超声造影对肝细胞癌微波消融疗效评估及对局部复发预测价值研究

目的 探讨超声造影(CEUS)对肝细胞癌(HCC)患者微波消融(MWA)疗效的评估价值及对局部复发的预测价值。方法 选取中南大学湘雅医学院附属海口医院自2020年1月至2022年1月收治的106例接受MWA治疗的HCC患者为研究对象。所有患者分别于术前、术后1个月,进行超声造影(CEUS)与增强CT(CECT)检查。根据1年随访结果将患者分为复发组(n=21)与未复发组(n=85)。记录并比较两组术前CEUS的上升时间(RT)、达峰时间(TTP)、峰值强度、平均通道时间、曲线下面积。采用多因素Logistic回归分析检验HCC患者MWA后局部复发的影响因素。绘制受试者工作特征(ROC)曲线分析CEUS定量参数对肿瘤复发的预测价值。结果 CEUS、CECT评估消融疗效的准确性分别为92.45%(98/106)、94.34%(100/106),差异无统计学意义(P>0.05)。复发组、未复发组患者肿瘤直径比较,差异有统计学意义(P<0.05)。复发组患者RT、TTP均低于未复发组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,RT、TTP均为...     

经皮微波消融治疗近肠道肝细胞癌74例疗效分析

目的 评价超声引导下经皮微波消融(MWA)对近肠道部位肝细胞癌的安全性、局部疗效、长期预后,并分析预后影响因素.方法 回顾性分析2008年3月至2010年7月接受超声引导下MWA治疗的74例初发近肠道肝细胞癌患者的临床资料.观察完全消融率、术后并发症、局部肿瘤进展,计算术后长期生存率并分析预后影响因素.结果 90枚肿瘤中的84枚首次达到完全消融,完全消融93.3％;局部肿瘤进展10.8％;1、3、5年总生存率和无瘤生存率分别为97.3％、74.3％、45.9％和87.7％、51.4％、31.1％;HCV是影响无瘤生存率的独立危险因素,多发肿瘤是影响总生存率的独立危险因素.结论 经皮MWA是治疗近肠道肝细胞癌安全、有效的方式,术前肠道准备、穿刺采用平行肠道进针方式、术后禁食水可降低肠道损伤风险.     

微波消融治疗单发5cm以下肝细胞肝癌预后及其影响因素分析

目的 探讨微波消融(MWA)治疗单发5 cm以下肝细胞癌的预后及其影响因素.方法 回顾性分析2011-2013年就诊患者资料,随访期至2016年3月.结果 按照入选标准,共纳入603例患者,完全消融率为5.8％ (35/603),不同肿瘤直径组别间完全消融率差异无统计学意义(P=0.056).严重并发症发生率为1.7％(10/603),平均生存期时间(59.6±1.9)个月,1、2和3年总生存率分别为94.7％、81.9％及71.8％.不同年龄、肿瘤直径之间总生存率无明显差异(P=0.225、0.777),不同性别和复发间隔时间之间总生存率差异有统计学意义(P=-0.029、＜0.001).单因素及多因素分析表明,性别、术前白蛋白水平及复发间隔时间是总生存率的影响因素(P值=0.035、0.006及＜0.001).结论 MWA治疗单发肝细胞癌疗效确切,具有安全、微创等特点,不同年龄、肿瘤直径之间总生存率无明显差异,性别、术前白蛋白水平以及肿瘤复发间隔时间是影响患者总生存率的独立影响因素.     

腹腔镜辅助超声引导下射频消融治疗膈顶部原发性肝细胞癌疗效评价

目的 探讨腹腔镜辅助超声引导下射频消融治疗膈顶部原发性肝细胞癌的可行性、安全性及有效性.方法 解放军总医院肝胆外科2013年1月至2016年3月连续收治的膈顶部单发原发性肝细胞癌患者23例,所有患者采用腹腔镜辅助超声引导下射频消融治疗,观察围术期并发症发生情况并随访长期疗效.结果 23例患者均成功施行腹腔镜辅助超声引导下射频消融治疗,所有患者围术期均无大出血、胆瘘、重度胸腔积液、血气胸等严重并发症发生,术后2～3d CT检查提示消融区完全覆盖肿瘤,随访9～38个月患者总体生存情况令人满意.结论 腹腔镜辅助超声引导下射频消融治疗膈顶部原发性肝细胞癌具有可操作性,并且安全有效.     

