发症出现.9例患者术后分别行1～4次肝动脉化疗栓塞介入治疗(TACE).1年生存率为85.7%(6/7),2年生存率为50.0%(3/6). 结论:腹腔镜直视引导定位下肝癌射频消融治疗为不能手术的原发性肝癌及多发性肝转移癌提供了一种微创、安全、有效、方便的治疗方法,与TACE结合效果更佳.     

经皮肝穿刺射频消融术对肝癌的疗效观察

目的 观察经皮肝穿刺射频消融术对肝癌的热消融作用及其适应证。方法在局麻或硬膜外麻醉下及B超引导下,射频穿刺电极经皮穿刺入肝癌瘤体内,对其进行消融。结果60例患者的96个瘤体中,直径<3.5 cm的41个(42.7％)瘤体获得一次手术热消融。其中,38个完全缓解(CR),3个部分缓解(PR),有效率(CR+PR)100％。41个瘤体中,36个经CT或MRI随访6～24个月,未见复发。直径≥3.5 cm～12 cm的55个(57.3％)瘤体可分2,3次手术,术后1～3个月CT或MRI提示,瘤体CR 2个,PR 37个,CR+PR70％。结论经皮肝穿刺射频消融术治疗肝癌,对直径<3.5 em的瘤体疗效可靠,对直径≥3.5 cm的瘤体仍具有部分热消融的作用。     

高温射频消融结合放化疗治疗肺部肿瘤的疗效观察

目的 探讨高温射频消融与放化疗联合应用于肺部恶性肿瘤治疗的临床疗效及安全性.方法 选取肺部恶性肿瘤患者90例,采用随机数字表法分为观察组与对照组,各45例.观察组给予射频消融联合放化疗治疗,对照组给予放化疗治疗,对比两组患者治疗后的疗效、肿瘤复发率、生存率、并发症及生活质量.结果 观察组CR为7例,PR为27例,总有效率为75.56%,对照组CR为4例,PR为21例,总有效率为55.56%,观察组总有效率高于对照组,差异有统计学意义(P<0.05);观察组出现白细胞减少、血小板降低、消化道症状、肝肾功能障碍的发生率分别是31.11%、44.44%、46.67%、35.56%,对照组出现白细胞减少、血小板降低、消化道症状、肝肾功能障碍的发生率分别是40.00%、51.11%、53.33%、42.22%,两组患者并发症发生情况比较,差异无统计学意义(P>0.05);观察组肿瘤复发率为4.44%,低于对照组的17.78%(P<0.05);在1年生存率的随访中,观察组生存率为95.56%,高于对照组的82.22%(P<0.05);观察组QOL改善稳定率为88.89%,高于对照组的64.44%(P<0.05).结论 高温射频与放化疗联合治疗肺部肿瘤疗效显著,可显著提高患者生存率及生活质量,值得临床推广.     

CT引导下经皮穿刺射频消融治疗晚期肺部恶性肿瘤6例体会

目的:总结CT引导下经皮射频消融治疗晚期肺肿瘤的经验。方法:6例晚期肺肿瘤患者,CT引导下经皮穿刺射频消融,术后配合全身化学药物治疗,分析其治疗效果、安全性、并发症等。结果:手术成功率100%,术后6例痰中带血、3例少量液气胸及胸痛、2例轻度呼吸困难及中度发热,经对症等处理均自愈;1例肺脓肿并败血症。术后1月CT评价消融效果:完全消融3例（50%）,部分消融3例（50%）,消融有效率100%。术后3月评价近期疗效,除1例术后3月9天死于并发症,其余5例中CR 2例（40%）,PR 2例（40%）,PD 1例（20%）,近期总有效率80%。远期疗效还在进一步治疗及随访中。结论:CT引导下经皮穿刺射频消融治疗晚期肺肿瘤简单、安全、微创、有效,值得推广应用。     

