CT引导经皮穿刺^125I粒子植入治疗胰头癌

目的探讨CT引导经皮穿刺^125I粒子植入治疗胰头癌的价值。方法2005年10月～2012年8月,16例胰头癌在CT引导下采用经皮经胃（10例）或经皮经肝经文氏孔（6例）穿刺胰头癌植入^125I粒子,术后1、3个月进行cT随访。结果16例^125I粒子植人全部成功,植入粒子12～38颗,平均23．5颗,放射性粒子分布良好,间距均〈1．5cm。穿刺过程中无一例并发症发生。6例出现一过性血淀粉酶升高120～195U／L（正常值为25～100U／L））,未经特殊处理2—3d后转为正常,无胰漏发生。术后发热4例,体温均〈38．0℃,未经处理第2天恢复正常。未发生胃肠道漏,经肝脏穿刺患者未出现肝功能异常,穿刺针道无肿瘤种植性转移。右上腹和腰背部疼痛缓解（术后VAS评分3～7分,平均4．5分）,患者食欲增加。术后3个月患者均生存;术后1、3个月行上腹部增强扫描,3个月时肿瘤CR2例（12．5％）,PR10例（62．5％）,SD3例（18．8％）,PD1例（6．2％）。结论对晚期胰头癌失去手术机会者,胰头癌合并有全身性疾病不能承受手术治疗者,以及不能承受化疗和体外放射治疗者,经皮穿刺^125I粒子植入为一种有效的治疗方法。     

术中超声在原发性肝癌手术以及射频消融中的应用

目的探讨术中超声在原发性肝癌手术切除以及射频消融治疗中的作用。方法对45例原发性肝癌患者行术中超声检查并将其结果与术前经腹超声检查进行对比，观察术中超声在原发性肝癌手术切除以及射频消融治疗中的作用。结果45例原发性肝癌患者共有肿瘤瘤灶60个，术前超声、术中超声诊断符合率分别为78．30％、95．00％，术中超声高于术前超声检查（P=0．0072）。对直径0．5～2．0cm的肿瘤瘤灶检出率术中超声为100％，高于术前超声的63．00％（P=0．012）。对术中未触及的8个瘤灶于术中超声引导下行肝脏局部切除术。对14个不宜手术切除的瘤灶行术中超声引导下射频消融治疗并短期随访观察，有效率为85．70％。结论术中超声可提高肝癌小瘤灶的检出率，减少漏诊以及误诊，并可在术中对无法触及以及不宜手术切除的瘤灶行术中超声引导的肿瘤切除以及射频消融治疗，具有很高的实用价值。     

超声引导经皮穿刺冷冻治疗肝癌的实验和临床研究

目的：探讨经皮穿刺冷冻治疗原发性肝癌的应用价值。方法：（1）家猪12只,腹腔镜下显露肝脏,Trocar针穿刺腹壁,经一非金属鞘将冷冻头插入肝右叶冷冻;（2）11例原发性肝癌,超声引导穿刺扩张皮肤直至肝内肿瘤表面,保留一非金属鞘,LCS－2000冷冻机5mm冷冻头经鞘管 至肿瘤中心冷冻,结果：（1）实验动物术后无腹腔内出血,冷冻穿刺部位无严重冻伤。（2）11例病人冷冻后恢复均顺利,其中5例肿瘤缩小≥50％,1例肿瘤完全消失。结论：超声引导下经皮冷冻治疗肝癌是一种安全可行,新型微创的局部治疗新方法。     

CT引导下经皮穿刺冷冻消融治疗肺转移癌

目的 观察CT引导下经皮穿刺冷冻消融治疗肺转移癌的有效性及安全性。方法 对59例肺转移癌患者（80个转移灶）行CT引导下经皮穿刺氩氦刀冷冻消融治疗,统计治疗有效率、疾病控制率、并发症及生存情况[局部肿瘤进展（LTP）时间、无进展生存期（PFS）及总生存期（OS）]。结果 共对59例80个肺转移癌成功完成75例次冷冻消融。冷冻消融治疗有效率为85.33%(64/75),疾病控制率为94.67%(71/75),治疗后1及2年的LTP率分别为49.08%及32.83%、无进展生存率分别为37.02%及19.37%、总生存率分别为58.14%及33.49%。72例次（72/75,96.00%）出现国际介入放射学学会（SIR）A～B级并发症,3例次（3/75,4.00%）出现SIR C级并发症,其中咳嗽（49/75,65.33%）、咯血（41/75,54.67%）及疼痛（19/75,25.33%）最为常见;未见SIR D～F级并发症。结论 CT引导下经皮穿刺氩氦刀冷冻消融治疗肺转移癌较为有效且安全。     