超声引导经皮微波消融治疗肾上腺肿瘤

目的观察超声引导经皮微波消融治疗肾上腺肿瘤的安全性和临床疗效。资料与方法 9例肾上腺肿瘤患者(9个病灶),其中肾上腺转移癌5例,肾上腺嗜咯细胞瘤1例,肾上腺非功能性腺瘤3例。肿瘤直径2.0～4.5cm。治疗时在超声引导下将水冷式微波天线置入肿瘤内,肿瘤直径<2cm者使用一根微波天线,肿瘤直径>2cm者使用2根微波天线。邻近肠道的肾上腺肿瘤,在微波辐射时瘤周测温,保持治疗温度<54℃,同时辅以瘤周无水乙醇注射(5～8ml)以增强疗效。微波消融后3d内行超声造影观察有无残存肿瘤,造影无肿瘤残存者于治疗后第1、3个月,随后每3～4个月行增强CT/MR评价肿瘤的治疗效果。结果 8例病灶在1次消融后完全坏死,1例病灶在2次消融后完全坏死,微波消融无严重并发症出现,随访期内未发生肿瘤局部复发。结论超声引导经皮微波消融肾上腺肿瘤安全有效、副作用小,是治疗局限性肾上腺肿瘤的有效方法。     

超声引导下微波消融治疗低危甲状腺微小乳头状癌的疗效观察

目的 研究分析超声引导下微波消融(MWA)治疗43例低危甲状腺微小乳头状癌(PTMC)的有效性和安全性.方法 选取43例病理证实为甲状腺微小乳头状癌(43枚结节)的患者行超声引导下MWA,并于术后定期行常规超声检查、甲状腺功能等检查,分析MWA术后消融区域最大直径缩减率(MDRR)、结节体积缩减率(VRR)、消融病灶吸...     

高功率微波消融治疗近大血管肝细胞癌33例

目的评价近大血管的肝细胞癌(HCC)进行高功率微波消融治疗的疗效和安全性。方法对33例新发单发HCC的患者经皮肝穿刺微波消融治疗,该33病灶均为距离直径大于3 mm的血管0.5 cm以内,其中近门静脉支17例,近肝静脉12例,同时靠近的4例。所有患者均在B超引导下,采用单针或双针100 W的高功率微波热凝2～4 min。并作短期随访,观察肿瘤消融疗效及并发症情况。结果所有患者均安全完成微创消融手术。2例(6.1%)出现局部肿瘤进展,7例(21.2%)出现新病灶(7/33),5例复查CT可见局部血供异常,5例消融灶远端出现胆管轻度扩张,另1例术后6个月出现肝门部胆管狭窄伴肝内胆管扩张。结论高功率微波治疗近血管的肿瘤疗效肯定,但有造成胆管损伤的风险。     

射频消融和微波消融治疗原发性肝细胞癌的近期疗效及对免疫功能的影响

目的:探讨射频消融和微波消融治疗原发性肝细胞癌的近期疗效及对免疫功能的影响。方法:随机将64例原发性肝细胞癌患者分为射频消融组和微波消融组,对2组患者的近期疗效进行评价,观察记录2组治疗前后相关免疫功能指标的变化,并与同期正常健康体检者(对照组)进行对比分析。结果:微波消融组术中消融时间明显短于射频消融组,差异有统计学意义(P0.01)。2组各免疫指标差异无统计学意义(P0.05)。结论:射频消融和微波消融治疗原发性肝细胞癌均能取得较好的近期疗效,均能明显提高肝癌患者术后的免疫功能;微波消融由于消融时间更短、操作更简单,有利于降低麻醉和其他不必要的手术风险,一定程度上减少了由于手术损伤而造成的术后短期内免疫功能下降的发生。     

