气冷微波固化与传统微波固化杆温对治疗效应影响的比较研究

背景与目的高杆温限制了传统微波固化的应用与发展.气冷微波固化在该领域目前有所突破.本研究探讨气冷微波固化与传统微波固化有关杆温的应用比较.方法动物实验,成年猪2头,分别用传统微波及气冷微波进行超声引导经皮瘤内穿刺固化,比较二者在穿刺点皮肤灼伤程度、引导针表面温度、组织粘附天线情况以及凝固灶形态等方面的不同.临床应用,观察5例接受传统微波固化术的肝癌患者与8例接受气冷微波固化术的肝癌患者在疼痛、皮肤灼伤、碳化组织粘附天线以及局部疗效和复发等方面的差异.结果动物实验传统微波固化80 W×10min,杆温达到119～160℃之间;穿刺点皮肤严重灼伤;拔针后见天线前端有碳化组织粘附;肝内凝固灶有严重拖尾现象.气冷微波固化80 W×10 min,杆温28.8～39.9℃之间;穿刺点皮肤无红肿等灼伤表现;拔针后天线前端无碳化组织粘附;凝固灶无明显拖尾现象.临床结果传统微波固化皮肤灼伤率为60%;天线前端碳化组织粘附率是40%;术后所有病例均中至重度上腹疼痛,延续时间1周至2月;肿瘤完全固化率80%;局部复发率20%.气冷微波固化不会引起穿刺点皮肤灼伤;所有病例拔针后天线前端均未见碳化组织粘附;50%患者术后觉上腹轻度疼痛,均于一周内好转;肿瘤完全固化率100%;无局部复发率.结论气冷却技术可以安全、可靠地降低微波天线杆温,消除高杆温引起的负面影响.气冷微波固化较传统微波固化疗效好.     

优化射频消融术参数设置的离体猪肝实验研究

背景与目的:经皮射频消融术作为一种微创治疗手段,目前广泛应用于肝癌的治疗中。最初的射频技术只能在离体猪肝上取得1.4～1.6cm的消融直径,今经过多方面的改进,射频消融范围明显增大。射频消融范围是否足够、能否完全包围整个肿瘤是治疗成败的关键。本实验通过优化射频工作方式的研究,探讨能增大单针射频消融范围,同时能减少射频进针次数,从而降低针道转移机会,并提高小肝癌射频消融疗效的方法。方法:第一步采用方式A(起始功率为10W,每分钟步升10W)、B(起始功率为50W,每分钟步升10W)和C(起始功率为90W,持续至功率自动下降至10W),对经加工后的共22例离体圆柱形正常猪肝进行消融;第二步采用射频工作方式A,调整针尖到电极板距离分别为3、8和13cm,对22例离体圆柱形正常猪肝进行消融。比较各种参数设置下消融灶的特征(消融灶平衡径、垂直径、类圆率、消融体积、能量输出和消融时间等)。结果:采用方式A进行消融所得消融灶大小平均为2.5cm×2.7cm,比采用方式B和C进行消融时大(方式B、C的消融灶大小分别为1.6cm×1.8cm和2.0cm×1.5cm)。方式A的消融体积是10.0cm3,明显大于方式B和C(分别是3.1cm3和2.1cm3),而消融时间也明显延长(分别是281.9、79.4和61.4s),而且采用方式A消融时所得病灶比方式C更接近圆球形。消     

经皮微波凝固疗法治疗肺癌的临床应用

目的　探讨经皮经肺微波凝固治疗周围型肺癌的临床疗效、CT影像的变化及不良反应。方法　使用针式单极微波辐射天线 ,CT引导下经皮经肺穿刺周围型肺癌 ,以 2 4 5 0MHz的微波 ,6 5W辐射 6 0s,对原发性肺癌 8例、转移性肺癌 12例 ,共 2 0例患者的 2 8个病灶进行治疗。结果　随访 3～ 2 4个月 ,16例患者健在。全部肿块均缩小 ,缩小 5 0 %以上 13个病灶 ,病灶消失 3例 ,有效率5 7.1%。CT表现为即刻凝固灶呈约 3.5cm× 2 .5cm的软组织影 ,1周后凝固区域内见气化灶 ,外周有高密度反应区 ,1个月后凝固区进一步缩小 ,3个月后实变 ,1年后几乎消失 ,治疗后细胞学证实肿瘤组织坏死。此治疗方法无副作用及并发症。结论　经皮微波凝固疗法治疗周围型肺癌是高效、微创、安全的新方法。     

