经皮肝穿刺射频热凝治疗肝脏恶性肿瘤

目的 探讨经皮肝穿刺射频热凝治疗肝癌的意义。适应证和疗效评价标准。方法 1999年10月-2000年10月,100例肝脏恶性肿瘤患者进行了B超引导经皮肝穿刺射频热凝治疗。患者治疗后每个月进行血清肿瘤标记物检测、B超检查,治疗后1个月复查MRI。结果 患者肝功能ChildA级67例,ChildB级29例,ChildC级4例,原发性肝癌76例,转移性肝癌24例,小肝癌（未手术,肿瘤直径≤5cm)甲胎蛋白阳性者治疗后甲胎蛋白转阴占75.0%(21/28),明显下降占21.4%(6/28)。B超复查肿瘤缩小、MRI或CT提示≤5cm肿瘤完全凝固性坏死率85.9%(61/71)。结论 经皮肝穿刺射频热凝（PRFA）作为肿瘤透热治疗的一种方法,对于小肝癌尤其是无手术指征,或有手术指征但位于肝中央区,临近腔静脉或肝门区的小肝癌,是一种微创、时间短、安全方便、疗效可靠的新方法,对于大肝癌,PRFA可与肝动脉介入化疗栓塞联合应用,提高疗效。     

经皮肝穿刺射频热凝治疗原发性小肝癌

目的：探讨经皮肝穿刺射频热凝（PRFA）治疗肝癌的效果和适应证。方法：对16例原发性小肝癌患者行PRFA治疗的临床资料进行回顾性分析。结果：16例肝癌的直径均≤3cm。PRFA治疗后甲胎蛋白转阴者占93．3％（14／15）。B超，CT复查肿瘤缩小，并有包膜形成。0．5，1，2年生存率分别为93．8％，100％，100％。结论：PRFA是一种具有微创、时间短、安全方便、疗效可靠的治疗小肝癌的新方法。尤其适于有手术禁忌症，或有手术指征但位于肝中央区、临近腔静脉或肝门区的小肝癌。     

射频消融肝脏恶性肿瘤并发症的防治

目的探讨肝恶性肿瘤射频消融术中、术后并发症的预防和治疗. 方法 1999年10月～2003年3月,353例经病理和临床证实为原发性肝癌、继发性肝恶性肿瘤者进行452例次射频消融治疗,其中经皮肝穿刺治疗344例,开腹术中进行9例.未手术原发性肝癌198例,肝癌术后复发81例,继发性肝恶性肿瘤74例.定期随访,了解与手术相关的近、远期并发症. 结果发生并发症12例,其中电极皮肤灼伤2例,气胸1例,右胸腔积液1例,腔静脉血栓1例,右肝管损伤狭窄1例,胃损伤外瘘1例,肝左外叶胆管外瘘1例,单纯肝脓肿1例,肝脓肿致升结肠外瘘1例,肝脓肿致十二指肠、肝、右胸腔内瘘1例,内出血1例.并发症发生率2.65%(12/452),并发症相关死亡率8.33%(1/12). 结论射频消融是一种微创治疗,但对于肝门区、肝表面和与空腔脏器贴近的部位,尤其是有腹腔手术史且空腔脏器与肝脏相粘连者,经皮肝穿刺射频治疗有一定危险性.术前适应证选择恰当,术中仔细操作,术后加强监护、预防感染、止血等,一些并发症是可以有效预防和治疗的.     

射频消融在肝肿瘤治疗中的并发症

射频消融(radiofrequency ablation，RFA)治疗是在超声、CT或其他影像学设备的引导下，将射频电极针插入肿瘤内，利用高频交流电对局部组织进行高温热凝固，从而达到杀灭肿瘤的目的。RFA是近年来肝肿瘤局部治疗方法中发展较快的方法之一，可经皮、经腹腔镜或开腹术中进行，具有创伤小、疗效高的特点。目前认为，RFA是一种相对安全有效的方法，尤其对于无法手术切除的肝脏肿瘤有很好的姑息治疗效果。近年来，随着RFA方法的广泛应用和治疗病例的     