超声引导定位深部冷冻治疗肝癌

目的：探讨超声引导定位在深部冷冻治疗肝癌的作用。方法：应用ToshilbaSSA-240A型超声显像仪对52例肝癌患者采用直接探查肝脏引导定位或经皮超声定位引导深部冷冻治疗肝部,并进行冷冻实时监测。结果：52例肝癌患者经术前超声引导定位后对瘤体穿刺部位准确,冷冻彻底。结论：超声引导定位对深部冷冻治疗肝癌是一种安全,有效,简单而准确的方法,易于推广。     

内镜超声引导下胰腺占位性病变细针穿刺活检的评价

目的采用内镜超声引导下细针穿刺活检对胰腺肿块进行定性诊断，为手术方式及其它治疗方法的选择提供依据，并评价该法的临床意义。方法对CT、MRI和B超诊断为胰腺占位性病变的16例病人进行了内镜超声引导下穿刺活检（EUS-FNAB），同时观察病变的大小、形态、位置、有无周围血管侵犯和淋巴结转移。结果16例中12例（75％）得到足够的细胞量，8例（50％）得到足够的组织量。其中11例（68．6％）经病理和（或）细胞学诊断为胰腺癌或高度疑似胰腺癌，3例仅见炎性上皮细胞，8例病人经手术证实。EUSFNAB诊断的敏感性为78．6％，特异性为100％，病人均未出现感染、出血、胰瘘和胰腺炎等并发症。结论内镜超声引导下对胰腺占位性病变的细针穿刺活检在鉴别诊断中具有重要的价值，值得临床推广应用。     

无穿刺架超声定位引导经皮肾取石术

目的 探讨无穿刺架超声定位引导经皮肾取石术治疗肾结石的临床应用价值。方法总结我院采用无穿刺架超声定位x引导经皮肾取石术治疗324例肾及输尿管上段结石的临床资料。其中复杂性肾结石232例,结石位于左侧147例,右侧126例,双侧51例。轻度肾积水131例,中度肾积水179例,重度。肾积水65例,最大肾结石10．2emx5．3cm。肾结石合并输尿管结石201例,总肾功能不全52例。结果所有病例均手术成功,平均手术时间175＋25minf45～210）,平均经皮肾通道建立时间16．5±5．4min。一期碎石成功244例（75．3％）,需二期碎石取石80例（24．7％）,多通道手术42例（13．0％）,其余为单通道。结石完全清除率89．8％（291／324）,发生严重出血3例（0．9％）,2例输血400ml。术后发热38例（11．7％）。结论无穿刺架超声定位引导建立经皮肾通道技术可行,安全准确,也可作为经皮肾取石术的引导穿刺方法。     

超声引导经皮细刀头氩氦刀靶向冷冻治疗肝癌

目的:探讨经皮细刀头氩氦刀靶向冷冻治疗肝癌的有效性及安全性。方法:从2006年6月至2007年6月,广东省佛山市第一人民医院在超声引导下采用Cryo Hit氩氦刀147mm细刀头对26例原发性肝癌、15例复发性肝癌和13例转移性肝癌总共105个瘤灶（直径0.8～12.0cm）经皮靶向冷冻治疗。每3～6个月复查血清肿瘤标记物、B超、CT或MR评价瘤灶坏死情况,采用Kaplan Meier统计分析存活率。结果:原发性肝癌组、复发性肝癌组以及转移性肝癌组术后1年累积存活率分别为81.82%、46.22%和80.21%。术后复查B超、CT或MR均提示瘤灶不同程度的缩小甚至消失,对于直径<3cm的肿瘤完全坏死率达96.2%,直径3～5cm的肿瘤完全坏死率达90.6%,直径＞5cm的肿瘤完全坏死率达28.6%。无出血、胆漏等严重并发症发生。结论:超声引导经皮细刀头氩氦刀靶向冷冻治疗肝癌是继射频、微波之后又一安全、有效的经皮局部消融治疗新方法,其远期疗效还有待长期随访观察。     

