射频消融治疗化疗栓塞后肝癌

目的 评价射频消融治疗化疗栓塞后肝癌的临床疗效.方法 97例经病理证实的原发性肝癌患者在经过多次栓塞后仍有肿瘤残余,且均存在无法再栓塞的困难.所有患者均予CT导引下的肿瘤射频消融术.术后监测AFP的动态变化及肝脏CT或MRI的结果来评价疗效.结果 93例(96%)患者在12个月随访内无肿瘤复发征象,仅有4例患者出现了局灶复发和远处转移.结论 化疗栓塞术结合射频消融术是治疗肝癌的一种有效的联合治疗手段.     

多次肝动脉化疗栓塞术联合射频消融在肝癌治疗中的临床应用

目的评价多次肝动脉化疗栓塞(TACE)联合射频消融(RFA)治疗肝癌的临床疗效。方法对经多次TACE治疗后仍有肿瘤残余的10例肝癌患者分别行B超引导下射频消融治疗,术后随访监测甲胎蛋白(AFP)的动态变化及肝脏CT表现来评价疗效。结果 RFA治疗后3~6个月,生存率为100%,其中9例患者AFP<400 ng/mL,CT检查无肿瘤复发征象者8例,有肿瘤复发征象者2例。9~12个月复查,8例患者AFP<400 ng/mL,CT增强扫描未发现肿瘤复发征象;有肿瘤复发征象的患者2例,再次行射频消融治疗。8例患者随访时间达到24个月,其中6例患者AFP<400 ng/mL,CT增强扫描未发现肿瘤复发者7例;1例患者死亡。结论多次TACE联合射频消融为中晚期肝癌治疗提供了新的治疗思路与途径。     

肝动脉化疗栓塞联合CT引导射频消融序贯治疗中小肝癌的临床应用

目的探讨肝动脉化疗栓塞(TACE)联合CT引导射频消融(RFA)序贯治疗原发性中小肝癌的临床应用。方法对59例肝细胞性中小肝癌患者实施TACE联合CT引导RFA序贯治疗。结果 59例患者初次治疗,共80枚病灶,行TACE和RFA序贯治疗技术成功率100%。术后随访6～24个月,21例患者有病灶残余,再次行RFA或序贯治疗,3例再次联合放射性125I粒子植入治疗后,病灶控制良好。并发症有胆汁瘤合并胆道感染1例、门静脉分支血栓1例。结论 TACE联合CT引导RFA序贯治疗中小肝癌是一种微创、有效的方法,同时注意手术操作细节,对提高手术成功率,降低手术并发症有重要意义。     

微波介入疗法治疗晚期肝癌1例

目的 探讨对于原发性肝癌术后复发患者的综合治疗方法。方法 原发性肝癌术后复发患者1例。男性，74岁，1995年因原发性肝癌行左肝外叶切除术，术后5年发现肝右后叶肿瘤复发，伴有肝内转移灶。入院后先行肝动脉插管，由于血管走行变异，插管效果不满意，于2001年1月手术探查，术中考虑到如果切除肿瘤，剩余肝脏体积过小，难以维持功能，即行肝右后叶肿瘤4点微波固化，右前叶肿瘤1点微波固化。同时于肝动脉及门静脉行双化疗泵植入。术后定期经肝动脉及门静脉化疗泵进行化疗及栓塞。并于术后10个月开始进行了4次B超引导下肿瘤内无水酒精注射。结果 患者术后恢复顺利，未出现全身及局部并发症。现状后10个月，患者饮食、活动如常。术后1个月时体重56．2kg，现在体重为59．6kg。甲胎蛋白于术后3个月降至正常，并维持5个月，近2个月又升高。计算机体层摄影片示碘油栓塞效果好，肿瘤明显缩小，甲胎蛋白升高后，目前肿瘤仍无增大。结论 该疗法对本例原发性肝癌术后复发患者有显著疗效，延长了患者生命，提高了患者生活质量。今后应增加病例数量，以求对该疗法进行科学评估。     

