经皮射频消融术在肝脏肿瘤治疗中的临床价值

目的；对44例原发性肝癌和肝转移瘤行射频消融（radiofrequency ablation,RFA)治疗，研究其近期局部治疗效果、不良反应和副作用。方法：原发性肝癌和肝转移瘤共44例，病灶总数共67个。经RFA治疗后随访2－6个月，运用螺旋CT三期扫描评价肿瘤治疗效果。结果：肝脏肿瘤直径≤3．0cm者26个、3．1－4．0cm者21个、4．1－5．0cm者11个，≥5.1cm者9个，经RFA治疗后肿瘤完全坏死分别为24个、19个、9个、6个。螺旋CT增强扫描表现为肿瘤去血管化征象，或并有体积缩小。结论：RFA治疗是效果好、副作用小、安全可靠的局部治疗肝脏肿瘤的方法。     

多次肝动脉化疗栓塞术联合射频消融在肝癌治疗中的临床应用

目的评价多次肝动脉化疗栓塞(TACE)联合射频消融(RFA)治疗肝癌的临床疗效。方法对经多次TACE治疗后仍有肿瘤残余的10例肝癌患者分别行B超引导下射频消融治疗,术后随访监测甲胎蛋白(AFP)的动态变化及肝脏CT表现来评价疗效。结果 RFA治疗后3~6个月,生存率为100%,其中9例患者AFP<400 ng/mL,CT检查无肿瘤复发征象者8例,有肿瘤复发征象者2例。9~12个月复查,8例患者AFP<400 ng/mL,CT增强扫描未发现肿瘤复发征象;有肿瘤复发征象的患者2例,再次行射频消融治疗。8例患者随访时间达到24个月,其中6例患者AFP<400 ng/mL,CT增强扫描未发现肿瘤复发者7例;1例患者死亡。结论多次TACE联合射频消融为中晚期肝癌治疗提供了新的治疗思路与途径。     

螺旋CT导引下肺部肿瘤射频热消融治疗的应用研究

目的 通过对肺肿瘤射频热消融（RFA）治疗效果的观察，评价其技术特点、安全性和疗效。方法 30例肺肿瘤患者共46个肿瘤接受了RFA治疗（其中肺部原发性肿瘤20例，转移瘤10例），在CT引导下将消融电极刺入到距肿瘤边缘组织1cm处，根据病灶大小，将子针打开至合适直径，达到靶温度后，持续7～15min。对患者进行1～9个月的随访，通过胸部X线片和增强螺旋CT观察治疗效果。结果 30例患者46个肿瘤，共做消融灶123个，治疗区域坏死率为100％。（1）随访1个月30例，46个肿瘤瘤体完全消融41个，占89.13％；部分消融5个，占10.87％。（2）随访3～9个月26例，40个肿瘤病灶完全缓解（CR）33个，部分缓解（PR）4个，无变化（NC）2个，进展（PD）1个，总有效率达925％（37／40）。结论 RFA治疗肺部肿瘤疗效肯定、安全，是1种应用前景较好的方法。     

CT导向下经皮射频消融术治疗肾上腺恶性肿瘤

目的对29例肾上腺肿瘤患者行射频消融（RFA）治疗，研究其近期局部治疗效果、不良反应和副作用。方法肾上腺肿瘤患者共29例，病灶总数31个，其中直径≤2．0cm的病灶共5个，2．1-4．0cm者18个，4．1-6．0cm者5个，≥6．1cm者3个，经RFA治疗1个月后行螺旋CT双期增强扫描评价肿瘤治疗效果。结果上述病灶经消融治疗后达到完全坏死者分别为5个、18个、3个、2个。患者无严重并发症出现。结论RFA治疗安全可靠，副作用小，是治疗肾上腺恶性肿瘤的有效方法之一。     

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。     

超选择性肾动脉栓塞术联合射频消融治疗肾癌的临床应用

目的 探讨超选择性肾动脉栓塞术联合射频消融(RFA)治疗肾癌的疗效.方法 分析2009年1月至2011年4月9例肾癌患者超选择性肾动脉栓塞联合RFA.患者均在超选择性肾动脉栓塞术后3～7 d,在CT引导下行RFA.术后1个月行肾脏病灶穿刺活检和CT增强检查评价其疗效.结果 9例患者随访1～6个月,未发现.肾脏肿瘤增大,...     