MSCT引导下冷极射频消融治疗难治性恶性肿瘤的应用价值

目的探讨在MSCT引导下经皮穿刺冷极射频消融治疗难治性恶性肿瘤的安全性、疗效及其应用价值。方法76例恶性肿瘤84个瘤灶，瘤体直径3．0～15．0cm，平均8．5cm。根据消融术前MSCT图像制定治疗计划，在MSCT引导下经皮穿刺准确将针型电极插入肿瘤预定位置进行热消融，消融温度58～90℃，治疗时间15～120min。术后2h复查，观察有无急性并发症。术后1个月和每3个月CT复查观察肿瘤有无残留和复发，必要时可多次治疗。通过影像学评估消融的疗效，并统计生存期。结果76例恶性肿瘤84个瘤灶在MSCT引导下消融针均准确插入肿瘤预定位置并顺利完成热消融过程，未见严重并发症。术后1个月复查，84个瘤灶完全坏死15个；不完全坏死和部分坏死45个，总有效率71．43％（60／84）。治疗后生存率随访：6个月90．79％，12个月63．16％，18个月36．84％，24个月14．47％。结论在MSCT引导下经皮穿刺冷极射频消融技术是一种创伤小、易耐受、安全有效的治疗难治性恶性肿瘤的方法。     

超声引导下连续置换法治疗单纯性肾囊肿的临床应用

目的评价超声引导下连续置换法治疗单纯性肾囊肿的临床疗效和随访结果。方法146名单纯性肾囊肿患者的临床资料,以经皮穿刺乙醇硬化法治疗的患者为A组,超声引导下连续置换法治疗的患者为B组,比较两组治疗前后及随访过程中患者囊肿大小及临床症状的改善。结果经连续置换法治疗后,囊肿直径的变化优于经皮穿刺乙醇硬化法,囊肿直径分别由治疗前的（8．76±3．05、9．00±3．09）cm减小至治疗后3个月的（4．45±1．50、4．97±1．60）cm、6个月的（2．47±0．270、2．95±0．56）cm、12个月的（1．39±0．23、1.76±0．42）cm以及〉12个月的（0．65±0．14、1．02±0．29）cm,两组间有显著差异（P〈0．05）;治疗后,两组患者临床症状的总改善率分别为94．3％和98．4％,差异无统计学意义（P〉0．05）。结论超声引导下连续置换法治疗单纯性肾囊肿简单、安全,在治疗效果上具有显著的优越性,值得临床上推广应用。     

CT-guided pancreatic percutaneous fine-needle biopsy in differential diagnosis between pancreatic cancer and chronic pancreatitis

Differential diagnosis between pancreatic cancer and chronic pancreatitis is still difficult to establish. In 63 patients with suspected pancreatic neoplasm we performed: serum CA 19-9 assessment, abdominal ultrasound. CT scan and CT-guided pancreatic percutaneous fine-needle biopsy. The conclusive diagnosis was pancreatic cancer in 40 patients and chronic pancreatitis in 23 patients. With regard to the differential diagnosis, sensitivity and specificity were respectively 80% and 78% for serum CA 19-9, 75% and 65% for abdominal US. 85% and 70% for CT scan. 00% and 87% for percutaneous fine-needle biopsy. We conclude that CT-guided percutaneous fine-needle biopsy is the most reliable method for differential diagnosis between pancreatic cancer and chronic pancreatitis.     

Phase I study of percutaneous cryotherapy for colorectal liver metastasis

BACKGROUND: The aim was to determine the safety and feasibility of percutaneous cryotherapy for treating irresectable colorectal liver metastases. METHODS: Liquid nitrogen cryoprobes were inserted percutaneously into metastases using the Seldinger technique under computed tomographic guidance. Single-probe treatments were performed with either 3.6- or 6.3-mm cryoprobes (ice-ball volumes 18 and 59 cm3 respectively), or dual-probe treatments with two adjacent 6.3-mm probes (ice-ball volume 205 cm3). Treatment involved a single freeze--thaw cycle. RESULTS: Fifteen patients received 25 single-probe treatments and seven patients received 14 dual-probe treatments. The treatment-related mortality rate was zero and complications occurred after six of 39 treatments. Liver metastasis growth was significantly delayed for 2 months after dual-probe but not single-probe treatment. Metastasis cryotherapy stimulated an immediate rise, followed by a fall, in serum carcinoembryonic antigen (CEA) level, associated with immune upregulation that was significantly greater after dual-probe treatments. CONCLUSION: Ablation zones that were approximately four times larger than those produced by previously described percutaneous techniques delayed the growth of metastases, reduced serum CEA concentration, and induced detectable inflammatory and T-lymphocyte responses. Percutaneous cryotherapy for treatment of colorectal liver metastases is feasible and may have a place in conjunction with chemotherapy.     