螺旋CT引导肺癌射频消融治疗应用及近期疗效分析

目的:探讨螺旋CT引导下射频消融治疗肺癌的应用,并对近期疗效进行分析。方法:回顾性分析我院2009年12月至2010年12月间收治的行CT引导下射频消融治疗的肺癌病例,总结临床病例资料特点,治疗后1-3月复查胸部螺旋CT、PEC-CT,探讨治疗后并发症及近期作用效果。结果:入组病例38例,其中男性26例,女性12例,平均年龄65岁。这些病例中鳞癌9例,腺癌24例,肉瘤样癌1例,小细胞癌4例。治疗前CT值平均(45.7±13.8)HU,治疗后CT值平均(23.8±11.2)HU,差异有统计学意义(P<0.05)。肿瘤完全缓解5例(CR 13.2%),部分缓解24例(PR 63.1%),稳定7例(SD 18.4%),进展2例(PD 5.3%)。并发症包括:气胸、皮下气肿、发热、血痰,经对症治疗后均好转。结论:CT引导下射频消融具有微创、安全、可重复操作等优点,能够获得满意的局部控制率,有望成为不能接受手术治疗的早期周围型肺癌患者的首选治疗方法,同时能为中晚期肺癌患者提供一种有效的减瘤治疗。     

射频消融联合动脉灌注化疗治疗局部晚期肺癌

目的 探讨CT引导下经皮射频消融(radiofrequency ablation,RAF)联合动脉灌注化疗治疗局部晚期肺癌。方法 29例原发性局部晚期肺癌患者,随机分成两组。A组14例,射频消融前或后一周内行动脉灌注化疗;B组15例,单纯射频消融治疗。两组射频消融患者均在CT引导下、局麻或静脉全麻下行射频消融治疗;消融温度70℃-90℃,治疗时间每次5min-30min。两组患者射频消融治疗2月后常规行螺旋CT平扫或增强检查,按RECIST标准判定疗效并进行生存分析。结果 A组14例共行射频消融22次,其中8例行2次,每例患者射频消融前或后一周内行动脉灌注化疗;B组15例共射频消融治疗29次,其中10例进行2次,2例行3次射频消融治疗。CT复查显示:A组:完全缓解(CR)0例,部分缓解(PR)13例,稳定(SD)1例,进展(PD)0例,治疗有效率92.8%(13/14)。B组:完全缓解(CR)0例,部分缓解(PR)13例,稳定(SD)1例,进展(PD)1例,治疗有效率86.6%(13/15)。两组治疗差异无统计学意义(P＞0.05)。一年生存率分别为85%,76%,生存率差异有统计学意义(P＜0.05)。结论 射频消融联合动脉灌注化疗治疗是治疗局部晚期肺癌一种有效方法,近期疗效确切、远期效果需进一步观察。     

CT引导下射频消融治疗中晚期非小细胞肺癌的近期疗效观察

背景与目的 近年来,射频消融术(Radio-Frequency Ablation,RFA)作为一种新的局部治疗手段运用于肺部肿瘤的治疗.取得了很好的临床效果.本文探讨CT引导下射频消融治疗中晚期肺癌的临床价值.方法 对66例中晚期非小细胞肺癌的68个病灶(其中2例病人各治疗2个病灶)在三维重建CT引导下进行射频消融治疗,观察近期疗效.结果 66例病人经CT引导下射频消融,即刻及1个月复查CT提示病灶阴影增大.而64个病灶CT值降低,占94.1%,4个病灶CT值增加,占5.9%.1个月复查SPECT提示T/N降低至正常值以下的患者占82.4%(56/68).治疗后3个月CT扫描显示在68个肿瘤中,没有肿瘤完全消失(CR)者,肿瘤缩小者(PR)73.5%(50/68),肿瘤无变化者(SD)2.9%(2/68),肿瘤增大者(PD)8.8%(6/68),6例增大的病灶进行了第2次消融;3个月复查SPECT提示T/N降低至正常值以下的患者占79.496(54/68).无严重并发症,无围手术期死亡.结论 CT6[导下射频消融治疗中晚期非小细胞肺癌安全可行,近期疗效明显.     