改进经皮微波凝固治疗大肝癌技术的研究

目的：改进微波肝组织凝固技术,为该技术在治疗大肝癌的应用奠定基础。方法：对离体牛肝采用不同的条件进行微波辐射,测量单点及两点辐射的组织温度和凝固范围,借助计算机模拟技术设计多点辐射方案并通过体外肝实验验证。临床上,对９个和４个施行单点和两点辐射的肝癌结节测温,对１６个３－６ ｃｍ的肝癌结节按多点辐射方案进行治疗。结果： ６０ Ｗ × ３００ ｓ的微波辐射可形成横径 ３． ０ ｃｍ的凝固区。两点辐射的最佳距离为２．５ｃｍ。７针穿刺可形成横切面直径７．１ｃｍ的球形凝固区。 １６个经治结节仅２个坏死不完全。结论：适当延长单点辐射的时间及使用合适的多点穿刺方案可使微波凝固治疗的适应证扩大至６ ｃｍ的肿瘤。     

经皮微波热凝固治疗肝癌的疗效观察

目的:观察超声引导经皮肝穿刺微波热凝固治疗肝癌的疗效。方法:21 例肝癌患者经皮肝穿刺植入频率为2 450 MHz的单导或双导微波天线,在丙泊酚静脉麻醉下对肿瘤进行一次整体覆盖原位热凝固治疗。结果:对21 例患者的23 个瘤体进行28 次治疗,平均随访6.7 个月,16 例生存,4 例死亡,1 例失访,术后AFP正常或明显下降,10 个瘤径≤5.0 cm的瘤体一次整体凝固,13 个瘤径>5.0 cm的瘤体术后肿块内血流信号大部分消失,治疗前后肝功能无明显变化,16 例次术后2 d ~ 6 d中度发热,1 例出现胸腔积液。结论:超声引导经皮肝穿刺微波热凝固治疗肝癌近期疗效满意,是一种定位准确、操作简单、安全价廉、可重复的微创手术。     

MR引导微波治疗肝癌的临床初步研究

目的研究利用MR导引微波治疗肝癌的可行性.方法利用0.23TMR导引微波热凝固治疗肝癌患者.结果在MR引导下,微波天线可以准确、安全地置入肿瘤内,而且没有严重并发症.结论MR导引微波治疗是可行的,而且它可以准确的显示毁损区的形状和边缘.     

肝动脉栓塞对微波凝固范围影响的实验研究

目的 通过活体动物实验,研究肝动脉栓塞后对微波凝固范围的影响。方法 选取10只实验犬的24个适合肝叶,分别进行单纯微波凝固(对照组)和肝动脉碘化油 明胶海绵栓塞后微波凝固(实验组),每组12个肝叶。微波输出功率50W,输出时间为300s和400s。测温针与微波天线平行放置于其两侧5～20mm范围内,测量温度分布情况。术后处死动物,沿穿刺针解剖肝脏,观察比较凝固灶的大小、形态。标本经福尔马林固定后,光镜下观察病理改变。结果 微波凝固术时,天线周围温度由内向外呈递减分布,实验组温度下降梯度明显低于对照组。当微波输出功率50W、输出时间300s时,对照组单极微波凝固形成纵径25～33mm、横径13～22mm的椭球形凝固灶,实验组形成纵径33～44mm、横径24～32mm的椭球形凝固灶。输出时间400s时形成的凝固灶略大于输出时间300s时的凝固灶,但差异无显著性。结论 肝动脉栓塞后可使肝动脉血流引起的散热效应消失,使微波凝固的范围明显增大。     

