氩氦刀冷冻消融治疗肝癌患者围术期护理

目的:探讨氩氦刀冷冻消融治疗肝癌患者的临床疗效及围术期护理方法。方法:选取2016年2~11月收治的42例采用氩氦刀冷冻消融治疗的肝癌患者为观察组,选取2015年2~11月收治的40例采用经导管肝动脉化疗栓塞治疗的肝癌患者为对照组。比较两组治疗效果,总结氩氦刀冷冻消融治疗的围术期护理方法。结果:观察组甲胎蛋白转阴率、肿瘤完全坏死率、12个月生存率均高于对照组(P0.05),术后不良反应发生率低于对照组(P0.05),满意度高于对照组(P0.05)。结论:氩氦刀冷冻消融治疗肝癌的临床疗效满意,完善的围术期护理是治疗有效的关键。     

氩氦刀治疗兔肝脏肿瘤疗效的实验研究

目的利用兔VX2肝脏肿瘤模型,对其进行氩氦刀治疗。探讨氩氦刀治疗兔VX2肝脏肿瘤的疗效。方法将VX2细胞株接种于30只新西兰大白兔的肝脏内,共42个病灶,用多层螺旋CT观察兔VX2肝脏肿瘤的生长,植入2周末和3周末后分别取15只,共22个病灶(A组)和15只,共20个病灶(B组)进行氩氦刀治疗,并分别在治疗后5周进行多层螺旋CT(MSCT)扫描进行观察,并与病理相对照。结果VX2细胞株接种于兔肝成功率高,多层螺旋CT显示该肿瘤周围血供丰富,A、B两组在治疗后5周,MSCT显示肿瘤完全坏死率分别为68%(15/22)、30%(6/20);转移率分别为23%(5/22)、65%(13/20),与病理检查相符,并且两组之间对比肿瘤完全坏死率及转移率均有显著性差异(P<0.05和P<0.01)。结论移植性兔VX2肝脏肿瘤血供特点类似人类原发性肝癌,是介入治疗实验研究十分有用的肝癌模型。氩氦刀治疗可以抑制其生长和转移,疗效与其治疗的时机密切相关。     

CT引导下经皮多针组合射频消融治疗大肝癌的疗效观察

目的:探讨多针组合射频消融治疗在大肝癌(≥5 cm)治疗中的价值及临床疗效.方法:回顾性分析我科2008年8月至2009年10月肝癌患者共15例.其中初诊原发性肝癌8例,肝癌术后复发3例,转移性肝癌4例,共23个病灶,直径1.0～7.3 cm.其中≤5 cm者6个,5.0～6.0 cm者14个,6.0～7.0 cm者3个,平均(5.5±0.6)cm.≥5 cm的共17个病灶,均行一次多针组合射频消融.患者依次编号,建立动态随访制度,术后24 h内即刻复查CT或MRI检查,并于第l、3、6个月分别行CT或MRI双期增强扫描评价治疗疗效.结果:1个月后肿瘤影像学评价,17个病灶中,14个完全消融,呈完全坏死,坏死率迭82%,部分消融3个,周边可见残留病灶,全组15例目前全部存活.13例动态随访6个月未见复发,2例术后3个月出现肝内转移.结论:CT引导下多针组合射频消融是治疗大肝癌近期疗效确切,是一种安全、微创、有效的方法.     

MRI导航氩氦刀治疗恶性肿瘤55例分析

目的探讨MRI导航氩氦刀治疗恶性肿瘤的应用。方法对55例恶性肿瘤患者在MRI导航下准确定位,经皮穿刺进行氩氦刀冷冻治疗。结果 55例恶性肿瘤患者在MRI导航下完成氩氦刀冷冻治疗,其中35例的病灶完全被冰球覆盖,20例病灶冰球覆盖80%以上,随访冷冻治疗后1个月复查CT增强或MRI增强检查,35例病灶完全坏死:肿瘤100%无强化;20例的病灶部分坏死:肿瘤无强化区≥50%;近期总有效率达100%。结论 MRI导航可准确确定靶器官与周围组织的关系,方便选定进针角度和深度,定位精确度高,成功率高,使手术过程简化、安全,可实时观察冰球大小,判断治疗效果。     

