射频消融辅助肝切除术在巨大肝脏肿瘤治疗中的应用

目的:比较射频消融辅助肝切除术与嵌夹结扎法在巨大肝脏肿瘤切除中的有效性及安全性。方法:共31例诊断为巨大肝脏肿瘤的患者纳入回顾性研究,其中15例采用射频消融辅助肝切除术（RF-LR组）,16例采用传统的嵌夹结扎法（CC-LR组）。比较两组间出血量、输血情况、手术时间、术后并发症发生情况及生存率。结果:两组患者术前评估未见明显差异。CC-LR组患者中位术中出血量（1 000 ml vs 600 ml,P=0.005）及需输血患者例数（13例 vs 6例,P=0.029）较RF-LR组显著升高,但两组间手术时间、肝门阻断、术后并发症发生情况、围手术期死亡例数并无统计学差异。RF-LR组术后1年、2年、3年总体生存率分别为80.0%、70.0%、35.0%,与CC-LR组患者（76.9%、61.5%、38.5%）比较未见统计学差异（P>0.05）。结论:射频消融辅助肝切除术能有效减少巨大肝脏肿瘤患者术中出血量及输血患者例数,尤其对合并肝硬化患者适用,且与嵌夹结扎法具有相似的长期生存率。     

肝癌射频消融治疗技术进展

<正>射频消融(radiofrequency ablation,RFA)是将射频电极针(或电极导管)直接插入到肿瘤组织中,利用460kHz射频电流在组织中产生的热效应(90℃¹10℃)直接杀灭肿瘤细胞的一种微创治疗技术。RFA应用于肝癌的治疗已有近20年的历史,随着治疗设备的不断改进和临床技术的不断提高,RFA在肝癌治疗中的应用范围不断扩展,疗效确切、微创安全,正发挥越来越大的作用。一、肝癌病灶原位灭活消融技术RFA治疗时,射频电极针直接插入肝癌病灶中。射频电极针的构造、输出功率、消融时间与消融体积及消融效果密     

肝肿瘤的射频热能消融术

对于不能手术切除的原发或继发肝脏恶性肿瘤,目前常用的介入治疗方法有肝动脉栓塞化疗、经皮无水酒精注射、微波、激光、冷冻等.现介绍目前新发展起来的一种介入治疗方法--经皮经肝射频热能消融术(RFTA).     

超声引导经皮射频消融膈下肝肿瘤的安全性研究及疗效观察

  目的   探究超声引导下经皮射频消融对膈下肝肿瘤疗效及安全性。   方法   射频治疗79例共138个肝肿瘤,其中膈下肿瘤组76个,非膈下肿瘤组62个。比较两组并发症、完全消融、局部肿瘤复发发生率。   结果   两组完全消融率分别为92.1%（70/ 76）、98.4%（61/62）,两组比较差异无统计学意义（χ2=2.49,P=0.12）。随访局部肿瘤复发两组分别19.7%（15/76）、6.5%（4/62）,差异有统计学意义（χ2=5.08,P=0.02）;无瘤生存期分别为膈下肿瘤组（21.0±1.4）个月、非膈下肿瘤组（24.7±1.7）个月,差异有统计学意义（χ2=3.84,P=0.05）。10例患者发生并发症,胸水并发症发生率存在差异（χ2=4.52,P=0.034）,无射频治疗相关死亡,无针道转移发生,消融技术成功率为100%。   结论   射频消融是一种安全有效的微创治疗技术。肿瘤位置影响消融效果,膈下肿瘤较肝中央处肿瘤易发生消融区域肿瘤复发,术中麻醉医生的协作有利于消融的顺利完成。      

射频切除术(RFA)治疗肝肿瘤及其影像学疗效评价的现状

目前，肝癌的治疗仍以手术切除为主。经皮射频切除术（PRFA，PercutaneousRadiofrequencyAbla－tion）是近年来针对中晚期或因各种原因不能手术的许多病例，开展的一项微创介入性新技术，为原发性和继发性肝肿瘤提供了—种新的治疗手段。１RFA治疗肝癌的原理和操作方法射频治疗肝肿瘤的原理犤１～４犦与激光、微波及高强度聚焦超声治疗肿瘤相同，均是—种热损毁的方法。其依据是肿瘤细胞对热的耐受能力比正常细胞差，局部加温至３９℃～４０℃可致癌细胞停止分裂，达４１℃～４２℃后可杀死癌细胞或引起DNA损伤。射频切除术是通过一特…     