冷循环射频消融治疗肝脏肿瘤42例报告

探讨冷循环射频消融治疗肝脏肿瘤的可行性和有效性。应用冷循环电极射频消融治疗42例肝脏肿瘤60个结节。37例在局麻超声引导下、2例在腹腔镜辅助下和3例在开腹术中行射频消融,射频消融治疗75点次。治疗后通过CT和MR随访,随访时间2～14个月,肿瘤完全低密度灶者占70%(42/60),增强扫描局部病灶有强化(残留或复发)8.3%(5/60)。初步研究结果提示,冷循环射频消融治疗肝脏肿瘤是有效和安全的。     

51例肺癌经皮射频消融治疗疗效及预后因素分析

摘 要：［目的］ 评价应用经皮射频消融治疗肺癌的疗效和安全性,并分析影响其预后的因素。［方法］ 将随访资料完整的51例肺癌患者纳入分析,应用经皮射频消融进行治疗,评价近期及远期疗效和治疗并发症。应用Kaplan-Meier法和多因素Cox模型分析全组患者的生存预后情况。［结果］ 全组患者获CR4例（7.8%）,PR 31例(60.8%),SD 11例(21.6％),PD 5例(9.8%)。疾病控制率为90.2%。随访0.5~3年,随访率为92.7％。0.5、1、2、3年的生存率分别为53％、32%、16％和4%,中位总生存时间(OS)为19.2个月。21例出现并发症,术中出现气胸１例,咯血3例。其他术后并发症包括胸部疼痛2例、术后发热15例。Cox多因素分析显示,肿瘤直径、临床分期、有无结合化疗和KPS评分是影响预后的独立因素。［结论］ 经皮射频消融治疗肺癌近期和远期疗效均较好,并发症可耐受;肿瘤直径、KPS评分、临床分期、有无结合化疗可能是影响经皮射频消融治疗肺癌预后的因素。     

FEM analysis of RF breast ablation: multiprobe versus cool-tip electrode

BACKGROUND: Radio-frequency ablation (RFA) has recently received much attention as an effective minimally invasive strategy for the local treatment of tumors. The purpose of this study was to evaluate the efficacy of single-needle cool-tip RF breast ablation in terms of temperature distribution and duration of the procedure as compared to multiprobe RF breast ablation. MATERIALS AND METHODS: Two different commercially available radiofrequency ablation needle electrodes were compared. Finite-element method (FEM) models were developed to simulate the thermoablation procedures. A series of ex vivo radiofrequency thermal lesions were induced to check the response of the FEM calculations. RESULTS: Data obtained from FEM models and from ex vivo procedures showed that cool-tip RF breast ablation assures better performances than multiprobe RF breast ablation in terms of temperature distribution and duration of the procedure. Histopathological analysis of the cool-tip RF thermoablated specimens showed successful induction of coagulation necrosis in the thermoablated specimens. CONCLUSION: Data obtained from FEM models and from ex vivo procedures suggest that the proposed cool-tip RF breast ablation may kill more tumor cells in vivo with a single application than the multiprobe RF breast ablation.     

规范化射频消融治疗肝脏肿瘤

目的 探讨规范化射频消融治疗肝脏肿瘤的疗效、适应证、并发症和治疗规范.方法 严格按照术前评估、术中完全损毁和术后即时评价的规范化操作程序,对421例肝脏肿瘤患者进行冷循环射频消融治疗,共634处病灶,行射频消融1121次.结果 全组421例患者无术中死亡.全部634处病灶中有514处完全消融,占81.1%.其中最大径＜3 cm病灶的完全消融率为91.4%(382/418),3～5 cm病灶为78.9%(97/123),>5 cm病灶为37.6%(35/93).术后有147例(34.9%)出现一过性发热,136例(32.3%)出现腹痛,38例(9.0%)出现恶心,12例(2.9%)出现胸腔积液,2例(0.5%)出现肝脓肿,1例(0.2%)出现胆漏.结论 规范化射频消融治疗肝脏肿瘤效果确切,无严重并发症发生.     