高频热水消融治疗肝癌的疗效

目的探讨CT引导下高频热水消融（high-fequency induced thermotherepy,HITT）治疗原发性肝癌和肝转移癌的疗效、副作用和并发症。方法使用HITT治疗56例原发性肝癌和肝转移癌病人（男44例,女12例）的64个病灶（其中8例病人有2个病灶）,56例病人中42例为原发性肝癌（HCC）,14例为结直肠癌肝转移。肿瘤直径1.6～7.0cm（平均3.5cm）。其中HCC病人先行肝动脉化疗栓塞术（TACE）,再行HITT治疗。HITT的治疗效果通过治疗后1个月复查螺旋CT评估。结果通过对术后1个月CT影像学资料的观察,结果显示64个原发性肝癌和肝转移的48（75%）个病灶完全坏死。肿瘤直径〈3cm的病灶完全坏死率为90%（27/30）;3～5cm的病灶完全坏死率为72%（13/18）;〉5cm的病灶未呈现完全坏死。没有病人治疗后出现明显并发症。结论本研究显示HITT是治疗直径〈3cm经TACE治疗后的原发性肝癌和肝转移癌病人的一种安全和有效的方法,而它对3～5cm的病灶相对有效。     

肺部肿瘤氩氦刀冷冻治疗后影像学评价

目的研究CT导向经皮穿刺氩氦刀靶向治疗肺部肿瘤后影像学变化及临床疗效和预后评价。方法采用CT引导下,经皮肺穿刺氩氦刀靶向治疗肺癌及肺转移瘤。结果96例患者中肺癌82例、肺转移瘤14例,共110病灶,单发病灶89例,多发病灶7例。氩氦刀共治疗103次,平均每次治疗1.06个病灶,每次最多治疗2病灶。肿瘤直径最小1.2cm,最大15cm,平均(4.0±2.5)cm。其中瘤灶直径小于2cm的12个,直径在2~4cm之间的51个,直径在4~6cm之间的24个,直径大于6cm的23个。冰球彻底覆盖瘤灶达其边缘外lcm者25例。直径小于4cm的肺内63个肿块显效率100%,直径4~6cm的肺内24个肿块,显效率95.8%,直径大于6cm的23个肺内肿块,显效率69.6%。肺部肿瘤冷冻后CT表现病灶处开始可见逐渐增大的低密度类圆形冷冻区,与非冷冻区有明显的界线。冷冻区中心CT值为负值,术后即刻CT检查病灶CT值平均下降30~50Hu(P<0.001)。随着氩氦刀冷冻治疗后时间延续,大部分肿块有不同程度的缩小或消失,同组治疗前后比较P<0.001。以直径小于4cm最明显,特别是直径小于2cm病灶,观察3个月后均已消失。个别原体积比较大(本研究>6cm)的肿块反而增大,且见新病灶出现。术后12个月追踪了81病灶,复查CT示:81个被消融肿块完全消失的16个(19.8%);缩小的42个(51.9%);稳定的17个(20.9%);增大的6个(7.4%);总有效率为92.6%。结论研究肺部肿瘤氩氦刀靶向治疗后CT影像学表现对其疗效的评价及预后判断有重要参考价值。     

肝脏恶性肿瘤行经皮氩氦刀冷冻治疗的临床观察

对我院2010年6月～2012年10月收治的53例肝脏恶性肿瘤患者给予经皮氩氦刀冷冻治疗的临床资料进行回顾性分析,探讨肝脏恶性肿瘤行经皮氩氦刀冷冻治疗的临床疗效。结果经皮氩氦刀冷冻治疗血清肿瘤标记物转阴率为81%,CT或MRI等显示肿瘤坏死,没有明确的存货病灶。经过术后随访,一年生存率为98.4%。经皮氩氦刀冷冻治疗肝脏恶性肿瘤临床疗效显著,是一种安全有效的治疗方法,值得在临床上广泛使用和推广。     

CT引导下氩氦刀冷冻治疗肺癌后疗效的影像学评价

目的:研究CT引导下经皮穿刺氩氦刀靶向治疗肺部肿瘤后的影像学变化及临床疗效的评价.方法:采用CT引导下,经皮肺穿刺氩氦刀靶向治疗36例肺癌及肺转移瘤患者.结果:36例患者中肺癌27例、肺转移瘤9例,共42个病灶,单发病灶28例,多发病灶8例.氩氦刀共治疗39次,平均每次治疗1.08个病灶.术中冷冻覆盖范围≥瘤体70%的瘤灶数为38个,总有效率90.5%.冷冻区CT值为负值,术后即时CT扫描CT值下降≥30Hu的瘤灶为32个,瘤细胞有效灭活率为76.2%.氩氦刀冷冻治疗1个月复查CT,CT值下降≥30Hu的瘤灶为31个,瘤细胞有效灭活率为73.8%,瘤灶大部分有不同程度的缩小,按照实体肿瘤评价标准,总有效率92.9%.3例瘤灶体积反而增大,且见新病灶出现.结论:研究肺部肿瘤氩氦刀靶向治疗后CT影像学表现对其疗效的评价有重要参考价值.     