分期手术联合射频消融和化疗栓塞治疗结肠癌肝转移12例

目的探讨分期手术联合射频消融、肝动脉化疗栓塞治疗结肠癌术后双叶肝转移的临床价值。方法 2004年12月—2007年12月我科选择性接收并采取分期手术治疗结肠癌术后双叶肝转移患者12例。Ⅰ期手术,结扎横断大多数结肠癌转移灶隶属肝叶的门静脉Ⅰ级分枝(左:右=1:11),射频消融残余肝叶内转移灶,并经胃十二指肠动脉植入肝动脉化疗泵;术后通过化疗泵行3个疗程化疗栓塞。Ⅱ期手术,全部化疗疗程结束后4周行半肝切除术。随访30月,记录术后并发症、化疗客观疗效和毒副作用、残余肝和肝外发现转移瘤时间以及实际生存时间。结果围术期内患者无死亡和肝功能衰竭,呼吸道感染/尿道感染/切口感染(2/2/2,例)是主要的术后早期并发症。患者化疗后无CR,PR 83.3%(10/12),主要不良反应为白细胞减少/血小板减少/贫血(6/3/3,例次)。2例患者术后10月残余肝内发现转移灶(超声引导下射频消融),4例患者术后17月发现肝外转移(肺2例,骨2例;立体定向R-刀治疗)。1、2年总体实际生存率分别为100%和75%,中位生存期26个月。结论分期手术联合射频消融、肝动脉化疗栓塞治疗部分结肠癌术后双叶肝转移患者近期疗效满意,不良反应可耐受,且能增加患者肝转移癌切除率、提高生活质量和生存期,是治疗结肠癌术后双叶肝转移的较好模式之一。     

射频消融辅助肝切除治疗原发性肝癌的研究

目的:评价射频消融(RFA)辅助肝切除术治疗原发性肝癌的可行性、安全性及疗效。方法:25例原发性肝癌在全麻下行肝切除术,肝断面采用RFA进行辅助治疗,共治疗27个肿瘤,平均最大肿瘤直径(5.4±1.8)cm。结果:25例均顺利完成RFA辅助肝切除术。平均射频治疗时间(30.5±5.8)min,术后创面平均出血量(124.6±45.5)ml。未出现严重并发症。随访13～62个月(平均31个月),1例肿瘤切除边缘复发,6例发现肝内新病灶,2例肺转移,1例腰椎转移。再次采用经皮RFA治疗3例,肝动脉化学栓塞(TACE)治疗4例,8例死于肿瘤复发或肝功能衰竭。结论:RFA辅助肝切除术治疗原发性肝癌安全可行,可有效进行肝断面止血、降低肿瘤局部复发率。     

干扰素治疗原发性肝癌的实验和临床研究

原发性肝癌的治疗逐渐发展成为以手术切除、介入肝动脉化疗栓塞、肝移植等多种方法序贯联合的综合性治疗模式.尽管疗效得到提高,但因原发性肝癌起病时的隐匿性和治疗后相当高的复发和转移率使得远期生存率仍不能令人满意.新的用于治疗原发性肝癌的药物和新的治疗方式在不断地探索之中.     

介入治疗原发性肝癌移植术后复发的价值

目的探讨原发性肝癌肝移植术后复发患者的临床表现及介入治疗价值。 方法2004年3月～2011年6月14例肝移植术后复发的肝癌患者行综合介入治疗,包括肝动脉化疗栓塞32次、肝动脉泵置泵1例、经皮肝穿刺胆道引流1例、经内镜逆行性胰胆管造影术1例,高强度聚焦超声1例。 结果肝癌复发灶呈肝内多发、肝外广泛转移的特点,多为富血供肿瘤,合并血管及胆管并发症者各2例;接受介入治疗后至今存活2例,12例从接受肝移植治疗到死亡平均生存16.1个月。 结论原发性肝癌肝移植术后采用介入治疗可有效抑制肝癌术后复发灶及转移灶的生长,消除移植术并发症对患者的危害,延长患者的生存时间并提高生活质量。     

TACE联合高强度聚焦超声治疗肝癌的研究进展

肝癌是我国常见的恶性肿瘤,绝大多数患者就诊时已是中晚期,错过了手术切除机会。经导管动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)是手术不能切除中晚期肝癌的首选治疗方法,但因肿瘤恶性程度高,单一TACE治疗难以达到治疗目的。TACE联合射频消融(radiofequency     

复发性小肝癌再次手术与射频消融的临床分析

目的:总结复发性小肝癌的外科治疗方法。方法回顾性分析2005年1月至2008年6月第1次手术后复发的小肝癌35例患者的临床资料,分为再次手术组和射频消融组,比较两组术后3年生存及复发情况。结果再次手术组18例,均行肿瘤局部切除术,射频消融组17例,均行局部射频消融治疗。再次手术组3年无瘤存活率(66.1%,11/18)高于射频消融者(47.1%,8/17)(P<0.05),手术切除肿瘤局部复发率(22.2%,4/18)低于射频消融(35.6%,5/17)(P<0.05),直径<3cm的肿瘤,采用手术或射频消融治疗3年生存率和复发率差异无统计学意义(P>0.05),3～5cm肿瘤采用手术治疗者3年生存率高于射频消融治疗,复发率低于射频消融治疗(均P>0.05)。结论对复发性小肝癌瘤体小于3mm者应根据患者情况并充分考虑患者意愿进行治疗,对肿瘤为者则以手术为宜。     