冷循环射频消融治疗肝肿瘤近期疗效观察

目的：观察冷循环射频消融治疗肝肿瘤的近期疗效。方法：运用HG-3000型单针冷极射频肿瘤治疗机对43例肝癌患者总计117个瘤体进行消融治疗。运用CT及B超观察瘤体的变化,测定AFP、CEA、肝功能,并与治疗前进行比较。结果：117个瘤体的生长均受到明显抑制,AFP值较治疗前明显下降（P〈0.05）;CEA值呈持续升高趋势,治疗后第3、4、5月CEA值与治疗前比较有明显差异（P〈0.05）;肝功能在治疗后1、2周变化较为明显,4、5周后恢复治疗前水平。结论：冷循环射频消融治疗肝肿瘤近期疗效满意,并发症少。     

射频消融联合肝动脉栓塞化疗及盐酸注射治疗肝癌

目的 探讨射频消融(RFA)联合肝动脉化疗栓塞(TACE)及盐酸治疗不能手术切除的肝癌的效果.方法 尉40例肝癌应用RFA联合TACE及盐酸治疗的临床资料进行回顾性分析.结果 原发性肝癌(PHT)30例,转移性肝癌(MPT)10例.治疗后影像学显示病灶好转或稳定39例.盐酸破坏30例中治疗前甲胎蛋白阳性26例,术后降至正常26例.未发生严重并发症.结论 RFA联合TACE及盐酸破坏肿瘤系安全、可耐受、有效的新的综合治疗方法,可提高不能切除的肝癌的治疗效果.

Abstract：

Objective To explore the effect of radio frequency ablation (RFA) combined with transcatherterarterial chemo embolization (TACE) and percutaneous puncture hydrochloric acid injection(PHI) for hepatic tumors unable to resection. Methods The clinical data of 40 cases of patients with unable resection liver cancer (URLC) treated by RFA combined with TACE and PEI were analyzed retrospectively.Results There were 30 cases of primary hepatic tumor(PHT) and 10 cases of metastasis hepatic tumor(MPT) , in this series. Examination of ultrasound, CT and MRI showed the tumors shrink or steady in 39 patients.Among 30 patients with damage by ethanol, 18 cases were AFP positive before treatment and 16 cases of them AFP decreased to normal level after operation. No severe complication was seen in the series. Conclusion RFA combined with TACE and PEI is a safe, well tolerable and effective method for hepatic cancer, and may improve the treatment efficacy of URLC.     

肝肿瘤的射频热能消融术

对于不能手术切除的原发或继发肝脏恶性肿瘤，目前常用的介入治疗方法有肝动脉栓塞化疗、经皮无水酒清注射、微波、冷冻等。现介绍目前新发展起来的一种介入治疗方法－经皮经肝射频热能消融术（RFTA）。     

射频消融治疗肝癌

射频消融治疗肝癌是近十余年来发展起来的介入导向治疗方法之一，近年对其工作原理、适应证、禁忌证、术中方法学、随访观察、并发症及面临的问题等研究有较大进展。现就此作一综述。     

Early results after radiofrequency-assisted liver resection

AIMS AND BACKGROUND: Intraoperative blood loss during liver resection remains a major concern due to its association with higher postoperative complications and shorter long-term survival. The aim of this study was to assess the feasibility and safety of a novel concept for liver resection using a radiofrequency energy-assisted technique. METHODS: From January 2001 to July 2002, 42 patients were operated on using radiofrequency energy-assisted liver resection. Radiofrequency energy was applied along the resection edge to create a 'zone of desiccation' prior to resection with a scalpel. RESULTS: Median resection time was 50 mins (range, 30-110). The median blood loss during resection was 30 mL (range, 15-992). Mean preoperative and postoperative hemoglobin values were 13.7 g/dL (SD +/- 1.6) and 11.8 g/dL (SD +/- 1.4), respectively. No blood transfusion was registered, nor was any mortality observed. There were 3 postoperative complications, one subphrenic abscess, one chest infection and one biliary leak from a hepatico-jejunostomy. Median postoperative stay was 8 days (range, 5-86). CONCLUSIONS: Liver resection assisted by radiofrequency energy is feasible, easy and safe. This novel technique offers a new method for 'transfusion-free' resection without the need for sutures, ties, staples, tissue glue or admission to an intensive care unit.     