CT引导下经皮射频消融治疗肾上腺转移性肿瘤的初步疗效

目的 探讨CT引导下经皮射频消融(RFA)治疗肾上腺转移癌的近期疗效、安全性和不良反应.方法 肾上腺转移癌患者共19例,病灶总数24个,肿瘤直径为1.5-7.8 cm,平均直径3.5 cm.19例患者原发灶来源于肺癌6例,肝癌5例,肾癌5例,结肠癌3例.经RFA治疗3个月后行CT增强扫描评价肿瘤治疗效果.结果 上述24个病灶经消融治疗后,CT增强扫描显示20个肿瘤完全消融;其余4个病灶在治疗后仍有部分残留组织强化区,提示有残留肿瘤,未完全消融.5例患者出现血压波动,6例患者术后出现轻微疼痛,2例患者在术后出现一过性血尿.其余患者无严重并发症.结论 CT引导下RFA治疗肾上腺转移癌是一种安全、有效、并发症少的微创治疗方法.     

CT导向射频消融术治疗肝脏肿瘤

目的:探讨CT导向下经皮肝穿刺射频消融(radiofrequency,RFA)治疗肝脏肿瘤的安全性和有效性。方法:原发和转移性肝脏肿瘤28例,采用Radoionics中空冷却射频仪在CT引导下将射频电极置于肝肿瘤内,同时置入20G的穿刺针,从穿刺针中注入生理盐水5~10ml后进行治疗。并随访6~36个月,运用螺旋CT三期扫描评价治疗效果。结果:28例肝脏肿瘤,病灶32个,原发者20例,转移者8例,肿瘤最大直径≤3cm为26个,肿瘤直径在3~5cm之间为6个,经过RFA治疗,肿瘤完全坏死为25个,部分坏死占7个。6个月生存率100%,12个月生存率71.4%(20/28),生存36个月1例,部分病例还在随访中,未见其他严重并发症。结论:CT导向下经皮肝穿刺射频消融治疗肝脏肿瘤是一种安全、有效的方法。对于肿瘤直径≤3cm的肝脏肿瘤治疗效果较佳。     

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。     

CT引导下射频消融治疗肺部恶性肿瘤的临床应用

目的 探讨CT引导下射频消融(RFA)治疗肺恶性肿瘤的疗效、不良反应和安全性.方法 对21例肺恶性肿瘤患者的31个瘤体进行CT引导下RFA治疗,对其中14个瘤体进行2次以上重复消融.术前常规CT引导下经皮穿刺活检或支气管镜检查获取病理学诊断,10例为非小细胞肺癌,其中鳞癌5例,腺癌4例,未分化癌1例,转移性肺癌11例.瘤体直径<5 cm的肿瘤25个(15例),5～8 cm的肿瘤6个(6例).所有患者术后3、6个月后行增强CT检查评价肿瘤疗效.结果 31个肿瘤均顺利完成RFA治疗.肿瘤疗效评估显示:CR 5个,PR 17个,NC 5个,PD 4个,总有效率(CR+PR)为71.0%.术中并发少量气胸8例,液气胸1例.13例术后见暗红色痰,6例术后疼痛,13例术后轻度发热.全部患者未出现其他严重并发症.平均住院时问为5-7 d.结论 CT引导下经皮穿刺RFA治疗肺部恶性肿瘤,近期疗效确切,是一种安全、有效、并发症较少的微创治疗方法.     