Radiofrequency ablation of recurrent hepatocellular carcinoma in a patient after liver transplantation: two-year follow-up

Orthotopic liver transplantation is frequently performed for patients with end-stage liver disease complicated by the development of small hepatocellular carcinomas (HCCs). Since the adaptation of the Milan criteria, the rate of posttransplantation recurrence has significantly decreased to a rate of 10%-20%. In the setting of recurrence after transplantation, survival rates are poor, with a median of 9 months. Survival can be extended with use of definitive therapies, most often surgical. The present report describes a patient with recurrent intrahepatic HCC after liver transplantation who was treated with radiofrequency ablation and has survived 24 months with normalization of alpha-fetoprotein levels and no evidence of viable tumor on imaging.     

Transcatheter Arterial Embolization for Tumor Seeding in the Chest Wall After Radiofrequency Ablation for Hepatocellular Carcinoma

Tumor seeding in the chest wall was depicted at follow-up CT obtained 9 months after radiofrequency ablation for hepatocellular carcinoma. Transcatheter arterial embolization was successfully performed, injecting emulsion of 10 mg of epirubicin and 1 ml of iodized oil followed by gelatin sponge particles via the microcatheter placed in the right eleventh intercostal artery. The patient died of tumor growth in the liver one year after the embolization, but no progression of the tumor seeding was noted during the follow-up period. We conclude that transcatheter arterial embolization was effective for the control of tumor seeding after radiofrequency ablation for hepatocellular carcinoma.     

Actual role of radiofrequency ablation of liver metastases

The liver is, second only to lymph nodes, the most common site for metastatic disease irrespective of the primary tumour. More than 50% of all patients with malignant diseases will develop liver metastases with a significant morbidity and mortality. Although the surgical resection leads to an improved survival in patients with colorectal metastases, only approximately 20% of patients are eligible for surgery. Thermal ablation and especially radiofrequency ablation emerge as an important additional therapy modality for the treatment of liver metastases. RF ablation shows a benefit in life expectancy and may lead in a selected patient group to cure. Percutaneous RF ablation appears safer (versus cryotherapy), easier (versus laser), and more effective (versus ethanol instillation and transarterial chemoembolisation) compared with other minimally invasive procedures. RF ablation can be performed by a percutaneous, laparoscopical or laparotomic approach, and may be potentially combined with chemotherapy and surgery. At present ideal candidates have tumours with a maximum diameter less than 3.5 cm. An untreatable primary tumour or a systemic disease represents contraindications for performing local therapies. Permanent technical improvements of thermal ablation devices and a better integration of thermal ablation in the overall patient care may lead to prognosis improvement in patients with liver metastases.     

完全腹腔镜肝切除术治疗肝细胞癌合并肝硬化的研究

目的：探讨完全腹腔镜肝切除术（PLH）治疗肝细胞癌合并肝硬化的可行性、安全性及疗效。方法：2003—07～2012—07的17例肝细胞癌合并肝硬化患者在全麻下行PLH,共治疗20个肿瘤,平均肿瘤直径（4．4±1．4）cm。肝功能Child—Pu小A级6例,B级11例。结果：17例均顺利完成PLH。平均手术时间（143．4±50．3）min,平均术中出血量（334．1±221．9）ml。无一例中转开腹,未出现大出血、严重胆漏、肝功能衰竭等并发症。术后平均住院时间（6．4±2．4）d。术后随访12～73个月（平均39．3个月）,1例肿瘤切除边缘复发,5例发现肝内新病灶,1例肺转移。经皮射频消融治疗4例,肝动脉化学栓塞（TACE）2例,6例死于肿瘤复发或肝功能衰竭。结论：PLH治疗肝细胞癌合并肝硬化安全可行,治疗效果肯定,具有局部创伤小、全身炎症反应轻、术后恢复快等优势,最适于肝脏表浅部位的肿瘤。     

18F-FDG PET/CT in evaluation of radiofrequency ablation of liver metastasis

Image-guided radiofrequency ablation (RFA) is a minimally invasive therapy option in the treatment of primary and secondary hepatic malignancies, which are not suitable for surgery/chemotherapy, and more recently, for tumors with limited hepatic involvement and solitary liver metastasis. Accurate assessment of treatment response after RFA remains a concern. Conventional imaging modalities have limitations of differentiation between residual/recurrence from post-RFA changes. We illustrate images of 3 patients in whom (18)F-FDG PET/CT was used for response assessment and restaging after RFA in liver tumors.     