肝脏恶性肿瘤超声引导微波消融后局部肿瘤进展:2529例病人的危险因素分析

<正>目的确定肝脏恶性肿瘤超声引导下经皮微波消融(MWA)后局部肿瘤进展(LTP)的发生率和危险因素。材料与方法纳入2005年7月—2012年12月间通过MWA治疗     

肝癌微波消融术后患者复发的危险因素分析

目的探讨胆囊切除对行肝癌微波消融（microwave ablation,MWA）患者预后的影响。 方法72例接受MWA治疗肝癌的患者,分为胆囊切除组（36例）和非胆囊切除组（36例）,分析总生存率（overall survival,OS）和无进展生存率（progression free survival,PFS）,比较胆囊切除组和非胆囊切除组的预后结果。采用单因素和多因素Cox分析评估总生存率和无进展生存率的潜在危险因素以及比较两组之间的预后。 结果本研究胆囊切除组纳入36例（50.00%）,非胆囊切除组纳入36例（50.00%）。胆囊切除组中位OS为35.55个月（4.20～36.00个月）,非胆囊切除组31.19个月（10.80～36.00个月） （P=0.894）。随访结束前,胆囊切除组和非胆囊切除组的死亡率分别为22.22%和22.22%。胆囊切除组1、2、3年累积总生存率分别为91.67%、79.91%、75.71%,非胆囊切除组分别为97.22%、88.72%和73.81%（P=0.97）。胆囊切除组中位PFS为7.67个月（1.68～32.30个月）,非胆囊切除组为18.25个月（2.24～33.60个月） （P<0.01）。随访结束时,胆囊切除组和非胆囊切除组肝癌复发率分别为69.44%和91.67%,胆囊切除组1、2、3年累积无进展生存率分别为36.11%、16.67%、0.00%,非胆囊切除组分别为77.78%、46.89%和0.00%。非胆囊切除组的累积无进展生存率明显高于胆囊切除组（P<0.01）。多因素分析显示肿瘤数量为3（HR=18.91,95%CI：1.54～232.99,P=0.02）是与OS相关的独立危险因素。多因素分析显示胆囊切除术（HR=3.55,95%CI：1.74～7.26,P<0.01）,肿瘤数量为2和3（HR=2.21,95%CI：1.10～4.42,P=0.02;HR=3.63,95%CI：1.26～10.45,P=0.02）和AFP≥400 ng/mL（HR=0.43,95%CI：0.19～0.98,P<0.05）是与PFS相关的独立危险因素。 结论肝细胞癌患者在MWA后行胆囊切除术后更易发生肝内复发,这可能与γ-GT水平升高有关,且复发率随时间增加而增加。     

Early diffuse recurrence of hepatocellular carcinoma after percutaneous radiofrequency ablation: analysis of risk factors

Objective

To evaluate the risk factors affecting early diffuse recurrence within 1 year of percutaneous ultrasound-guided radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC).

Methods

Out of 146 patients who received transcatheter arterial chemoembolisation (TACE) for treatment of recurrent HCC after percutaneous ultrasound-guided RFA, we selected 23 patients with early diffuse recurrence. Early diffuse recurrence was defined as three or more new recurrent HCCs within 1 year of initial RFA. As a control group, we selected 23 patients, matched exactly for age and sex, in which there was no local tumour progression or new recurrence after RFA. To analyse the risk factors, we examined patient factors and tumour factors.

Results

Recurrent tumours occurred from 30 to 365 days after RFA (median time, 203 days). Univariate analysis indicated that larger tumour size and poorly defined margin were significant risk factors (P?<?0.05). Multivariate analysis indicated that poorly defined margin was a significant risk factor (P?<?0.05).