~(18)F-FDG PET对肺癌氩氦刀治疗后肿瘤变化规律的研究

目的用~(18)F-FDG PET显像观察肺癌氩氦刀治疗后原发灶与转移灶的变化规律,探讨氩氦刀治疗的最佳适用证。方法选择2003年3月至2015年8月在解放军总医院接受氩氦刀治疗的41例肺癌患者,术前2周内行~(18)F-FDG PET,然后在CT引导下行经皮氩氦刀手术,术后30～60天完成第一次~(18)F-FDG PET复查。结果肿瘤瘤体直径≤3 cm组肿瘤周缘残留比例明显低于瘤体直径3 cm组,病灶完全灭活率显著高于瘤体直径3 cm组,差异有统计学意义(P 0. 05)。术前无淋巴结转移的患者,术后亦无明显淋巴结转移。术前有淋巴结转移的患者,120个转移淋巴结病灶,17. 5%的淋巴结缩小或活性降低,82. 5%的淋巴结增大或活性增强,且新增7. 5%的转移淋巴结。而术前伴远处转移的病例,氩氦刀治疗后其转移病灶均表现为病变进展。结论氩氦刀治疗肺癌T2期以上患者疗效欠佳,无淋巴结转移患者疗效明显高于有淋巴结转移患者,原发灶灭活后对转移灶没有明显抑制作用,反而表现出肿瘤活性增强,对于此类患者建议综合治疗。     

索拉菲尼联合肝动脉栓塞化疗和氩氦刀消融治疗晚期肝癌的效果观察

目的：对比索拉菲尼单药与联合应用肝动脉栓塞化疗术（ TACE）、经皮局部氩氦刀消融（PLCT）综合治疗失去手术机会的肝癌的治疗效果。方法回顾性分析64例无法手术切除的肝癌患者的临床资料,行索拉菲尼单药或索拉菲尼联合 TACE、PLCT 治疗。其中索拉菲尼单药治疗32例,联合介入和氩氦刀消融治疗32例,随访时间6～32个月,观察两组患者治疗效果和肿瘤进展时间。结果所有患者顺利完成治疗,无手术相关死亡及严重并发症。64例患者中,完全缓解（ CR）11例,部分缓解（PR）31例,稳定（SD）14例,进展（PD）8例,其中单药治疗组 CR 3例,PR 11例,SD 12例,PD 6例;联合介入和氩氦刀消融组 CR 8例,PR 20例,SD 2例,PD 2例,两组比较差异有统计学意义（χ^2=14.028,P=0.003）。中位肿瘤进展时间分别为20周和53周,两组比较差异有统计学意义（χ^2=14.773,P=0.000）。结论针对无法手术切除的肝癌,索拉菲尼联合 TACE 和 PLCT 治疗效果较好,可延长肿瘤进展时间。     

Effects of combining transarterial chemoembolization with percutaneous microwave coagulation therapy for hepatocellular carcinoma abutting the diaphragm

Objective: This study aims to explore the clinical effectiveness of a combination therapy of transarterial chemoembolization (TACE) and percutaneous microwave coagulation therapy (PMCT) in treating hepatocellular carcinoma (HCC) abutting the diaphragm. Material and methods: Six cases with HCC were treated with TACE followed by PMCT one month later with the aid of artificial pneumothorax. Results: CT/MRI revealed complete necrosis in the tumor lesions and the treated tumor margins (≥5?mm). Serum alpha-fetoprotein (AFP) levels markedly declined in patients who originally had higher serum AFP levels. Postoperative complications such as fever, mild hepatic dysfunction and pleural effusion were alleviated within a short period of time. All patients were closely monitored through follow-up; all patients survived, except for one patient who received a liver transplantation. Conclusions: As lesions are either invisible or poorly visible in sonography, determining an effective treatment for HCC abutting the diaphragm remains a particular challenge. TACE and PMCT combined therapy with the aid of artificial pneumothorax proved to be an available treatment option.     