A modified radiofrequency-assisted approach to right hemihepatectomy

AIMS: To evaluate a modified radiofrequency-assisted approach to right hemihepatectomy. METHODS: Following a bilateral subcostal incision and intraoperative ultrasonography, the liver was mobilized in the standard manner, and a cholecystectomy was performed. The portal vein was isolated, encircled, and ligated. After demarcating the liver parenchyma, coagulation necrosis was achieved using a radiofrequency-assisted device along the line demarcated for transecting the liver parenchyma. The actual transection of the liver parenchyma and the right portal vein was done using a surgical scalpel along the radiofrequency-coagulated line. The right hepatic vein was coagulated using the radiofrequency sealer or by stitching in the resection plane. The hepatic artery was not dissected and was sealed together with the bile ducts in the resection plane using the radiofrequency instrument. The hepatic vein was not divided. RESULTS: Between July 2005 and July 2006, a total of 49 liver resections were performed in our unit. Of these, the radiofrequency-assisted technique was used in 33 cases with metastatic disease; 14 of these cases had right hemihepatectomies, including 2 repeat resections. The mean operation time was 180min (range, 120-240min), and the average blood transfusion was 0.14U (range, 0-2U). Postoperatively, there was no morbidity, such as bleeding, infection, or biliary fistula, related to the liver resection technique, and no patients died as a result of surgery. In 8 out of the 14 right hemihepatectomies, a right-sided pleural effusion was observed; 3 of them required evacuation. CONCLUSION: This paper describes a modified radiofrequency-assisted hemihepatectomy, which allows one to obtain control of the portal blood flow going into the resected part of liver. The modified approach appears to be simple and safe.     

Modified radiofrequency-assisted liver resection: a new device

BACKGROUND: Radiofrequency ablation (RF) is emerging as new therapeutic method for the management of hepatic tumors. So far the RF-assisted hepatectomy has been described using an electrode initially designed for ablation of unresectable tumors. Herein, we describe a new technique for liver resection using a bipolar radiofrequency device. METHOD: Ten patients undergo liver resection using a bipolar radiofrequency device. A minimal zone of desiccation around the tumor is created between pairs of opposing electrodes as a result of a minimum amount of energy released. This coagulated plane can be divided with a scalpel. RESULTS: The liver parenchyma was divided with minimal blood loss. No intensive care unit admission was needed. There was no postoperative biliary leak or any other septic complication. CONCLUSION: The technique is safe and feasible, simplifies liver resection and appears to be associated with minimal morbidity and maximum liver parenchyma preservation.     

原发性肝癌切除术后胸水成因的临床研究

目的 探讨原发性肝癌切除术后胸水发生的成因.方法 选取手术切除的原发性肝癌病人133例为对象进行回顾性研究.结果 133例病人中有69例出现胸水.胸水组(G1组)中行右肝手术尤其是行右三角韧带及右冠状韧带分离者比例明显高于无胸水组(G2组),且术后并发腹水量较高.无胸水组术后肝功能明显好于胸水组.术前肝功能、术中出血量、肝门阻断时间、肿瘤大小等两组间比较差异无统计学意义.结论 肝切除术后并发胸水,主要和手术部位、术后肝功能及肝周韧带分离有关.肝切除对右肝韧带的游离和膈肌损伤是导致术后胸水发生的主要原因.在围手术期维持良好肝功能的前提下,术中仔细分离肝周韧带,减少膈肌的损伤,可能有助于减少术后胸水的发生.     