Conclusion

Larger tumour size and poorly defined margin may be risk factors for early diffuse recurrence of HCC within 1 year of RFA. Tumours with such risk factors should be treated with a combination of TACE to minimise the potential for therapeutic failure.

Key Points

? Ultrasound-guided radiofrequency ablation (RFA) is widely used for hepatocellular carcinoma (HCC). ? Early diffuse recurrence after RFA is an important prognostic factor ? The risk factors for recurrence are larger tumour size and poorly defined margins ? Tumours with such risk factors should be treated with transarterial chemoembolisation.     

Intrahepatic recurrence after percutaneous radiofrequency ablation of hepatocellular carcinoma: analysis of the pattern and risk factors

PURPOSE: To evaluate the pattern and risks for intrahepatic recurrence after percutaneous radiofrequency (RF) ablation for hepatocellular carcinoma (HCC). MATERIALS AND METHODS: We studied 62 patients with 72 HCCs (< or =4 cm) who were treated with percutaneous RF ablation. The mean follow-up period was 19.1 months (6.0-49.1). We assessed the incidence and cumulative disease-free survival of local tumor progression (LTP) and intrahepatic distant recurrence (IDR). To analyze the risk factors, we examined the following, for the LTP: (1) tumor diameter, (2) contact with vessels, (3) degree of approximation to hepatic hilum, (4) contact with hepatic capsule, (5) presence of ablative safety margin, (6) degree of benign periablational enhancement and (7) serum alpha-fetoprotein; for the IDR: (1) severity of hepatic disease, (2) presence of HBsAg, (3) serum alpha-fetoprotein, (4) whether RF ablation was the initial treatment and (5) multiplicity of tumor for IDR. RESULTS: The incidence of overall recurrence, LTP and IDR was 62.9%, 26.4% and 53.2%, respectively. The cumulative disease-free survival rates were 52%, 82% and 56% at 1 year, 26%, 63% and 30% at 2 years, respectively. Univariate analysis showed that the significant risk factors for LTP were: a tumor with a diameter >3 cm, contact of HCC with a vessel and an insufficient safety margin (p<0.05). A multivariate stepwise Cox hazard model showed that the measurement of a tumor diameter >3 cm and insufficient safety margin were independent factors. Only the increased serum alpha-fetoprotein was a significant risk factor for IDR (p<0.05). CONCLUSION: Intrahepatic recurrence after percutaneous RF ablation is common. Large HCC (>3 cm) with high serum alpha-fetoprotein should be treated more aggressively because of higher risk for recurrence.     

Prognostic factors for survival in patients with hepatocellular carcinoma after percutaneous microwave ablation

PURPOSE: To determine the long-term survival and prognostic factors in patients with hepatocellular carcinoma treated with percutaneous microwave ablation. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained. A database of cases of hepatocellular carcinoma in 288 patients (259 men, 29 women; mean age, 54.8 years +/- 11.4 [standard deviation]; age range, 25-82 years) with 477 histologically proved lesions who underwent percutaneous microwave coagulation therapy between May 1994 and October 2002 was retrospectively analyzed. Prognostic factors for survival were evaluated by means of univariate and multivariate analyses. RESULTS: The mean follow-up period after microwave ablation was 31.41 months +/- 20.43 (range, 5-106 months). The 1-, 2-, 3-, 4-, and 5-year cumulative survival rates among all 288 patients were 93%, 82%, 72%, 63%, and 51%, respectively. Ninety-three patients (32%) died. Local recurrence or new tumors occurred in 100 patients (35%). Age (P = .836), sex (P = .073), preablation serum alpha-fetoprotein level (P = .136), and preablation treatment (P = .256) were not related to prognosis, while tumor number (P = .004), tumor size (P < .001), Child-Pugh classification (P = .003), tumor differentiation (P = .026), and local recurrence or presence of new tumors (P = .004) significantly affected survival at univariate analysis. At multivariate analysis, only tumor size (P < .001), number of nodules (P = .005), and Child-Pugh classification (P = .01) each had a significant effect on survival. CONCLUSION: With use of microwave ablation, there is a high probability of long-term survival of patients with a single lesion of 4.0 cm or less in maximum diameter and Child-Pugh class A cirrhosis.     