High operative risk of cool-tip radiofrequency ablation for unresectable pancreatic head cancer

BACKGROUND AND OBJECTIVES: To report and discuss the effect, complications and mortality of cool-tip radiofrequency ablation (RFA) for unresectable pancreatic cancer. METHODS: During October 2003 to July 2004, sixteen patients with unresectable pancreatic cancer were treated by open cool-tip RFA. One-half of the 16 patients had tumors located in the pancreatic head. A 5-mm minimum safe distance between RFA site and major peripancreatic vessels was kept to avoid injury to the vessels. RESULTS: Six of twelve patients with back pain got pain relief postoperatively. Pancreatic fistula occurred in three patients (18.8%) and healed smoothly in 7-10 days with routine abdominal drainage. The mortality was 25% (4/16). In the four death cases, tumors were all located in the pancreatic head; three patients with tumor close to portal vein died suddenly of massive gastrointestinal hemorrhage on the 4th, 30th, 40th postoperative day respectively and a 79-year-old patient died of acute renal failure on the 2nd postoperative day. CONCLUSIONS: Standard use of cool-tip RFA was dangerous for pancreatic head cancer close to portal vein, in which a 5-mm minimum safe distance between RFA site and major peripancreatic vessels might not be enough to avoid injury to the vessels.     

冷极射频消融术治疗放化疗后进展的非小细胞肺癌

目的：探讨冷极射频消融术治疗放化疗后进展的非小细胞肺癌的疗效及安全性.方法：选择30例放、化疗后进展的非小细胞肺癌患者,CT引导下采用冷极射频消融治疗,术后1个月和每3个月复查CT观察有无残留和复发,必要时可多次治疗,通过影像学评价疗效,观察术中、术后并发症.结果：30例患者在CT引导下消融针均准确穿刺,进入肿瘤预定位置并顺利完成消融过程,未见严重并发症.行冷极射频术后1个月复查胸部CT发现大多数肿瘤较术前有不同程度的缩小、坏死、密度减低.根据影像学表现,肿瘤完全坏死10.0%（3/30）,不完全坏死40.0%（12/30）,部分坏死23.3%（7/30）,总有效率73.3%（22/30）.结论：冷极射频消融术是肺癌治疗行之有效的治疗措施之一,疗效确切、安全可靠、创伤小,并可重复治疗.     

Radiofrequency Ablation for Liver Metastases after Transarterial Chemoembolization: A Systemic Analysis

Background: This systemic analysis was conducted to evaluate tumor recurrence rate and one-year survivalrate for patients with liver metastases received radiofrequency ablation after transarterial chemoembolizationand introduce a new method of radiofrequency ablation by puncture navigation technology for single livermetastases after transarterial chemoembolization. Materials and Methods: Clinical studies evaluating tumorrecurrence rate and one-year survival rate. Appling the innova trackvision software to process one liver metastasesreceived transarterial chemoembolization and using radiofrequency ablation by puncture navigation technologyto treat the liver metastases. Results: 3 clinical studies which including 235 patients with liver metastasesafter transaeterial chemoembolization were considered eligible for inclusion. Systemic analysis suggested thattumor recurrence rate was 23% (54/235), one-year survival rate was 76% (178/235). The new procedure wasperformed successfully and the patient received a good prognosis. Conclusions: This systemic analysis suggeststhat radiofrequency ablation is a good method for liver metastases after transarterial chemoembolization andcould receive a relatively good prognosis.     

左、右半结肠癌肝转移患者射频消融治疗疗效及生存的对比分析

目的:探讨原发部位分别位于左、右半结肠的结肠癌肝转移患者行超声引导下肝转移瘤射频消融术后的生存差异及预后影响因素分析。方法:回顾性分析2010年1月至2015年12月于我科行射频消融治疗的结肠癌肝转移患者100例,其中左半结肠癌62例,右半结肠癌38例,分析原发部位不同的结肠癌肝转移患者在进行超声引导下射频消融治疗后的生存情况。结果:左半结肠癌肝转移患者射频消融术后1、3、5年总体生存率及中位生存期均高于右半结肠癌肝转移患者（88.71% vs 73.68%、62.90% vs 30.02%、49.72% vs 26.33%、55个月 vs 23个月）,且二者生存曲线差异具有统计学意义（P＜0.05）。经Log-rank检验及COX多因素分析,左、右半结肠癌肝转移患者射频消融治疗术后的生存情况存在差异。此外,原发灶淋巴结转移情况、患者术前CA199水平及原发灶分化程度是患者射频消融治疗术后生存情况的影响因素。结论:左半结肠癌肝转移患者射频消融术后整体生存率明显高于右半结肠癌肝转移患者,左半结肠癌与右半结肠癌肝转移患者在射频消融治疗术后生存状况存在明显差异。     