手术切除347例原发性肝癌的临床分析

目的:探讨347例原发性肝癌手术切除的临床疗效及其影响因素.方法:对347例手术切除的原发性肝癌患者的临床资料和随访结果进行分析.结果:原发性肝癌手术切除的并发症发生率为6.34%(22/347),围手术期死亡率为1.15%(4/347).术后1、3和5年总生存率分别为87.96%、48.47%和22.82%.肿瘤直径＜3 cm的患者,其术后1、3和5年生存率分别为95.24%、83.33%和75.00%.肿瘤大小与术后1年生存率无明显相关性(P＞0.05),但肿瘤直径＞5 cm患者的术后3和5年生存率分别为41.88%和17.05%,明显低于肿瘤直径≤5 cm患者的77.78%和60.00%(P=0.000).结论:合理掌握原发性肝癌切除适应证以及根据肿瘤大小确定切缘距离能够降低并发症和围手术期死亡率,并提高生存率.定期监测原发性肝癌高危人群能够提高小肝癌的检出率.此外,术中B超能够有效定位小肝癌,甲胎蛋白是原发性肝癌完整切除和复发转移的敏感指标.     

腹腔镜肝切除在肝癌治疗中的应用

目前,以手术为主的综合治疗仍被公认为是肝癌治疗的首选方案.微创外科理念的确立,以及肝脏外科技术和腹腔镜技术的不断发展创新,使腹腔镜肝切除技术在肝癌治疗中的应用价值日益凸显.     

腹腔镜下肝癌切除术与射频消融术治疗肝细胞癌的疗效观察

目的探讨腹腔镜下肝癌切除术(LH)与射频消融术(RFA)治疗肝细胞癌(HCC)的临床疗效。方法选取2015年1月至2017年12月间成都三六三医院收治的76例HCC患者,根据不同手术方式分为LH组和RFA组,每组38例。LH组患者采用LH治疗,RFA组患者采用RFA治疗,比较两组患者临床疗效、术前术后肝功能、免疫功能变化、术后疼痛程度及并发症。结果 RFA组患者总生存率为84. 2%,LH组为86. 8%,RFA组无瘤生存率为63. 2%,LH组为57. 9%,差异均无统计学意义(P> 0. 05)。术后7d,两组患者AST、ALT和TBil水平均降低,且RFA组患者均低于LH组,差异均有统计学意义(均P <0. 05)。术后7d,两组患者CD3~+、CD4~+和CD8~+水平均降低,且RFA组患者均优于LH组,差异均有统计学意义(均P <0. 05)。RFA组患者术后VAS评分为(2. 15±0. 35)分,LH组为(3. 28±0. 42)分,两组比较,差异有统计学意义(t=12. 74,P=0. 00)。RFA组患者术后并发症发生率为7. 9%,LH组为15. 8%,差异无统计学意义(P> 0. 05)。结论RFA与LH治疗HCC临床效果相当,并发症少,但RFA在改善肝功能和提升机体免疫功能方面较LH更有优势,且术后疼痛较轻,值得推广。     

Ⅲ Ⅳ型肝门胆管癌扩大肝切除临床疗效分析*

目的:探讨扩大肝切除对Bismuth-Corlette Ⅲ、Ⅳ型肝门胆管癌的临床疗效。方法:回顾性分析蚌埠医学院第一附属医院2008年1 月至2015年5 月61例Bismuth-Corlette Ⅲ、Ⅳ型肝门部胆管癌患者的临床资料。其中扩大肝切除组行半肝及以上肝切除和（或）联合尾状叶切除术22例;局限肝切除组行肝门区不规则肝切除术39例。结果:扩大肝切除组患者相比局限肝切除组手术时间长、术中出血量多。扩大肝切除组患者并发症发生率低于局限肝切除组患者;扩大肝切除组无围手术期死亡患者,局限肝切除组有2 例围手术期死亡患者;扩大肝切除组R 0 切除21例,R 0 切除率为95.5%（21/ 22）,局限肝切除组R 0 切除20例,R 0 切除率为51.3%（20/ 39）,差异具有统计学意义（P < 0.05）;扩大肝切除组1、3、5 年生存率分别是77.27% 、36.36% 、13.64% ;局限肝切除组1、3、5 年生存率分别是69.23% 、20.51% 、1.64% ,差异具有统计学意义（P < 0.05）。 结论:Bismuth-Corlette Ⅲ、Ⅳ型肝门部胆管癌扩大肝切除可以有效提高患者的R 0 切除率和生存率,改善患者的预后。