Risk factors for recurrence of small hepatocellular carcinoma after long-term follow-up of percutaneous radiofrequency ablation

Radiofrequency ablation (RFA) as a local therapy for liver cancer is widely used. The study is to evaluate the therapeutic efficacy of RFA on hepatocellular carcinoma (HCC) and identify the risk factors for recurrence. Clinical records of 124 patients with 135 small HCC with percutaneous RFA as a first-line treatment modality were evaluated in Liver Cancer Institute, Zhongshan Hospital from October 2001 to December 2006. With a median follow-up period of 46 months after RFA therapy, the 1-, 2-, 3-, 4-, and 5-year cumulative survival rates and disease-free survival rates were 91, 70, 61, 48 and 40% and 64, 44, 31, 24 and 24%, respectively. The total recurrence and metastasis rates were 50 and 6.5%, respectively. Independent risk factors for recurrence after RFA included tumor with diameter more than 3 cm, located near the intrahepatic blood vessels, subcapsular locations and PT prolonged more than 3 s. Severe complications occurred in 2 cases (1.6%), including biliary tract hemorrhage and subphrenic effusion. RFA appears to be a safe and effective treatment for HCC. It will benefit the efficacy of RFA therapy if those risk factors are considered during the clinical practice.     

Percutaneous tumor ablation for hepatocellular carcinoma

OBJECTIVE: This report reviews the current clinical status of percutaneous ablation of hepatocellular carcinoma (HCC). CONCLUSION: HCC is increasing in incidence. Multiple percutaneous ablation methods are now available for primary treatment or for bridging to transplantation. Percutaneous ethanol instillation and radiofrequency ablation are the most extensively evaluated percutaneous treatments for HCC. Newer technologies are being evaluated and may change future practice patterns.     

小肝癌氩氦刀治疗后复发因素预后分析

目的分析氩氦刀治疗小肝癌(直径小于5cm的肝癌)的长期疗效及复发转移的相关危险因素。方法采用氩氦超导手术系统,在B超引导下采用经皮氩氦刀治疗156例小肝癌患者。采用免疫组织化学方法分析肝癌组织血管内皮生长因子(VEGF)表达,PCR和DNA序列测定方法分析基本核心启动子(BCP)、前C区(PC)突变情况。以生存率、无复发生存率为预后指标进行单因素和COX比例风险模型多因素分析,分析变量包括肝癌临床病理特征、肝癌组织VEGF表达以及HBV病毒学因素(HBVDNA定量、基因型、BCP区和PC区突变)。结果156例肝癌患者氩氦刀术后随访中位时间37(8～48)个月,1、2、3年总生存率分别为92%、82%、64%,无复发生存率分别为72%、56%、43%,随访期内共85例(54.5%)复发。156例肝癌患者中,VEGF表达阴性60例,弱阳性表达49例,强阳性表达47例。HBVDNA<103copies/ml者14例,103～105copies/ml者82例,>105copies/ml者60例。142例HBVDNA>103copies/ml的患者中,HBVB型20例(14.1%),C型122例(85.9%)。PC区G...     

超声引导下射频消融治疗肝癌安全性与疗效分析

目的探讨超声引导下射频消融方法治疗肝癌的安全性与临床效果。方法选取我院2010年7月-2013年7月收治的35例肝癌患者,共61个病灶实施超声引导下经皮射频消融治疗,观察患者并发症情况及肿瘤消融情况,对比分析治疗前后的甲胎蛋白值、肿瘤大小及瘤体内的血供情况。结果所有病灶均消融成功,无严重并发症发生。经过4-15个月随访,复发13例,均给予再次射频消融。结论经皮射频消融治疗肝癌是一种安全、有效的热消融治疗技术,值得临床推广应用。