Needle-tract seeding after percutaneous cryoablation for lung metastasis of colorectal cancer

We report two cases of needle-tract seeding after percutaneous cryoablation for lung metastases of colorectal cancer. The targeted lung tumor was solitary in both cases. In patient 1, cryoablation was performed with a single cryoprobe, which was removed without freezing the cryoprobe tract. In patient 2, cryoablation was performed with two cryoprobes, both of which were removed after freezing of the cryoprobe tract. The seeding nodule appeared 5 and 7 months after cryoablation on the follow-up computed tomographic scan, respectively. In both cases, the seeding nodules were solitary and existed primarily in the subcutaneous to chest muscle layer, and could be completely resected under local anesthesia. Both lesions were pathologically confirmed as metastases from colorectal cancer. Local control was maintained in patient 1 for 4 years, until death due to progressive lung metastases. Patient 2 is alive without recurrences 8 months after resection.     

Initial experience with laparoscopically assisted percutaneous cryotherapy of renal tumors

BACKGROUND AND PURPOSE: Laparoscopic renal cryoablation is a feasible therapeutic option for small renal tumors. Advances in cryoablation technology have produced smaller cryoprobes. We review our initial experience with laparoscopic cryoablation utilizing 17-gauge cryoneedles. PATIENTS AND METHODS: Four patients aged 21 to 78 years underwent laparoscopy-assisted percutaneous cryotherapy between May 2003 and March 2004. The tumor size ranged from 1.5 to 2.5 cm. The procedure involved transperitoneal exposure of the tumor utilizing three 5- or 10-mm ports. The cryoprobes were placed percutaneously, without the need for tract dilation. Two freeze-thaw cycles were performed with cooling to below -70 degrees C. RESULTS: In all patients, the procedure was completed without complication. The mean operative time was 125 minutes. The mean blood loss was 29 mL. No perioperative complications occurred. In follow-up, one patient with a tumor suspected of being renal-cell carcinoma demonstrated residual enhancement and underwent percutaneous radiofrequency ablation. CONCLUSIONS: Laparoscopy-assisted percutaneous cryotherapy is a feasible treatment option in patients with small renal tumors. Laparoscopy allows mobilization of both anterior and posterior tumors. Direct viewing of the mass may facilitate accurate placement of the cryoneedles. The small size of the cryoneedles minimizes bleeding at the entry site.     

Cost analysis of open, laparoscopic, and percutaneous treatment options for nephron-sparing surgery

BACKGROUND AND PURPOSES: A variety of nephron-sparing options exist for the management of small renal masses. The perioperative cost of open (OPN) and laparoscopic (LPN) partial nephrectomy, laparoscopic (LCA), and CT-guided percutaneous (PCA) cryoablation was compared using a detailed computer model. PATIENTS AND METHODS: The model incorporates operative time, consumables, anesthesia, CT usage, percutaneous biopsy, hospitalization, and transfusion expenses. Starting values were derived from a retrospective review of 317 patients treated at the Johns Hopkins Medical Institutions within the past 7 years. Hypothesis testing was performed with sensitivity analysis. RESULTS: The PCA was 2.2 to 2.7 times less costly than the other options and resulted in a cost savings of $3625 to $5155 per case. For OPN, LPN, and LCA, the operative time and hospitalization accounted for 69% to 91% of the cost. In contrast, cryoprobe consumables were responsible for >70% of total cost of PCA. An OPN was 1.2x as costly as LPN and could achieve cost equivalence only with operative times of <2.8 hours or hospitalization of <3 days. An LCA was more costly than all forms of extirpative surgery if more than two cryoprobes were used. Reusing cryoprobes during LCA was always a less-costly option than adding a second cryoprobe to the procedure. The LCA was no longer cost advantageous over OPN if more than four CT scans were obtained during the first postoperative year or if local recurrence rates exceeded 23%. CONCLUSIONS: This model defines and simplifies a series of complex cost relations between the options for nephron-sparing surgery.     

Magnetic-resonance-guided percutaneous cryoablation of hepatic tumours.

OBJECTIVE: To study the feasibility of percutaneous cryoablation of hepatic tumours monitored by magnetic resonance imaging (MRI). DESIGN: Prospective study SETTING: University hospital, Norway PATIENTS: Six patients with hepatic metastases from colorectal cancer. INTERVENTIONS: Percutaneous cryoprobe positioning under general anaesthesia. Positioning and freezing monitored by near-real-time MRI using an open 0.5 Tesla MRI configuration system. MAIN OUTCOME MEASURES: Safety and feasibility of the procedure. Measurement of volumes of cryolesions. RESULTS: One patient developed a biliary leakage that had to be drained. Four patients developed pleural fluid. Two small tumours were adequately cryoablated. In the remaining 4 patients with large (>4 cm) tumours, an adequate cryolesion could not be formed. Cryolesion volumes larger than 105 cm3 were not produced even using 3-4 probes. MRI visualised the growing cryolesion well, but positioning of the cryoprobes was time-consuming. CONCLUSION: MR guided cryoablation is clinically feasible and gives good visualisation of the procedure. Patients with small tumours (<3 cm) seem to be best suited to this percutaneous approach as cryolesion volumes claimed to be adequate for tumour destruction can be produced. Measurement of tumour volume preoperatively may help to select patients who will respond.     