经皮肝穿刺冷循环射频消融治疗肝癌疗效分析

目的观察经皮肝穿刺冷循环射频消融术（Cool-tipRFA）对肝癌的热消融作用,探讨其适应证。方法在局麻下及B超引导下,射频电极经皮穿刺入肝癌瘤体内,对其进行消融。结果28例患者的38个瘤体中：直径≤3cm的26个瘤体,24个获得完全热消融,热消融率为91．9％;直径为3～5cm的7个瘤体中5个瘤体获得完全热消融,热消融率为71．4％;直径为5～8cm的5个瘤体中2个瘤体获得完全热消融,热消融率为40％。无明显术后并发症发生。术后6月、1年、2年及3年生存率分别为96．4％,89．3％,78．6％及60．7％。结论经皮肝穿刺冷循环射频消融术对直径≤5cm的肝癌疗效可靠,是一种安全、有效治疗肝癌的方法。     

多电极射频治疗肝肿瘤的并发症及防治

目的探讨多电极射频治疗肝肿瘤的并发症及其防治方法。方法对114例肝肿瘤病人进行了170次多电极射频治疗，临床观察治疗后的并发症及防治情况。结果并发症率9.6％，包括结肠穿孔1例，皮肤烧伤4例，胸腔积液5例，皮下出血1例；但无一例死亡。结论多电极射频技术用于治疗肝肿瘤的并发症率较低，且其并发症是可以防治的。     

第一肝门区小肝癌的经皮肝穿刺射频消融治疗

目的探讨对于位于第一肝门区的小肝癌行B超引导经皮肝穿刺射频消融(PRFA)治疗的可行性、疗效和应注意的问题。方法2000年4月至2002年10月选择肿瘤位于第一肝门区、≤5cm、病理或临床证实为原发性或继发性肝癌的21例患者进行PRFA治疗。治疗前甲胎蛋白(AFP)阳性者治疗后定期复查AFP。治疗后1个月复查MRI或CT确定肿瘤是否完全坏死,以后每3个月定期复查。Kaplan-Meier法计算“无瘤”生存率和累积生存率。结果AFP转阴率约为78％,MRI或CT显示第一肝门区肿瘤完全凝固坏死率为90．5％(19／21)。0．5、1、1．5、2年无原位复发生存率均为94．7％;0．5、1、1.5、2年无“瘤旁复发”生存率分别为90．0％、77．1％、77．1％和77．1％;0．5、1、1．5、2年总生存率分别为89．2％、82．8％、82．8％和55．2％。胆管狭窄发生率为4．8％。结论第一肝门区小肝癌并非PRFA治疗的禁忌证,只要治疗时穿刺点选择恰当、穿刺路径合理、超声监测下电极展开确切、热凝范围控制恰当,对于第一肝门区小肝癌PRFA是一种行之有效的治疗方法。     

射频消融治疗肝肿瘤的并发症

RFA作为一种有效的微创治疗肝肿瘤技术而被接受，病死率为0%～3％，并发症的发生率为0.9％～17％。重要并发症包括出血、感染、胆管损伤、胸腔积液、肝功能不全及血栓形成等;轻微并发症包括皮肤烧伤、胆汁瘤、胆道出血等。轻微并发症和副反应发生率多于严重并发症且大多具有自限性。笔者综述Medline文摘，Ovid全文，EBESCO，维普中文科技期刊等数据库于2003年1月—2006年3月有关射频消融（RFA）治疗肝肿瘤并发症的报道文献，分析RFA治疗肝肿瘤术后并发症的种类及其预防策略。     

肝肿瘤多电极射频治疗的并发症及防治

目的 探讨多电极射频治疗肝肿瘤的并发症及其防治方法。方法 对114例肝肿瘤患进行了170次多电极射频治疗，临床观察治疗后的并发症及防治情况。结果 并发症率9.6%，包括结肠穿孔1例，皮肤烧伤4例，胸腔积液5例，皮下出血1例；但无一例死亡。结论 多电极射频技术用于治疗肝肿瘤并发症率较低。且是可以防治的。     

