经皮射频消融治疗巨大肝癌

目的总结冷循环射频消融(RFA)治疗巨大肝癌的临床疗效和经验。方法采用CT引导下经皮穿刺冷循环RFA治疗巨大肝癌24例,每个病灶进行射频消融1～4次,其中22例患者结合1～6次TACE治疗,术后通过增强CT或MR评价疗效,所有病例随访12～37个月。结果10例病灶完全坏死,余14例病灶大部分坏死,1年生存率83%,中位生存时间20个月,13例患者现仍存活。结论CT引导下经皮穿刺冷循环RFA治疗巨大肝癌安全、有效。     

经皮射频消融治疗膈下肝癌

目的评价CT引导下冷循环射频消融治疗膈下肝癌的可行性和疗效。方法20例肝癌患者共25个膈下病灶在CT引导下行冷循环射频消融治疗,术后复查增强CT或增强MR,观察病灶坏死情况。结果18个病灶完全坏死,病灶完全坏死率72%,其余7个病灶大部分坏死,无严重并发症。结论CT引导下冷循环射频消融术治疗膈下肝癌安全、有效。     

CT引导下射频消融术在肝脏恶性肿瘤治疗中的临床应用

目的评价肝动脉化疗栓塞(TACE)联合全麻下CT引导下经皮穿刺射频消融(RFA)治疗肝脏恶性肿瘤的疗效。资料与方法原发性肝癌患者20例,肿瘤切除术后复发6例,肝转移瘤5例,男23例,女8例,年龄40～74岁。所有患者均先行TACE术(1～2次),然后在全麻CT引导下经皮穿刺行RFA治疗,其中2例联合手术行RFA治疗,2例做了2次RFA治疗。随诊2～36个月,观察并发症和疗效。结果 31例患者共进行43次RFA治疗,未出现任何严重并发症。23个肿瘤完全坏死,11个部分坏死。结论 TACE联合全麻下CT引导下RFA治疗肝脏恶性肿瘤是一种有效的微创治疗方法。     

CT引导经皮射频消融术对肺部肿瘤的治疗效果

目的评价CT引导经皮射频消融术（RFA）对肺部肿瘤的近期治疗效果,并阐述CT扫描在疗效评价中的作用。方法 34例经临床和病理证实的肺部肿瘤患者,包括原发性肺癌23例（25个病灶）和转移瘤11例（17个病灶）,起初均经CT引导经皮RFA治疗,随后对所有患者的RFA近期疗效利用螺旋CT平扫与增强扫描进行了逐例随访与评价。结果在34例的42个病灶中,RFA导致了35个病灶完全坏死,增强CT表现为肿瘤去血管化,近期随访无复发;7个病灶未完全坏死,增强CT表现为残留肿瘤强化,近期随访有进展。本组患者中未发生与操作有关的严重并发症。结论 RFA对肺肿瘤的治疗具有确切而明显的近期疗效,是一种侵袭性小且安全的方法,而CT平扫与增强扫描可为疗效评价提供可靠信息。     

经皮射频消融联合乙醇消融治疗肾上腺转移癌

目的总结CT导向下冷循环射频消融(RFA)联合乙醇消融(PEI)治疗肾上腺转移癌的效果和经验。方法采用CT导向下冷循环RFA联合PEI治疗18例肾上腺转移癌患者共21个病灶,术后复查增强CT或MR,观察病灶坏死情况。结果18个病灶完全坏死,3个病灶大部分坏死,病灶完全坏死率86%,无严重并发症。结论CT导向下冷循环RFA联合PEI治疗肾上腺转移癌安全、有效。     

CT引导下经皮射频消融治疗较大原发性肝癌的临床应用

目的 探讨CT引导下经皮射频消融(RFA)治疗较大原发性肝癌的疗效.方法 对27例TACE治疗效果欠佳的较大原发性肝癌患者行CT引导下经皮RFA治疗,肿瘤大小5.4-11.0 cm,平均6.2 cm.单发病灶23例,2个病灶4例,共31个病灶.AFP阳性22例.术后通过增强CT及AFP检测评价疗效,所有病例随访2～20个月.结果 射频治疗后1个月随访显示,31个肿瘤中14个(45.2%)肿瘤完全坏死,内部及边缘无明显强化;17个肿瘤部分坏死.22例AFP阳性患者,AFP明显降低15例(68.2%),不变3例(13.6%),升高4例(18.2%).并发症中3例出现表皮烫伤,1例顽固性呃逆,1例肝内出血,1例肝脓肿,1例术后出现严重低蛋白血症,术后2个月死亡.患者中位生存期为9.8个月,1年累计生存率29%.结论 对于不可切除的较大原发性肝癌,RFA是较有效的局部介入治疗方法,合理应用RFA治疗,可提高患者生活质量并延长患者的生存时间.     

