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1.
Radiofrequency ablation for malignant liver tumor 总被引:5,自引:0,他引:5
Radiofrequency ablation (RFA) has been widely practiced to treat unresectable malignant liver tumors. It has the merits of localized tumor ablation and preservation of maximal normal liver parenchyma. In recent years, there has been a tremendous expansion in the application of RFA for patients with malignant liver tumors. However, the therapeutic effect of this local ablation treatment needs to be balanced against its risks and possible local failure. This review focuses on the current status of RFA for malignant liver tumors, with special attention to the indication, approaches, complications, survival benefits, combination therapies, and comparison with other treatment modalities. Although the results of most clinical studies of RFA seem favorable, the associated risks and tumor recurrence should not be underestimated. Careful patient selection, meticulous RFA techniques, and prompt treatment of residual and recurrent tumors are necessary to ensure a better outcome after RFA. Until recently, there has been no strong evidence showing that RFA can replace any other treatment modalities in the management of liver tumors. Nonetheless, more convincing evidence by randomized trials is required for the establishment of a treatment protocol of RFA for patients with malignant liver tumors. 相似文献
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Curley SA 《The oncologist》2001,6(1):14-23
The majority of patients with primary or metastatic hepatic tumors are not candidates for resection because of tumor size, location near major intrahepatic blood vessels precluding a margin-negative resection, multifocality, or inadequate hepatic function related to coexistent cirrhosis. Radiofrequency ablation (RFA) is an evolving technology being used to treat patients with unresectable primary and metastatic hepatic cancers. RFA produces coagulative necrosis of tumor through local tissue heating. Liver tumors are treated percutaneously, laparoscopically, or during laparotomy using ultrasonography to identify tumors and guide placement of the RFA needle electrode. For tumors smaller than 2.0 cm in diameter, one or two deployments of the monopolar multiple array needle electrode are sufficient to produce complete coagulative necrosis of the tumor. However, with increasing size of the tumor, there is a concomitant increase in the number of deployments of the needle electrode and the overall time necessary to produce complete coagulative necrosis of the tumor. In general, RFA is a safe, well-tolerated, effective treatment for unresectable hepatic malignancies less than 6.0 cm in diameter. Effective treatment of larger tumors awaits the development of more powerful, larger array monopolar and bipolar RFA technologies. 相似文献
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Takeda Y Hasuike Y Kashiwazaki M Shin E Tsujinaka T 《Gan to kagaku ryoho. Cancer & chemotherapy》2002,29(12):2229-2233
The majority of patients with primary or metastatic liver tumors are not candidates for resection because of the size, location, or multifocality of their tumors, or because of inadequate hepatic function related to cirrhosis. Radiofrequency ablation (RFA) is an evolving technique for treating patients with unresectable primary or metastatic liver cancers. After obtaining the approval of our institutional review board for this study, 12 patients with HCC and 6 patients with metastatic liver tumors were treated using the LeVeen RF ablation system at the Department of Surgery of Osaka National Hospital between March 2000 and February 2002. Informed consent was obtained from all patients. Ultrasound-guided RFA was done during open surgery. In 12 patients, RFA was performed during laparotomy, while in 6 patients it was done transdiaphragmatically during thoracotomy. All treated tumors showed complete necrosis on imaging after the completion of RFA. After a median follow-up period of 288 days, the tumor had recurred in 5 out of 18 patients, and the median overall survival rate was 362 days. No deaths or major complications occurred in these 18 patients. Liver function tests (ALT, AST, GGT) that were elevated after RFA returned to baseline in most patients by day 7. In 5 patients who underwent RFA at laparotomy, bile leakage and liver abscess developed. There were no cases of bile duct injury or liver abscess in the patients receiving transdiaphragmatic RFA. In conclusion, transdiaphragmatic RFA during thoracotomy is a safe, well-tolerated, effective treatment for unresectable hepatic malignancies. 相似文献