经皮肝穿刺胆道引流严重并发症的预防经验

经皮肝穿刺胆道引流(PTCD)自1974年MoInar报告以来,已取得很多经验,但其严重并发症多达7.1%,死亡率1.4%,影响广泛开展。我院从1983年10月～1990年12月共施行PTCD112例,未发生严重并发症和死亡。现将我们的几点经验介绍如下: 资料和方法本组男53例:女59例,年龄17～82岁。其中急性梗阻性化脓性咀管炎49例,结石胆道梗阻23例,先天性胆总管囊肿及胆肠吻合口狭窄各2例,恶性梗阻性黄疸术前准备或     

肝癌射频消融治疗严重或少见并发症分析

目的分析射频消融(radiofrequency ablation,RFA)治疗肝癌的严重或少见并发症. 方法回顾分析2002年1月～2004年12月272例肝癌RFA治疗的严重或少见的并发症资料. 结果 272例肝癌行RFA 301次,严重或少见并发症10例,发生率为3.32% (10/301),其中2例导致死亡,病死率为0.66%(2/301).10例并发症包括:腹腔出血1例,感染2例(腹膜炎合并败血症1例,胆汁瘤继发肝脓疡1例),上消化道出血3例(其中1例为胆道出血),肝动静脉瘘1例,血气胸1例,食管胸膜瘘1例,肿瘤针道播散1例. 结论 RFA严重并发症依次为上消化道出血、感染、腹腔出血等.     

Contemporary management of benign hepatic adenoma using percutaneous radiofrequency ablation

Hepatic adenoma is a benign liver tumor that occurs primarily in women. Complete resection of the adenoma is the standard therapy. The authors present an unusual case report of a histologically proven benign hepatic adenoma occurring in an adolescent boy treated with percutaneous radiofrequency ablation (RFA). A 13-year-old adolescent boy presenting with complaints of back pain was incidentally found to have a 3.5 × 2.5-cm solitary hyperechoic region in the liver on ultrasound. Magnetic resonance imaging scan revealed a lobular solid mass in the posterior segment of the right lobe of the liver that did not have the classic appearance of a hemangioma. An ultrasound-guided percutaneous core biopsy of the lesion was performed. Histologic examination revealed a benign liver adenoma. The tumor was treated with RFA by the interventional radiologist. Postprocedure computed tomography scans obtained at 6 weeks, 8 months, and 1 year and magnetic resonance imaging scan obtained 2 years after the procedure showed complete ablation of the tumor with no evidence of tumor recurrence.Traditionally, surgical resection has been the mainstay of therapy for the treatment of benign hepatic adenoma. In selected cases of histologically proven hepatic adenoma, minimally invasive techniques such as RFA can be safely used as an alternative to open surgical resection.     

腹腔镜射频消融术治疗肝血管瘤

目的 :探讨腹腔镜射频消融治疗肝血管瘤的可行性及实用性。方法 :2 5例肝血管瘤患者全麻气管插管后 ,腹腔镜下行射频消融治疗 ,其中 5例同时行胆囊切除术。结果 :患者经治疗均获满意效果 ,术后无残留病灶 ,无明显并发症。结论 :腹腔镜射频消融治疗肝血管瘤安全可行 ,治疗彻底 ,是治疗肝血管瘤的微创新技术。     

腹腔镜下冷循环射频消融治疗肝癌

目的探讨腹腔镜下冷循环射频消融在肝癌治疗中的价值. 方法肿瘤位于肝脏脏面不适于在B超引导下进行射频治疗的原发性肝癌12例,转移性肝癌3例,肝癌破裂出血4例,全身麻醉,术中先腹腔镜探查,明确肿瘤位置确定穿刺点,然后在腹腔镜引导下,穿刺肿瘤行射频消融治疗. 结果全组未发生手术并发症.4例肝癌破裂出血停止,术后复查肿瘤缩小,血AFP显著下降.术后1个月32个肝癌病灶,完全消融27个,消融不全5个,完全消融率84.4%(27/32).3个月后CT示9例肿瘤病灶完全坏死,AFP降至正常;6例病灶部分坏死.随访2～18个月,平均8.2月,15例生存,4例死亡(3例肝功能衰竭,1例消化道大出血). 结论腹腔镜引导下冷循环射频消融治疗肝癌比B超引导下射频治疗定位更加准确,治疗效果肯定,手术并发症发生率低.     