肺部恶性肿瘤射频消融治疗后CT影像学改变

目的:观察分析肺部恶性肿瘤射频消融治疗后CT影像学改变。方法:搜集因肺部恶性肿瘤行CT引导下射频消融治疗的患者226例(共计消融灶233个),分析评价治疗后病灶CT影像学改变。患者中原发性肺癌201例,肺转移癌25例。接受射频消融的病灶直径1.00～10.60cm,平均(4.36±2.45)cm。平均随访时间13.61个月(1～30个月)。结果:215例患者(95.13%)治疗后立即出现消融灶周围肺组织内毛玻璃样改变,多在1个月内吸收;191患者(84.51%)治疗后肿瘤立即出现增大,127例患者(56.19%)出现消融灶内多发小空泡形成。术后51例患者(22.57%)出现空洞,恶性胸水多发生在治疗3个月以后。121例患者(65.05%)在术后第一个月随访时胸部CT提示病灶有增大,46.15%和50.89%的患者在3个月及6个月复查时病灶缩小,之后这一比例开始降低,至12个月时,只有33.64%的患者病灶较上一次评估时缩小,到24个月时这一比例降低到4.35%。结论:病变周围的毛玻璃样改变、空洞形成、多发小空泡形成和胸膜改变是射频消融后最常见的CT改变。体积较大的病灶更可能出现空洞改变,射频消融术后1个月内病灶多出现增大表现,治疗后6个月是病灶缩小最明显的时期,6个月后出现的病灶较上一评估周期增大提示患者肿瘤进展。CT是射频术后疗效评估的有效手段之一。     

CT引导下经皮穿刺射频消融补救性治疗晚期肾癌

目的探讨射频消融治疗肾细胞癌（RCC）的有效性及安全性。 方法收集56例不适宜外科切除治疗的RCC患者。肿瘤直径为2.6～8.6 cm,平均（5.6±1.2）cm。CT引导下行经皮穿刺射频消融术。随访评估临床效果、肾功能和并发症状况。 结果本组56例患者中,病灶直径<4 cm的35患者射频治疗后1、3、6个月复查时均未见病灶强化,病灶直径>4 cm的21例,在术后3个月复查时13例出现治疗边缘强化,活检证实为复发病灶,再次行射频消融治疗。截止随访时间内,50例存活,6例死于非肿瘤原因。射频治疗前后肾功能变化差异无统计学意义。并发症轻微,无肾脏出血、感染、肾盂损伤等严重并发症。 结论经皮穿刺射频消融治疗可使无外科手术机会的RCC患者生存获益,并能很好的保护患者肾功能,同时并发症轻微,可作为一种重要的治疗手段。     

肝肿瘤经皮射频切除术后CT表现

目的 研究肝肿瘤经皮射频切除术后病灶及周围肝实质的CT表现。材料与方法 回顾性分析32例肝肿瘤患者（原发性肝癌28例,转移性肝癌4例）共40个病灶经皮射频切除术前后CT表现。CT检查采用普通或螺旋CT扫描,后者增强扫描为双期螺旋扫描。结果 术后平扫治疗区为低密度,范围增大,大多数边界不清。增强扫描低密度区边界清晰。29个病灶（肿瘤大小1．5－4．3cm,平均3．1cm）治疗区无强化,11个病灶（肿瘤大小4．9－11．0cm,平均6．4cm)仍见残留癌灶强化。其他征象有：治疗区周围强化,病灶内出血、含气,胸水和腹水。结论 肝肿瘤经皮射频切术后CT检查,特别是增强扫描对评估治疗效果和发现并发症有很大价值。     

Radiofrequency ablation of pulmonary malignancies

Radiofrequency ablation (RFA) with a maximum output of < or = 70 W was used under CT guidance to treat 14 tumors (median diameter 1.5 cm, range 0.8 to 2.4 cm) in 6 patients. Primary lung cancer was treated in 2 patients, and metastatic lung tumors were treated in 4 patients. Good response was confirmed in 6 tumors on CT images, in one tumor on PET images, and in 2 tumors by histologic examination. In the other 5 tumors, curative effect was not determined because consolidation shadows surrounded the tumors. Complications were mild (pneumothoraces, 5; sputum cruentum, 4; subcutaneous emphysema, 3) except for one case of pleurisy. RFA of pulmonary malignancies appears to be a safe, effective treatment if a low output of less than 70 W is applied.     

Open radio-frequency thermal ablation of renal VX2 tumors in a rabbit model using a cooled-tip electrode: feasibility,safety, and effectiveness