多排螺旋CT引导氩氦刀治疗肺癌

目的探讨多排螺旋CT引导经皮氩氦刀治疗肺癌的临床价值。方法在多排螺旋CT引导下，41例肺癌患者接受了氩氦刀治疗。共49例次。手术病灶72个。结果3个月后复查CT，肿瘤直径〈3cm者冰球冷冻有效范围100％，局部肿瘤控制率100％；肿瘤直径3-5cm者冰球平均冷冻有效范围92.3％，局部肿瘤控制率78．1％；肿瘤直径〉5cm者冰球平均冷冻有效范围69.8％，局部肿瘤控制率56．2％；总的局部肿瘤控制率为78．9％。并发症主要有咯血18例（43．9％）；气胸6例（14．6％）；胸腔积液2例（4．9％）；术后发热9例（22．0％）。结论多排螺旋CT引导经皮氩氦刀治疗肺癌是目前较为理想的方法。     

原发性肝癌首次TACE术后CT灌注与MRI的研究初探

目的：探讨分析CT灌注和MRI平扫评价原发性肝癌TACE术后肿瘤残留的能力。方法：选择TACE治疗后CT平扫不能明确有无局部肿瘤生长的病例30例,行DSA检查前行CT灌注和MRI平扫。以DSA结果为标准,分析比较CT灌注和MRI平扫对肿瘤残存的显示和确认情况。结果：以DSA为标准,CT灌注、MRI平扫的敏感性分别为96.6%、72.4%,特异性为10.0%、95.0%,准确性为61.2%、81.6%。结论：CT灌注对判断TACE术后病灶肿瘤组织残留较MRI平扫敏感,但准确性较差,不宜临床应用,考虑与化疗药物缓释及栓塞物刺激引起的炎性反应有关。     

超声造影在肝癌再次或多次射频消融中的应用

目的通过对原发性肝癌（HCC）患者病灶再次及多次进行冷循环射频消融（CRFA）前后超声造影（CEUS）的观察,探讨超声造影方法评估治疗疗效。方法58例HCC患者均已经接受CRFA治疗1次,在第一次CRFA结束后10min、每隔2周～1月经增强CT（CECT）或CEUS证实局部有残留病灶;在CEUS的监测下,再次或多次进行射频消融治疗。结果58位HCC患者共进行CRFA治疗245次（第一次治疗共58次）,平均（34-1．78）次;第一组：病灶直径〈3cm,11例共18个病灶;第二组：病灶直径3—5cm;42例共53个病灶;第三组：病灶直径〉5cm,最大直径10．2cm,5例共9个病灶;第一组全部再次或多次进行了CRFA治疗;而第二、三组则是进行了CRFA＋TACE或PEIT联合治疗;随着时间的推移,肝脏出现多发病灶、门静脉癌栓的几率增加,且与原癌灶的直径有相关性,P〈0．05。第一组与后两组的1、2、3年生存率存在着差异,P〈0．001。结论CEUS可以动态显示靶区的微循环特点、残存病灶的形态及门静脉癌栓的形态特点,在选择治疗方式方面具有重要的指导意义。     

TACE联合PMCT治疗小肝癌的疗效评价

目的探讨肝动脉化疗栓塞术(TACE)联合微波凝固(PMCT)治疗小肝癌的疗效。方法 25例原发性肝癌患者,共28个病灶,直径均≤3cm。先予行TACE,2～4周后在CT引导下行PMCT。结果治疗后予穿刺活检及CT扫描,显示28个病灶完全性坏死,其中25个病灶周边正常肝实质有约3～5mm完整环状坏死,3个病灶周边正常肝实质环状坏死不完整。20例AFP升高者,治疗后4周内AFP降至正常水平。随访6～24个月,均未见复发。随访期内患者均存活。结论 TACE联合PMCT治疗小肝癌,疗效确切、安全、无严重并发症,是治疗小肝癌较理想的综合治疗方法。     

Neoadjuvant Transarterial Chemoembolization (TACE) before Percutaneous MR-guided Laser-induced Thermotherapy (LITT): Results in Large-sized Primary and Secondary Liver Tumors

Objectives: To evaluate the clinical value of neoadjuvant transarterial chemoembolization (TACE) before MR-guided laser-induced thermotherapy (LITT) for different large-sized liver tumors.Materials and methods: Repeated TACE were performed in 289 patients (mean 4.1 per patient) with unresectable HCC (n = 48) or liver metastases (n = 241) in a neoadjuvant intention using 10 mg/m² mitomycin as chemotherapeutic agent and 10 ml/m² lipiodol and microspheres for vessel occlusion. Tumor volume was measured by MR-imaging. As soons as the diameter of the tumor was observed to have decreased to less than 50 mm, the patients were treated with MRI-guided LITT 4 to 6 weeks after embolization.Survival rates of the different liver tumors of the combined protocol were compared to the results of the patients who were treated only with TACE or with the results of the patients who were treated directly with LITT.Results: In the neoadjuvant group repeated TACE enabled a reduction in tumor size and tumor perfusion in 166 patients (80 cases of metastases of colorectal cancer, 39 cases of metastases of breast cancer, 12 cases of metastases of other primary tumors, 3 cases of carcinoids and 32 cases of HCC), forming the basis of the performance of 322 (mean 2.0) MR-guided LITT procedures.The median survival period for patients with HCC was after the first treatment 25.0 months for the TACE group, 33.3 months for the LITT group and was statistically significant higher with 36.0 months in the patients with the combined treatment.In contrast to this the median survival for patients with colorectal liver metastases was 15.2 months for the TACE group, 23.6 months for the neoadjuvant treated patients and 32.6 months for the patients treated only with LITT.Conclusion: The combined treatment protocol (TACE followed by MR-guided LITT) appears to be a safe and effective treatment of large unresectable liver tumors. The combination of TACE and LITT results in significant superior survival rates in comparison to the results of TACE alone. HCC showed a better response to the treatment than liver metastases.     