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激光消融治疗肝癌的临床研究 总被引:3,自引:0,他引:3
目的 评价半导体激光对肝癌的治疗效果.方法经病理证实的肝癌32例,用达美德半导体激光治疗仪行激光治疗.治疗所用功率为2 W,所用能量为2 800~6 400 J.所有病例于治疗后即刻和第3天行B超随访.结果应用激光消融即刻超声复查,发现原肿瘤低回声区出现气化所致高回声;3天后,靶区呈3层回声,中央呈无回声,中间高回声,周围低回声.结论对于一些无法手术或放疗的肝癌患者,半导体激光治疗提供了一种可行而有效的方法. 相似文献
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《中国肿瘤临床与康复》2017,(11)
目的探讨超声造影在肝脏残留复发性恶性肿瘤射频消融中的应用。方法选取2014年6月至2016年6月间山东省临沂市肿瘤医院收治的78例肝脏残留复发性恶性肿瘤患者(113个病灶)为超声造影引导组,另选取同期接受常规超声检查的80例患者(118个病灶)为常规超声引导组。记录超声造影引导组患者治疗前后病灶数量、大小、边界及内部回声情况,将其术前肿瘤检出率、术中穿刺成功率及术后射频消融准确率,与常规超声引导组进行比较。结果超声造影引导组射频消融术后,实时谐波超声造影诊断,113个病灶中有6个(5.3%)可见动脉相内有局部增强区,门脉及延迟相增强区快速消退呈现低增强,判断仍存在残留。余107个(94.7%)病灶行超声造影始终未见增强,边界清晰,判断肿瘤已经完全灭活。超声造影引导组术前肿瘤检出率、术中穿刺成功率和肿瘤完全消融率分别为92.0%、92.9%和94.7%,常规超声引导组分别为80.5%、76.3%和83.9%,两组比较,差异均有统计学意义(均P<0.05)。结论超声造影在判断肝脏残留复发性恶性肿瘤射频消融术效果方面,提高了肿瘤诊断的敏感性、穿刺成功率和射频治疗准确性。 相似文献
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Hailiang Tang Huaping Sun Liqian Xie Qisheng Tang Ye Gong Ying Mao Qing Xie 《中国癌症研究》2013,25(3):339-345
Objective
Intracranial meningiomas, especially those located at anterior and middle skull base, are difficult to be completely resected due to their complicated anatomy structures and adjacent vessels. It’s essential to locate the tumor and its vessels precisely during operation to reduce the risk of neurological deficits. The purpose of this study was to evaluate intraoperative ultrasonography in displaying intracranial meningioma and its surrounding arteries, and evaluate its potential to improve surgical precision and minimize surgical trauma.Methods
Between December 2011 and January 2013, 20 patients with anterior and middle skull base meningioma underwent surgery with the assistance of intraoperative ultrasonography in the Neurosurgery Department of Shanghai Huashan Hospital. There were 7 male and 13 female patients, aged from 31 to 66 years old. Their sonographic features were analyzed and the advantages of intraoperative ultrasonography were discussed.Results
The border of the meningioma and its adjacent vessels could be exhibited on intraoperative ultrasonography. The sonographic visualization allowed the neurosurgeon to choose an appropriate approach before the operation. In addition, intraoperative ultrasonography could inform neurosurgeons about the location of the tumor, its relation to the surrounding arteries during the operation, thus these essential arteries could be protected carefully.Conclusions
Intraoperative ultrasonography is a useful intraoperative technique. When appropriately applied to assist surgical procedures for intracranial meningioma, it could offer very important intraoperative information (such as the tumor supplying vessels) that helps to improve surgical resection and therefore might reduce the postoperative morbidity.Key Words: Intraoperative ultrasonography, intracranial meningioma 相似文献10.
Radiofrequency thermotherapy for malignant liver tumors 总被引:3,自引:0,他引:3
Y Nagata M Hiraoka K Akuta M Abe M Takahashi S Jo Y Nishimura S Masunaga M Fukuda H Imura 《Cancer》1990,65(8):1730-1736
Inoperable malignant liver tumors have been treated by radiofrequency hyperthermia at Kyoto University Hospital since 1983. In this study, clinical hyperthermia for malignant liver tumor was evaluated for 67 tumors in which we could measure intratumor temperatures. Of the 67 tumors, 41 were hepatocellular carcinomas (HCC), six cholangiocarcinomas, and 20 metastatic tumors. Cholangiocarcinoma and metastatic tumors were more susceptible to this treatment than HCC. Of the three types of HCC, higher intratumor temperatures were achieved in the diffuse type than in the nodular or massive types. The minimum tumor temperature of HCC stayed below 40 degrees C in 46% of cases, especially in larger tumors. The local response rates (complete remission plus partial remission/all) were 28% and 11% for HCC and non-HCC, respectively, for thermochemotherapy; 86% and 33%, for thermoradiotherapy; and 33% and 89%, for thermotherapy with embolization. No apparent relationship was observed between the intratumor temperatures and local response rate. 相似文献