The purpose of this study was to evaluate the feasibility, safety, and effectiveness of radio-frequency (RF) ablation using an internally cooled-tip electrode on renal VX2 tumors implanted in rabbits. Thirty-three rabbits with implanted renal VX2 tumors were divided into two groups: an RF ablation (RFA) group (n=27) and a control group (n=6). In the RFA group, RFA was performed on 27 implanted VX2 tumors using a cooled RF electrode and they were divided into three subgroups according to the follow-up period: acute (1–3 days, n=12); subacute (1–4 weeks, n=9); and chronic (2–7 months, n=6). Contrast-enhanced spiral CT was performed before the RFA and at the day, day 3, weeks 1, 2, 4, and months 2 and 7, after the RFA. The therapeutic efficacy was evaluated by the survival rate, CT, and pathologic findings. The RFA of renal tumors was technically successful in each instance. Complete tumor ablation was achieved in 22 of the 27 rabbits (81.5%) in the RFA group: 5 rabbits survived longer than 8 weeks without any evidence of viable tumor (18.5%) and 17 rabbits were found free of viable tumors when killed (63.0%). Five rabbits showed local tumor relapse and/or hematogenous lung metastasis after ablation (a recurrence rate of 18.5%). There were 11 (40.7%) complications related to the procedure. This experimental study demonstrates the feasibility of RFA therapy to treat renal VX2 tumors in rabbits, although RFA for central tumors carries some major potential complications, including renal arterial injury. Electronic Publication     

Percutaneous radiofrequency thermal ablation of lung VX2 tumors in a rabbit model using a cooled tip-electrode: feasibility,safety, and effectiveness

RATIONALE AND OBJECTIVE: To evaluate the feasibility, safety, and effectiveness of percutaneous CT-guided transthoracic radiofrequency ablation (RFA) of lung VX2 tumors implanted in rabbits. MATERIALS AND METHODS: Thirty-five rabbits with implanted lung VX2 tumors were divided into two groups, an RFA group (n = 28) and a control group (n = 7). In the RFA group, RFA was performed on VX2 tumors using a 17-gauge internally cooled-tip electrode. Contrast-enhanced CT was performed before the RFA and on the same day, day 3, weeks 1, 2, 3, and months 1, 2, 6, and 9, after the RFA. The therapeutic efficacy was evaluated by CT and pathologic findings. RESULTS: RFA of lung tumors was technically successful in each instance. Complete tumor ablation was achieved in 19 of the 28 rabbits (67.9%) in the RFA group. Nine rabbits (32.1%) showed local tumor relapse and mediastinal lymph nodal or pleural metastasis. The animals in the control group died of end-stage malignancies with diffuse tumor spread and malignant pleural effusion (mean 26 +/- 2.7 days). There were 17 (60.7%) complications related to the procedure, ie, pneumothorax (n = 12), obstructive pneumonia (n = 3), hemothorax (n = 1), and burn (n = 1). RFA of centrally located VX2 tumors (in inner 2/3 of the lung) was more frequently associated with complications than RFA of peripherally located VX2 tumors ( P= 0.02). CONCLUSION: This experimental study demonstrates the feasibility of RFA therapy for treating lung VX2 tumors in rabbits, although RFA for central tumors carries the potential for major complications, including large pneumothorax or obstructive pneumonia.     

CT imaging findings of pulmonary neoplasms after treatment with radiofrequency ablation: results in 32 tumors

OBJECTIVE: The purpose of this study is to describe the CT appearance of thoracic neoplasms after treatment with radiofrequency ablation (RFA). MATERIALS AND METHODS: Thirty-two thoracic neoplasms in 26 patients had pulmonary RFA and imaging follow-up. Fourteen neoplasms were primary lung cancer and 18 were metastases. The mean pretreatment neoplasm size was 3.1 cm (range, 1.0-7.0 cm), and the average number of neoplasms treated per patient was 1.2 (range, 1-3). The mean follow-up was 10.1 months (range, 1-30 months). Imaging findings on CT were evaluated by three radiologists and documented by consensus. RESULTS: The most common finding immediately after treatment was peripheral ground-glass opacity surrounding the treated neoplasm, seen in 27 of 32 tumors (84%). This rapidly resolved in all but one patient by the end of the first month. Cavitation was seen in 10 of 32 tumors (31%) on follow-up CT and was most common in neoplasms in the inner two thirds of the lung and adjacent to a segmental bronchus. Sixty percent of the cavitations decreased in size on follow-up scans. Ten of 32 tumors (31%) that did not develop cavitation developed bubble lucencies on follow-up CT. Pleural thickening was found in 12 of 22 (55%) parenchymal neoplasms, and linear opacifications were seen between the treated lesion and adjacent pleura in 14 of 22 parenchymal tumors (64%). Pleural effusions were seen in four patients (15%). Fourteen of 22 tumors (64%) with follow-up imaging at 1 month enlarged from pretreatment CT scans. At 3 and 6 months after RFA, the majority remained stable in size. CONCLUSION: Peripheral ground-glass opacity, cavitation, bubble lucencies, and pleural changes are common findings on CT after RFA. Many treated neoplasms increase in size from baseline on 1- to 3-month follow-up CT scans and then remain stable thereafter. Enlargement of a treated tumor after 6 months is felt to represent local recurrence. Stability of a treated lesion beyond 6 months does not guarantee continued stability.     