Evaluation of hepatocellular carcinoma after treatment with transcatheter arterial chemoembolization: comparison of Lipiodol-CT, power Doppler sonography, and dynamic MRI

BACKGROUND: The purpose of this study was to compare the ability of Lipiodol-computed tomography (CT), power Doppler (PD) sonography, and dynamic magnetic resonance imaging (MRI) in evaluating the therapeutic effect of transcatheter arterial chemoembolization (TACE) on hepatocellular carcinoma (HCC). METHODS: TACE was performed by injecting an emulsion consisting of Lipiodol and a chemotherapeutic drug, followed by gelatin sponge particles, into 54 patients with 84 HCC lesions. Five to 7 days later, Lipiodol-CT, PD sonography, and dynamic MRI were performed. Findings from the three modalities were correlated with relapse within 1 year after TACE. RESULTS: All lesions with blood flow on PD sonography or intratumoral enhancement on dynamic MRI relapsed regardless of the findings with Lipiodol-CT. None of the negatively enhanced lesions on dynamic MRI relapsed regardless of the Lipiodol-CT findings. However, the readers could not evaluate the contrast uptake in 14 lesions that were already hyperintense on the precontrast images. These cases were considered unsuitable for qualitative assessment and reduced the applicability of MRI to 83% of the examined lesions (70 of 84). Although PD sonography perfectly predicted relapse in superficial (0-5 cm from abdominal surface) lesions of the right hepatic lobe, blood flow in deep (>5 cm) or left lobe lesions was undetectable regardless of the occurrence of relapse. As a result, Lipiodol-CT displayed 76.0% sensitivity, 67.6% specificity, and 72.6% accuracy. The sensitivity, specificity, and accuracy of PD sonography were 34.0%, 100%, and 60.7%, respectively. In the 70 lesions in which evaluation was possible, dynamic MRI achieved 100% sensitivity, 100% specificity, and 100% accuracy. CONCLUSION: Of the three modalities, dynamic MRI was the best for evaluating the efficacy of TACE in the treatment of HCC. We also found that superficial lesions of the right lobe are good candidates for PD sonography. However, high signals on precontrast MR images, motion artifacts, and ultrasonic attenuation remain key limitations.     

经肝动脉超声造影评价肝细胞癌引流区域特征的临床应用

目的 通过与经外周静脉超声造影比较,评价经肝动脉超声造影在显示肝细胞癌(HCC)引流区域特征方面的临床应用价值.方法 选取2018年8月至2019年2月在解放军总医院介入放射科住院并接受经导管化疗栓塞术(TACE)治疗的患者44例(54个病灶).患者术前行常规超声及经外周静脉肝超声造影检查,记录目标病变的位置、病灶数量...     

术后预防性TACE对具有不同高危复发因素肝癌患者的临床价值

目的:明确术后预防性TACE对高危复发肝癌患者的临床价值。方法:回顾性分析166例于我院临床诊断为原发性肝癌并接受根治性切除手术患者的临床资料,根据肿瘤直径是否>5cm以及切缘距离是否<1cm,观察术后预防性TACE的抗复发价值。结果:肿瘤直径超过5cm的患者,术后接受预防性TACE可以显著提高总体无瘤生存率,降低术后第1年的肝癌复发率(32.0%vs.66.1%),对第2、3、4年的肝癌复发率无显著影响。对于肿瘤直径<5cm的患者,以及切缘距离不足1cm的患者,术后预防性TACE对患者的无瘤生存率以及肿瘤复发率无明确影响。结论:术后预防性TACE对于肿瘤直径超过5cm的肝癌患者,可以降低早期复发的发生率,但对于1年以上较远期的肝癌复发无显著影响。对于切缘宽度较小的患者,术后预防性TACE的价值有待于进一步评价,但也无增加术后复发率的危险。