Laparoscopic radiofrequency ablation of unresectable hepatic malignancies

BACKGROUND: Radiofrequency ablation (RFA) of hepatic malignancies has been performed successfully via a percutaneous route or at laparotomy. We analyzed the efficacy and utility of laparoscopic intraoperative ultrasound and RFA in patients with unresectable hepatic malignancies. METHODS: Between November 1997 and November 1999, 27 patients with unresectable hepatic malignancies and no evidence of extrahepatic disease were entered in a phase 2 trial of laparoscopic intraoperative ultrasound and RFA. Real-time ultrasonography was used to guide RFA, and lesions were ablated at a temperature of 100 degrees C for 10 min. Overlapping ablations were performed for larger lesions. RESULTS: Additional tumors were identified in 10 (37%) of the 27 study patients by laparoscopy and laparoscopic intraoperative ultrasound despite extensive preoperative imaging. Radiofrequency ablation of 85 hepatic tumors yielded no mortality and only one case of postoperative bleeding. During a mean follow-up period of 14 months, four tumors (4.7%) locally recurred. Of the 27 patients, 11 (41%) remain free of disease at this writing; (22%) are alive with disease; and 10 (37%) have died with disease. CONCLUSION: Laparoscopic RFA and intraoperative ultrasound constitute a safe and accurate method for ablation of unresectable hepatic tumors.     

经皮射频消融治疗原发性肝癌并发症的护理

目的探讨经皮射频消融治疗原发性肝癌的护理要点。方法对32例行RF治疗的原发性肝癌患者手术前后护理及术后并发症进行回顾性分析。结果本组患者未遇到与消融治疗相关的死亡,15例患者（47%）出现并发症,包括腹痛9例,发热3例,恶心、呕吐2例,胸闷1例。结论充分的术前准备、针对性的护理及对患者出现并发症的密切观察,是PRFA治疗成功的重要因素。     

Laparoscopic radiofrequency ablation of hepatic tumors: Prospective clinical evaluation of ablation size comparing two treatment algorithms

Background: Radiofrequency ablation (RFA) is gaining increased acceptance for the local control of liver tumors. Essential for achieving local tumor control are reproducible volumes of ablation that encompass the tumor and a margin of normal liver parenchyma. The technical algorithm for performing ablations was arrived at in an animal model using normal liver. Limited amounts of data exist as to whether this translates to the human tumor model. Methods: We analyzed 531 ablated lesions in 154 patients undergoing laparoscopic RFA using RITA Medical Systems Starburst XL catheter deployed to a final diameter of 2–5 cm. The first 54 patients (algorithm 1) were treated with a larger initial deployment to 3 cm and incremental advancement of the catheter to the final diameter with a 20-min ablation time for a 5-cm lesion. The subsequent 100 patients (algorithm 2) were treated with a smaller initial deployment of 2 cm, incremental advancement to the final diameter, and 14-min total ablation time for a 5-cm lesion. Lesion size was measured on 1 week postablation CT scans. Analysis was performed using the two-tailed t-test. Results: Ablation zones tended to be larger with the second method. On 1 week postablation CT scans, mean ± SEM lesion sizes created using the first and second algorithms were 3.7 ± 0.1 cm vs 4.0 ± 0.1 cm at 3 cm deployment (p < 0.05); 4.3 ± 0.1 cm vs 4.8 ± 0.1 cm at 4 cm deployment (p < 0.05), and 5.5 ± 0.1 cm vs 5.6 ± 0.2 cm at 5 cm deployment (p > 0.05), respectively. The mean ± SEM total ablation times for the first and second algorithms were 7.9 ± 0.3 min vs 7.0 ± 0.2 min at 3 cm deployment (p < 0.05); 13.3 ± 0.3 min vs 11.1 ± 0.02 min at 4 cm deployment (p < 0.05); and 27.8 ± 1.2 min vs 21.4 ± 1.2 min at 5 cm deployment (p < 0.05), respectively. The small SEM values indicate little variation in lesion size. Conclusions: These results show that both algorithms create dependable and reproducible zones of ablation, essential for reliable tumor destruction. Algorithm 2 demonstrates that creating an initial small core of ablation with rapid coagulation of the center of the lesion allows for equivalent, if not larger, final volumes to be performed in less time. Presented at the annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons(SAGES),LosAngeles,CA,USA,10–15 March 2003     

Solitary hepatic gastrinoma treated with laparoscopic radiofrequency ablation.