超声引导下重叠布针射频消融肝癌的临床疗效观察

目的:评价超声引导下重叠布针内冷循环射频消融肝癌的临床应用价值.方法:71例患者,115个肿瘤结节(直径2.2～9cm),在超声引导下应用18G针尖裸露长度为2～3cm的冷循环电极针进行RFA治疗.每个肿瘤结节治疗2～8次,采用立体布针,多点重叠法.新发现的结节再次行RFA治疗.结果:即有患者临床症状改善,未发生严重伴发症.CT显示肿瘤完全坏死率在术后3～7天、3、6、12、24个月分别为88%、81%、78%、63%、40%,存活率在3、6、12、24个月分别为98%、95%、88%、61%.结论:超声引导下重叠布针内冷循环消融肝癌是有效和安全的方法,减少了残余肿瘤的机会.扩大了适用范围,延长了患者的寿命,改善了患者生活质量.     

超声引导经皮射频消融治疗肝癌的临床疗效分析

目的：探讨超声引导经皮射频消融治疗肝癌的临床疗效。方法对我院接受超声引导经皮射频消融治疗的56例原发性肝癌患者的临床资料进行分析。结果在术后1周,超声检查显示肝癌病灶为不均匀的回声增强,边界模糊,范围大于原病灶,内无血流信号,1个月后病灶表现为高回声,增强CT示病灶无强化。本组56例患者中8例患者的AFP在正常范围内,为14．29％（8/56）,术前及术后均＜10ng/ml,其余48例患者AFP值均不同程度地增高。结论超声引导下经皮射频消融治疗是一种安全有效的微创治疗法,值得临床推广。     

CT导向下射频消融治疗肝脏肿瘤

目的 研究射频消融(RFA)对肝脏恶性肿瘤的治疗效果.方法 对30例肝脏恶性肿瘤患者共38个病灶CT引导下进行经皮射频消融治疗,大小2.5～12 cm,其中原发性肝癌26例,转移性肝癌4例.应用美国RIDA 1500型射频消融仪,电极针为15G的9根伞状排列的可伸缩针,电极针打开后最大直径可达5 cm.术前术后均进行增强CT扫描,并定期随访.结果 RFA操作均顺利完成.平均5.5 d后患者康复出院或接受其他方案治疗. 治疗结束后即刻CT平扫,肿瘤内有小点状气体形成者20例,30 d后螺旋CT扫描,增强后38个结节中,直径≤3 cm的4个病灶全部坏死,直径在3～5 cm之间12个病灶,7个全部坏死,5个部分坏死, 直径>5 cm的22个病灶5个全部坏死,均为先行1～2次经肝动脉导管化疗栓塞治疗病人,17个病灶部分坏死.术后常见并发症主要为肝区疼痛、发热、气胸及胸腔积液,无射频治疗相关的死亡.结论 CT引导下经皮射频消融是一种安全有效治疗肝脏恶性肿瘤的方法.     

超声造影在肝癌病灶诊断及引导射频消融治疗中的应用价值

目的探讨超声造影（CEUS）在肝恶性肿瘤病灶诊断及引导射频消融（RFA）治疗中的应用价值。方法对经病理确诊并经RFA治疗的56例肝癌患者资料进行回顾性分析,术前比较增强cT、普通彩色多普勒超声（二维＋多普勒）和超声造影对肝癌（原发及转移）的检出率,观察二维及超声造影病灶图像差异及特点。对普通彩色多普勒超声引导组（62个病灶）和超声造影引导组（so个病灶）在术中引导RFA的消融效果进行对比并利用超声造影观察射频消融术后疗效。结果56例肝癌患者,112个病灶（原发灶36个,转移灶76个）。超声造影对肝癌病灶检出率为94．6％（106／112）,增强CT对肝癌病灶检出率为96．4％（108／112）,两者检出率比较差异无统计学意义0（x^2=0．42,P〉O．05）。普通彩色多普勒超声对肝癌病灶检出率为74．1％（83／112）,其与超声造影的检出率差异有统计学意义0（2=16,P〈0．05）。在普通彩色多普勒超声引导下进行RFA完全消融率为69％（43／62）,超声造影引导下完全消融率为84％（42／50）,两者的完全消融率差异无统计学意义舒=1．6,P〉0．05）。结论超声造影在RFA术前对肝脏肿瘤的诊断,术中对病灶的准确定位及实时引导穿刺,术后对手术疗效的随访观察都具有重要的应用价值。     

术中超声在冷循环射频治疗肝脏肿瘤中的作用

目的:探讨术中超声在冷循环射频治疗肝脏肿瘤中的应用价值。材料和方法:对31例肝癌患者在开腹手术时行术中超声检查,并以超声作为射频针穿刺的引导手段,动态观察手术进程。结果:31例患者均在术中超声引导下完成治疗。其中7例术前未发现小病灶。1例排除术前MR I诊断的1处假阳性病灶。结论:术中超声可发现术前影像学检查遗漏的小病灶,避免胆管、血管损伤等并发症,实时观察射频治疗过程并优化手术策略。     

Percutaneous radiofrequency ablation of osteoid osteoma using cool-tip electrodes without the cooling system

Purpose

The aim of this study was to evaluate the efficacy of percutaneous radiofrequency ablation (RFA) for osteoid osteoma (OO) using cool-tip electrodes without the cooling system.