2450兆赫微波在治癌中的应用

本文报告用2450兆赫微波加温(平温42.5℃)治疗22例癌症病人的实验性研究的初步结果。为便于测量2450兆赫微波透热的深度、测量皮肤和组织的温度和观察肿瘤的反应,作者仅治疗浅表性肿瘤。患者均经癌症的常规治疗-外科、放射治疗和化学治疗无效,且有局部复发或皮下转移。治疗使用MW/200型、频率2450兆赫微波机,最大功率是125W。辐射头约距表皮4 cm,不同的辐射头加热范围从14cm×17 cm的长方形到10cm直径的圆形。测温是在局部麻醉后用一个已校验过的装有热敏电阻的24号针头插入肿瘤组织治疗野中心,作为对组织温度的连续监测;在加温治疗中用另一个热敏     

活体猪肺微波消融组织热沉积剂量与消融范围的研究

目的 探讨活体猪肺微波消融过程中组织热沉积剂量和消融固化范围之间的相关性.方法 根据微波消融工作原理,遵循能量守恒定律设计实验.以活体家猪为实验对象,对实验猪的右肺进行微波消融.设置主机输出功率为40、60、80、100 W,消融时间5 min,每个功率消融10个位点.测定消融针尖端的有效输出功率、组织的热沉积剂量.结果 有效输出功率和组织热沉积剂量均随主机输出功率的增加而增加,消融体积亦随之增大.不同功率组消融体积与组织热沉积剂量的相关指数为97.2%,相关性极高.结论 有效输出功率比主机输出功率更准确的反映消融组织实际接受的功率;而组织的热沉积剂量可真实的反映组织接受的微波消融能量,两者有可能成为量化消融范围的标准.     

微波聚能刀治疗70岁以上肺癌患者疗效分析

目的:采用微波聚能刀局部毁损治疗70岁以上周围型非小细胞肺癌,探求微波治疗中晚期非小细胞肺癌的疗效.方法: 36例肺癌患者局麻后, 在CT 引导下用微波聚能刀经皮直接穿刺入肺癌瘤体内, 以40W-90W(一般为70W-90W)的功率,加热穿刺点10min-30min,加热范围应超过肿瘤边缘0.5cm-1cm,对其进行热凝固治疗 .随后观察患者症状、KPS评分改善情况,局部病灶影像学变化,疾病进展时间,生存时间以及不良反应.结果: 临床症状均有不同程度的改善,CT显示完全缓解6例(17%),部分缓解27例(75%),无变化及进展3例(8%).随访6-15个月,生存31例,死亡5例,1年生存率36%,半年生存率69%.结论:该综合疗法治疗中晚期非小细胞肺癌创伤小,严重并发症少,安全性高,疗效可靠,是老年非小细胞肺癌综合治疗的一种新方法.     

Comparison of microwave coagulation using a new type electrode with radiofrequency ablation in the liver of living animals]

In the present study, we compared microwave coagulation using a new type of electrode, a teflon-coated electrode that was developed in order to increase the area of coagulation, with radiofrequency ablation using a Radionics Cool-tip electrode inserted into the pig liver. Two Landrace male pig were put under general anesthesia. A microwave electrode (insulated area: 6 mm, teflon-coated electrode 16 G) and a radiofreqency (RF) electrode (Cool-tip RF single electrode 17 G) were passed through the surface of the livers of the pig. A thermometer was placed 1 cm from the tip of the electrode in order to measure the changes in the temperature of the area surrounding the electrode. In this study, the microwave setting was 80 W, and the RF pulse was set automatically. The coagulated and ablated areas of the liver were measured after 2.5, 5, and 10 minutes of energy delivery (n = 4). The diameter of the coagulated area of the liver following 2.5, 5 and 10 minutes of microwave exposure was 23.5 +/- 4.8 mm, 29.5 +/- 5.2 mm and 32.5 +/- 6.4 mm, respectively. On the other hand, the diameter of the ablated area of the liver following 2.5, 5 and 10 minutes of RF exposure was 18.5 +/- 4.1 mm, 24 +/- 7.8 mm and 28 +/- 4.9 mm, respectively. The mean temperature of the liver 1 cm from the microwave and RF electrodes (measured time: 2 minutes) was 69.6 degrees C and 56.3 degrees C. respectively (n = 12). Thus, the temperature of the area surrounding the microwave electrode was significantly higher than the temperature of the area surrounding the RF electrode (p = 0.0065). The teflon-coated microwave electrode achieved superior results to the Radionics Cool-tip electrode with respect to the diameter of the coagulated area and the temperature of the area in which the electrode was inserted, at the specified times.     