Local therapeutic treatments for focal liver disease

Patients diagnosed with primary hepatic malignancies or metastases to the liver remain a difficult population to treat. A small percentage of these people can undergo surgical resection or transplantation. The remaining nonsurgical aggregate does not often benefit from conventional radiation and chemotherapy; minimally invasive means either to cure or palliate these patients are a requirement for complete cancer care. This article discusses image-guided local therapies used to treat this difficult patient population, focusing predominantly on radiofrequency ablation.     

支气管动脉灌注化疗及栓塞术在肺癌综合治疗中的作用

目的探讨支气管动脉灌注化疗及栓塞术在肺癌综合治疗中的作用。 方法对78例病理确诊为肺癌的患者,行经支气管动脉灌注化疗及栓塞术,术后根据具体情况再选择手术、化学消融及射频消融、放疗等综合治疗。 结果78例患者中,支气管动脉灌注化疗及栓塞术后,有9例进行了手术切除,9例进行了射频消融,36例进行了放疗;放疗后复发再次行支气管动脉灌注化疗及栓塞术15例,单纯灌注化疗栓塞9例。 结论肺癌的治疗应采取综合治疗手段,需要综合分析,确立个体化的治疗方案,以最有利于患者为出发点,支气管动脉灌注化疗及栓塞术在肺癌综合治疗中起到很重要的作用,为手术切除、放疗、化学消融及射频消融等治疗手段提供了机会和可能。     

射频消融对原发性肝癌治疗评价及预后危险因素分析

目的：分析射频消融对原发性肝癌治疗及复发的临床治疗评价并探讨影响预后的相关危险因素。方法纳入本院肿瘤科经射频消融治疗的164例患者进行分析,研究内容包括治疗前后的肝功能、甲胎蛋白(AFP)的变化,复发率及生存期,并纳入与预后相关的危险因素,先通过单因素条件的 Logistic 回归分析预后的相关危险因素,再采用 COX 风险模型对影响预后的相关危险因素进行分析。结果治疗后患者的 AFP 及肝功能均明显改善,与治疗前比较差异有统计学意义(P <0.05);肿瘤完全消融率达87.50%;经过治疗后的肿瘤1、2、3、4年的复发率为17.9%、29.9%、45.9%、55.0%。结论射频消融术是一种有效的治疗原发性肝癌的治疗方法,原发性肝癌预后危险因素为肿瘤的分化程度、肿瘤复发、TNM 分期、AFP、术中输血、手术方式、肿瘤和手术部位、术前转氨酶水平。     

Embolization of liver tumors: Past, present and future

Curative therapies for hepatocellular carcinoma(HCC),such as resection and liver transplantation,can only be applied in selected patients with early tumors.More advanced stages require local or systemic therapies.Resection of HCC offers the only hope for cure.Even in patients undergoing resection,recurrences are common.Chemoembolization,a technique combining intraarterial chemotherapy with selective tumor ischemia,has been shown by randomized controlled trials to be efficacious in the palliative setting.There is now renewed interest in transarterial embolization/transarterial chemoembolization(TACE) with regards to its use as a palliative tool in a combined modality approach,as a neoadjuvant therapy,in bridging therapy before transplantation,for symptomatic indications,and even as an alternative to resection.There have also been rapid advances in the agents being embolized trans-arterially(genes,biological response modifiers,etc.).The current review provides an evidence-based overview of the past,present and future trends of TACE in patients with HCC.     

直肠癌的介入治疗

目的：评价直肠癌选择性动脉灌注化疗和栓塞的临床价值。方法：对32例直肠癌患者（29例行手术切除）中，12例术前采用Seldinger技术行选择性灌注化疗并部分用明胶海绵栓塞，3～10d内行直肠癌手术，17例术后行灌注栓塞，3例已有肝转移者只行灌注栓塞。结果：灌注栓塞后患者临床症状明显缓解。术前行介入治疗的患者中，10例行根治性切除（10／12），且术中出血明显减少。结论：直肠癌的动脉灌注化疗及栓塞安全有效，可提高手术切除率及减少术中医源性扩散和术后的转移、复发。