BACKGROUND: This is a case of a solitary hepatic gastrinoma in a 65-year-old male. The patient was diagnosed with Zollinger-Ellison syndrome in 1991. He had negative radiologic and surgical explorations at that time. He was maintained on proton-pump inhibitors for the next 10 years without symptoms. METHODS: A computed tomographic (CT) scan done in April 2001 demonstrated a 5-cm right hepatic lesion. Radionucleotide scanning with octreotide demonstrated intense activity in the same area in the right hepatic lobe. His serum gastrin was 317 pg/mL. He underwent laparoscopic radiofrequency ablation of the lesion. RESULTS: Treatment resulted in a 6-cm ablative area giving a 1-cm margin on the tumor. One- and 3-month follow-up CT scans demonstrated adequate ablation of the tumor. An octreotide scan done 3 months postoperatively did not reveal any areas of abnormal uptake. CONCLUSION: We report success with laparoscopic radiofrequency ablation as an alternative to major hepatic resection in patients with a solitary hepatic gastrinoma.     

射频凝固器在肝癌肝切除术中的应用

目的 探讨射频凝固器与传统钳夹法行肝癌肝切除术对术中出血和术后并发症的影响.方法 回顾性分析2011年1月至2012年6月第三军医大学西南医院收治的130例肝癌患者的临床资料,采用配对病例对照研究方法,将65例采用射频凝固器进行肝切除术的肝癌患者设立为射频凝固器组;同时根据肿瘤的大小、部位和Child-Pugh分级在肝癌数据库中配对选取65例临床病理特征类似的采用传统钳夹法进行肝切除术的患者设立为传统钳夹组.对两组患者术中和术后的相关参数进行统计学对比分析.计量资料用中位数加范围表示,均数比较用方差分析;计数资料比较用x2检验,当例数＜ 10时采用Fisher确切概率法.结果 射频凝固器组患者的术中断肝时间和肝门阻断时间分别为28 min(12～55 min)和10 min(0～ 15 min),明显短于传统钳夹组的45min(25 ～92m in)和15 min(10～32min),两组比较,差异有统计学意义(F=10.35,9.05,P＜0.05);射频凝固器组患者的术中出血量和术中输血量分别为150ml(50 ～350ml)和0ml,显著少于传统钳夹组的450 ml (250～ 2500 ml)和550 ml(0～2000 ml),两组比较,差异有统计学意义(F=15.86,P＜0.05);射频凝固器组65例患者未输血,显著多于传统钳夹组的48例(x2=19.58,P＜0.05).射频凝固器组患者术后第3、7天AST和TBil,术后第3天PT、Clavien外科并发症分级、住院时间分别为302 U/L(89 ～823 U/L)、54 U/L(16 ～325 U/L)、37 μmol/L(18～112 μmol/L)、24 μmol/L(9～66 μmol/L)、15 s(11 ～20 s)、22％(14/65)、12 d(8 ～36 d),与传统钳夹组的253 U/L(63～876 U/L)、62 U/L(22 ～ 376 U/L)、41 μmol/L(19 ～ 105 μmol/L)、25tμmol/L(11 ～59 μmol/L)、14 s(11 ～21 s)、26％ (17/65)、13 d(9 ～35 d)比较,差异无统计学意义(F =2.59,1.93,3.96,1.58,2.35,x2=0.381,F=1.58,P＞0.05);射频凝固器并发症发生率为17％(11/65),显著低于传统钳夹组的52％(34/65),两组比较,差异有统计学意义(x2=17.38,P＜0.05).其中射频凝固组只有2例患者发生术后出血,显著少于传统钳夹组的22例.但射频凝固器组有8例患者发生断面包裹性积液,其中5例需穿刺引流.传统钳夹组有2例患者发生肝功能不全;射频凝固器组有2例患者发生血红蛋白尿.结论 与传统钳夹法比较,射频凝固器行肝切除术具有出血少、安全、快捷的优点.