Materials and methods

A total of 17 patie 17 patients (13 males, 4 females; mean age 19.1 years; range 7?C49 years) with OO (tibia, n = 7; femur, n = 5; acetabulum, n = 2; radius, n = 1; talus, n = 1; lumbar spine, n = 1) underwent RFA. Using a cool-tip electrode without the cooling system, the lesion was heated to 90°C for 4 or 5 min. Procedures were considered technically successful if the electrode was placed into the nidus and the target temperature was reached and maintained for at least 4 min. Clinical success of the treatment was defined as complete or partial pain relief after RFA.

Results

All procedures were considered technically successful, although two patients encountered complications (pes equinus contracture, skin burn). Altogether, 16 of the 17 patients (94.1%) achieved complete or partial pain relief after primary RFA. Two patients had pain recurrence, with one of them treated successfully with a second RFA. The overall clinical success rate was 88.2%. Histological findings confirmed the presence of OO in 13 patients (76.5%).

Conclusion

Percutaneous RFA of OO using cool-tip electrodes without the cooling system is a safe, effective procedure.     

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.     

超声引导经皮射频消融治疗肝癌的探讨

目的 探讨超声引导在经皮穿刺射频消融技术治疗肝癌中的可行性与安全性。方法 应用超声对36例肝癌患进行穿刺引导，并实时检测射频消融的全过程。结果 36例患均在超声引导下顺利完成治疗，仅有1例术后肝包膜下出现小血肿。结论 准确的超声引导射频治疗肝癌术对提高疗效，减少并发症具有重要意义。     

Ultrasound-guided percutaneous radiofrequency ablation in elderly breast cancer patients: preliminary institutional experience

Breast cancer is a major source of morbidity and mortality in the elderly population and the number of patients will increase by 30% in future decades. Surgery and endocrine therapy could be considered as the standard treatment in elderly breast cancer patients, but anaesthesia for surgery requires a specific approach taking into account physiological and psychological alterations secondary to ageing. In cases with major alterations of performance status, percutaneous radiofrequency ablation (RFA) could be substituted for the surgical treatment. The aim of the current study is to evaluate the efficacy and feasibility of this technique. Five tumours in four consecutive patients (aged 79-82 years) contraindicated for surgery with symptomatic cT1-2N0M0, positive oestrogen receptor status, low grade were treated by percutaneous radiofrequency-lump ablation under local analgesia, using percutaneous ultrasound guidance. Thermal lesions were produced with RF power 30 W, at a frequency of 500 kHz. Ultrasound-guided percutaneous biopsy of the RF treated breast was performed during the follow-up. We report a successful RFA lump ablation experience in the treatment of four tumours (4/5). One local recurrence occurred within 4 months after RFA. The other biopsies taken during the follow up showed all fat necrosis within the oil cyst and no malignant cells. One abscess occurred at 9 months within the treated area. After a mean follow up of 29.4 months, all the patients are still alive without any other signs of recurrence or metastases. Ultrasound-guided percutaneous RFA is safe and feasible in the management of breast cancer in elderly patients. Nevertheless, further large comparative studies are needed in order to validate such a minimally invasive procedure in current practice.     

Radiofrequency thermal ablation of liver tumors

Radiofrequency ablation (RFA) of liver tumors was first proposed in 1990. New technologies enable us to produce liver thermal lesions of approximately 3–3.5 cm in diameter; RFA has consequently become an emerging percutaneous therapeutic option both for small hepatocellular carcinoma (HCC) and for non-resectable liver metastases, mainly from colorectal cancer. New devices (for example, triplet of cooled needles, wet needles) and combined therapies (tumor ischemia and RFA) have made it possible to treat large tumors. RFA can be carried out by a percutaneous, laparoscopic or laparotomic approach. Percutaneous RFA can be performed with local anaesthesia and mild sedation; deep sedation or general anaesthesia are also used. The guidance system is generally represented by ultrasound. CT or MR examinations are the more sensitive tests for assessing therapeutic results. The series of patients treated with RFA allow the technique to be considered as effective and safe, achieving a relatively high rate of cure in properly selected cases; it should be classified as curative/effective treatment for HCC, replacing percutaneous ethanol injection. The complication rate of RFA is low but not negligible; key elements in a strategy to minimize them are identified.     

Usefulness of live 3D echocardiography during radiofrequency ablation in a case of hepatocellular carcinoma

We report a case of hepatocellular carcinoma (HCC) with chronic hepatitis C virus (HCV) infection, which was successfully treated with percutaneous radiofrequency ablation (RFA) under live three-dimensional (3D) echocardiography guidance. Recently, it was reported that live 3D echocardiography was able to enhance the efficacy of catheter-based endomyocardial injection since the 3D images made it possible to observe the target from multiple directions so that it guided more accurately. A 63-year-old Japanese man had an HCC nodule of 3.0 cm in diameter at the S8 region of the liver. Here we applied live 3D echocardiography during RFA therapy with a LeVeen needle electrode. The echocardiography guidance allowed for easier and accurate approach for needle puncture. The guidance was also effective to confirm whether an enough safety margin for the nodule was obtained. Thus, live 3D echocardiography appears to safely guide RFA needles by accurate targeting for HCC nodule, providing real-time visualization when combined with echocardiography contrast.