术中超声在冷循环射频治疗肝脏肿瘤中的作用

Objective:To explore the feasibility and efficiency of intraoperative ultrasonography (IOUS) in the cool-tip radiofrequency ablation (RFA) of hepatic carcinoma.Methods:Thirty-one patients of hepatic carcinoma were enrolled in this study.In the process of open-surgical cool-tip radiofrequency ablations,tOUS was applied to assess the hepatic lesions,guide and monitor the process of RFA in real-time.Results:Under the guidance of intraoperative ultresonography,the open surgical RFA in all patients proceed smoothly.Seven additional hepatic lesions were found that were not detected in preoperative imaging.A false positive focal lesion reported by preoperative MRI was accurately ruled out by IOUS.Conclusion:Intraoperative ultrasonography is superior to ordinary imaging techniques in finding missed lesions,avoiding complications such as injuries of bile ducts and vessels.Monitoring the real-time RFA process thereby obviously optimizing the treatment of hepatic carcinoma.     

Risk factors for local progression after percutaneous radiofrequency ablation of lung tumors: evaluation based on a preliminary review of 342 tumors

BACKGROUND: The purpose of the study was to retrospectively evaluate the risk factors for local progression after percutaneous radiofrequency (RF) ablation of lung tumors. METHODS: The study included 128 patients (77 men, 51 women; mean age, 61.3 years) with 342 tumors (25 primary and 317 metastatic lung neoplasms; mean long-axis diameter, 1.7 cm) treated with RF ablation. The overall primary and secondary technique effectiveness rates were estimated using Kaplan-Meier analysis. Multiple variables were analyzed using the log-rank test, followed by multivariate multilevel analysis to determine independent risk factors for local progression. The primary and secondary technique effectiveness rates were again estimated when considering only tumors without independent risk factors. RESULTS: The median follow-up period was 12 months (range, 6-47 months). The overall primary and secondary technique effectiveness rates were 72% and 84% at 1 year, 60% and 71% at 2 years, and 58% and 66% at 3 years, respectively. Larger tumor size (hazard ratio [HR], 1.97; 95% confidence interval [95% CI], 1.47-2.65; P < .00001) and the use of an internally cooled electrode (HR, 2.32; 95% CI, 1.10-4.90; P = .027) were assessed as independent risk factors for local progression. The primary and secondary technique effectiveness rates when considering tumors smaller than 2 cm and treated with a multitined expandable electrode were 89% and 89% at 1 year and 66% and 78% at 2 years, respectively. CONCLUSIONS: Larger tumor size and the use of an internally cooled electrode were independent risk factors for local progression after RF ablation of lung tumors.     

三原发恶性肿瘤14例临床分析

目的:分析三原发恶性肿瘤的发病、诊断、治疗及预后情况.方法:回顾性分析14例三原发恶性肿瘤的临床资料,随访患者的生存状态.结果:男性 10 例,中位发病年龄67.5岁,女性4 例,中位发病年龄72岁;合并肿瘤相关家族史2 例,既往吸烟史 5例(全部为男性),中位吸烟指数600;第三原发肿瘤距离第二原发肿瘤间隔时间,7例<7个月,其余均大于24个月,第二原发肿瘤距离第一原发肿瘤间隔时间,3例<7个月,其余均大于15个月;消化系统恶性肿瘤发病部位占全部47.6%,发病率远高于其他部位;上皮性恶性肿瘤占全部发病部位的90.5%;治疗方法中手术为主的治疗比例为61.9%,以化疗、放疗等为主的综合治疗为26.2%,0.07%的病例放弃治疗,且均发生在诊断第三原发恶性肿瘤时;14例三原发恶性肿瘤患者中位生存时间184个月.结论:综合治疗有助于提高患者的总生存时间,早期发现及采用综合治疗手段可改善三原发恶性肿瘤患者的预后.