胰腺无功能性内分泌肿瘤的螺旋CT诊断与鉴别诊断

目的:分析胰腺无功能性内分泌肿瘤螺旋CT多期扫描的表现,提高CT对无功能性胰腺内分泌肿瘤诊断的正确性。材料和方法:回顾性分析25例经穿刺及手术病理证实的胰腺无功能性内分泌肿瘤的薄层螺旋CT多期扫描资料。螺旋CT采用常规平扫和薄层三期动态增强扫描即动脉期、门脉期和延迟期,三期扫描延迟时间分别为25s,70s和120s。结果:25例患者共检出26个病灶,位于胰头部10个病灶,胰颈部5个病灶,胰体部3个病灶,体尾部4个病灶,胰尾部4个病灶,其中1例同时有两个病灶分别位于胰头和体尾部。肿瘤平均大小为4.0cm。14个病灶呈等密度;12个病灶呈略低密度,密度不均匀,其中可见更低密度灶;其中5个病灶内可见钙化。增强扫描动脉期共18个病灶明显强化,其中6个病灶均匀强化,12个病灶不均匀强化,6病灶呈中等程度强化,2个病灶动脉期轻度强化。3例肿瘤位于胰头者,2例出现了胆道和胰管扩张,胰体尾部萎缩,另1例仅出现胰管轻度扩张,1例肿瘤位于体部者出现远端胰管扩张伴实质萎缩。25例患者8例出现多发肝富血供转移灶,其中1例患者同时出现肺和脊柱的多发转移,无胰周及后腹膜淋巴结转移;3例出现肿瘤邻近血管的侵犯,其余为邻近血管推移受压改变。结论:无功能性胰腺内分泌肿瘤多较大,富血供,常见钙化,较少出现周围血管及胰胆管直接侵犯,较少出现后腹膜淋巴结转移及神经丛侵犯,根据有无肝脏及其他脏器转移、淋巴结转移及周围血管侵犯,进一步提示肿瘤的良恶性。     

Percutaneous radiofrequency ablation of lung tumors in a large animal model

PURPOSE: Percutaneous radiofrequency ablation (RFA) is accepted therapy for liver tumors in the appropriate clinical setting, but its use in lung neoplasms remains investigational. We undertook this study to evaluate the feasibility and immediate effectiveness of RFA for treatment of both solitary pulmonary nodules and clusters of lung tumors in a large animal model. MATERIALS AND METHODS: Percutaneous RFA of 14 lung tumors in five dogs was performed under CT guidance. Animals were euthanatized 8-48 hours after the procedure. The lungs and adjacent structures were harvested for gross and histopathologic evaluation. RESULTS: Five solitary pulmonary nodules (range, 17-26 mm) and three clusters of three nodules each (range, 7-17 mm per nodule) were treated with RFA. All ablations were technically successful. Perilesional ground-glass opacity and small asymptomatic pneumothoraces (n = 4) were visualized during the RFA sessions. One dog developed a large pneumothorax treated with tube thoracostomy but was euthanatized 8 hours post-RFA for persistent pneumothorax and continued breathing difficulty. Follow-up CT 48 hours post-RFA revealed opacification of the whole lung segment. Gross and histopathologic evaluation showed complete thermal coagulation necrosis of all treated lesions without evidence of any viable tumor. The region of thermal coagulation necrosis typically extended to the lung surface. Small regions of pulmonary hemorrhage and congestion often surrounded the areas of coagulation necrosis. CONCLUSIONS: RFA can be used to treat both solitary pulmonary nodules and clusters of tumor nodules in the canine lung tumor model. This model may be useful for development of specific RFA protocols for human lung tumors.