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The role of focal liver ablation in the treatment of unresectable primary and secondary malignant liver tumors 总被引:3,自引:0,他引:3
Surgical resection is often the first-line treatment option for primary and select metastatic hepatic malignancies. A minority of patients with hepatocellular carcinoma undergo potentially curative resection. Similarly, patients with liver-only metastasis are candidates for resection less than 15% of the time because of bilobar disease in which resection would sacrifice too great a volume of hepatic parenchyma, tumor proximity to major vascular or biliary structures thus preventing adequate margins, or unfavorable tumor biology. Ablative techniques directed at tumor elimination while minimizing injury to the surrounding functional hepatic parenchyma may be offered to select patients with unresectable cancers. Radiofrequency ablation, percutaneous ethanol injection, transarterial chemoembolization, cryoablation, microwave coagulation, and laser-induced interstitial thermotherapy all offer potential local tumor control and occasionally achieve long-term disease-free survival. This review focuses on the indications, anticipated benefits, and limitations of these ablative techniques. 相似文献
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The potential of focal ethanol injection therapy (FEIT) as a component of combined treatment for malignant tumors was investigated. Thirty-four patients with inoperable primary and recurrent liver cancer received 72 FEIT procedures at the Institute's Clinic - 16 males (47%) and 18 females (53%), aged 35-80, (average 57), (1991-2004). Forty-three metastatic foci - colorectal carcinoma (23), non-colorectal carcinoma (20) and hepatocellular carcinoma (11) - were detected. Size of metastatic foci ranged 3.2-27.8 cm3 (average 15.4+/-6.4 cm3), while those of hepatocellular carcinoma - 156.7-982.4 cm3, (average 492.4+/-136.8 cm3). All patients received regional endovascular chemotherapy, without any life-threatening complications. Reduction in focal size after FEIT for hepatocellular carcinoma ranged 490.2+/-136.8 - 41.8+/-14 cm3. One-, three- and five-year survival was 100, 80 and 60%, respectively. In cases of hepatocellular carcinoma, ethanol-treated foci shrank by 88.4% - from 15.5+/-1.6 to 1.8 +/- 0.3 cm3 (p<0.05). One-, and three-year survival rates were 83 and 14%, respectively. After ethanol ablation, size of metastatic foci fell by 79%, from 13.9+/-4.3 to 2.9+/-2.4 cm3 (p<0.05). One- and three-year survival rates were 91 and 13%, respectively. 相似文献
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射频消融治疗恶性肿瘤现状 总被引:7,自引:3,他引:4
目前,恶性肿瘤的治疗多强调以手术切除为主的多学科综合治疗,而对于一些不能手术切除的肿瘤患者,微创介入疗法是一种较好的肿瘤姑息治疗手段。射频消融(radiofrequency ablation,RFA)是一种针对肿瘤局部的微创介入性疗法,已被证实是一种有效、安全、并发症少、定位准确的治疗恶性实体肿瘤的微创技术。近年来,此项技术已被广泛应用于多种恶性肿瘤,如肝癌、肺癌、乳腺癌等。随着RFA治疗原理研究的不断深入、射频消融技术的不断改进,局部肿瘤治疗的疗效将进一步提高,但仍需要随机化的研究和长期的随访来证实RFA在肿瘤治疗中的重要意义。 相似文献
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Nakamura S Kusuzaki K Murata H Takeshita H Hirata M Hashiguchi S Hirasawa Y 《Oncology reports》2001,8(2):365-368
We demonstrate our procedure of extra-articular wide tumor resection and its clinical outcome. The knee joint including the femorotibial, patellofemoral and the proximal tibiofibular joints was totally resected without any view of articular cartilage and synovium. The resected limb was reconstructed with endoprosthesis of the knee joint. The average score of the limb function evaluated by ISOLS criteria was 69.3% in all patients. The limb function of these patients was almost the same as that of the patients who received the intra-articular procedure. The procedure of extra-articular resection was theoretically necessary and clinically practical. 相似文献
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单纯高强度聚焦超声治疗恶性实体肿瘤 总被引:39,自引:0,他引:39
目的 研究高强度聚焦超声 (HIFU)治疗恶性实体肿瘤的安全性和有效性。方法 30例恶性实体肿瘤用单纯HIFU治疗 ,观察患者生命体征、主要脏器功能、影像学检查 (DSA、CT或MRI、SPECT等 )、穿刺活检、并发症和肿瘤转归的情况。结果 所有患者的生命体征平稳 ,心、肝、肾和肺功能正常 ,DSA示邻近的小动脉或小动脉以上的血管无损伤。平均随访 2 3.1个月 (10~ 38个月 ) ,存活2 6例 (87% )。 2 6例中 ,10例肿块完全消失 ;13例肿块缩小超过 5 0 % ,其中 8例行穿刺活检 ,病理证实为坏死的肿瘤细胞和 (或 )纤维组织 ;3例 (10 % )局部复发 ,其中 2例再次HIFU治疗 ,局部控制良好。2 6例中 ,有 5例出现新的远处转移 ,2例神经损伤 ,1例皮肤损伤。结论 单纯HIFU治疗恶性实体肿瘤是安全和有效的。 相似文献
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M.C. Jansen S. van Wanrooy R. van Hillegersberg A.M. Rijken F. van Coevorden W. Prevoo T.M. van Gulik 《European journal of surgical oncology》2008