经皮穿刺 125I放射性粒子组织间植入治疗Ⅳ期胰腺癌

目的明确经皮穿刺125I放射性粒子组织间植入治疗Ⅳ期胰腺癌的意义。方法回顾性分析超声引导经皮穿刺放射性粒子植入为首要治疗手段的37例Ⅳ期胰腺癌患者临床及随访资料。结果全组37例术后生存期(7.49±4.08)个月,范围为3~17个月;术前30例出现上腹和(或)背部疼痛,术后27例疼痛不同程度缓解;20例术前发现腹水,18例术后腹水减少或消失。结论125I放射性粒子治疗可有效提高Ⅳ期胰腺癌患者的生活和生存质量。     

Endoscopic computerized tomography guided percutaneous trans-gastric drainage: A case report on this hybrid approach

Percutaneous drainage, percutaneous transgastric drainage, and endoscopic ultrasound (EUS)-guided transgastric drainage are primarily utilized for drainage of fluid collections dorsal to the stomach. Percutaneous transgastric drainage is performed with computed tomography (CT) guidance, but it requires inflation of a balloon in the stomach, and gastric peristalsis makes it difficult to ensure a reliable puncture route via the stomach. Using endoscopy-assisted CT-guidance, we were able to safely and effectively perform percutaneous transgastric drainage.A 69-year-old man underwent a pancreaticoduodenectomy for cancer of the inferior section of the common bile duct. Postoperative day 5, the amylase value of the drainage fluid was 1,232 IU/L, we diagnosed a pancreatic fistula developed as a result of pancreaticojejunal anastomotic failure and we performed drainage at the drain which was placed in the foramen of Winslow intraoperatively, however fluid collection dorsal to the stomach was detected on a follow-up abdominal CT scan, and the fluid was a high value of amylase, we judged the drain was not working well and the pancreatic fistula occured. Endoscopy-assisted, CT-guided percutaneous transgastric drainage was therefore performed, and the pancreatic fistula was successfully closed the fistula.     

经腹超声在介入治疗局部进展期胰腺癌中的应用

胰腺癌是消化系统最常见恶性肿瘤之一,多数患者确诊时已不能根治性切除。介入治疗因其微创性和有效性近年来用于缓解胰腺癌晚期相关症状,提高患者生存质量。经腹超声已广泛用于引导胰腺癌介入操作,各种超声新技术的应用,有望改善非手术治疗局部进展期胰腺癌的疗效。本文对超声在局部进展期胰腺癌经皮介入治疗中的应用进展进行综述。     

Prophylactic hepatic irradiation following curative resection of pancreatic cancer

Background/Purpose It is unlikely that adjuvant chemoradiotherapy applied to the pancreatic bed alone significantly improves the survival of patients with resectable pancreatic cancer. The aim of the present study was to determine whether prophylactic hepatic irradiation (PHI) improved patient outcome after the curative resection of pancreatic cancer.Methods The study population was comprised of 34 patients (PHI group) who were administered PHI after curative resection of pancreatic cancer between September 1994 and December 2003. The whole liver was irradiated with a total dose of 19.8–22.0 Gy under continuous infusion of 5-fluorouracil. The cumulative rate of liver metastasis and the survival outcomes of the PHI group were compared with those of 31 patients without PHI (non-PHI group) who underwent curative resection of pancreatic cancer.Results The planned PHI was completed for 32 of the 34 patients. Two patients developed complications that might have been PHI-related. One developed liver abscesses which were successfully managed by percutaneous drainage. The other died of liver failure without recurrence 11 months after the operation. The cumulative incidence of liver metastasis was significantly lower for the PHI group than the non-PHI group (P = 0.0455). Patients in the PHI group also survived significantly longer compared to those in the non-PHI group (P = 0.0002).Conclusions The present findings suggest that PHI is well tolerated and is a potentially effective treatment strategy after curative resection of pancreatic cancer, thereby providing the basis for a randomized controlled trial.