经皮微波热凝治疗肝癌的疗效观察

目的 经皮微波肝穿刺对肝癌进行热凝损毁,观察其对肝癌的作用疗效。方法 52例患者在局麻或硬膜外麻醉下,使用2450MHz微波微型穿刺天线,在B超引导下直接经皮穿刺进入肝癌瘤体内,对其进行热凝固。结果 52例患者的97个瘤体中,直径均＜3cm的肿块61个（62．9％）能1次手术热凝损毁,其中57个（93．4％）经CT或MRI检查,并随访6－12个月,提示瘤体热损毁后未见复发;3－5cm的肿块36个（37．1％）,分2次手术,术后6个月CT或MRI检查提示,27个热凝损毁（75．0％）,9个大部分热凝损毁（25．0％）。经皮微波热凝治疗（PMCT）的患者均未见明显的副作用和其他并发症。结论 PMCT治疗肝癌,尤其对直径＜3cm的瘤体疗效可靠,对＞3．5cm或＜5cm的瘤体仍具有大部分或完全热损毁的作用。     

超声引导下经皮微波凝固治疗肝癌的临床应用

目的探讨超声引导下经皮微波凝固治疗肝癌的临床应用价值。方法治疗３２例肝癌５７个结节。每个点的凝固治疗采用输出功率６０Ｗ,作用时间２４０～３００秒。５７个结节进行９２次１８２个点的治疗。结果随访５～１８个月,平均１０．４个月,２９例健在,３例死亡。治疗后８５．９％（４９／５７）的肿块缩小,超声显示７８．２％（３６／４６）的肿块内血流消失,增强ＣＴ显示７６．４％（２５／３４）的肿瘤内无强化。原血ＡＦＰ升高１３例,治疗后１１例降至正常。２７例患者全身情况改善,１９例体重增加。１４例治疗后再次活检,１２例肿瘤呈完全性坏死,代之以纤维结缔组织增生。结论超声引导下经皮微波凝固肝肿瘤,在大部分病例可以达到使肿瘤完全性坏死的较好疗效,可望成为肝癌非手术治疗的重要途径。     

Tumor ablation with MRI navigation--a novel method of microwave coagulation therapy for hepatic tumor]

Fifty-eight patients with hepatic tumor which consisted of 22 hepatocellular carcinomas and 36 metastatic liver tumors were treated by microwave coagulation therapy with MRI navigation. The tumors were located in all segments of liver except S1. In 24 cases among them, the abdominal approach was difficult, because the tumors were located just below the diaphragm. These cases were selected for thoracoscope-assisted microwave ablation under MR-guidance across the diaphragm. All MR data were collected on a vertically oriented open MRI system (0.5 T SIGNA SP/i system: GE Medical Systems). The microwave electrode was introduced into the liver through a 14G needle via a percutaneous puncture with real-time MR image navigation. Microwave ablations at 60 W for 60 seconds were repeated several times depending on the tumor size. MR imaging may be employed as a reliable guide for percutaneous puncture. Moreover, sufficient safety margin could be obtained for hepatic tumor ablation. MR-guided microwave thermoablation therapy is a feasible method of treatment for hepatic tumors.     

Choice of YAG-Nd mode for conduction of interstitial laser coagulation in benign prostatic hyperplasia

Basing on the results of fundamental and experimental investigations, we have selected the YAG-Nd laser mode for interstitial laser coagulation (ILC) of the prostate using laser unit LAMIN-1 made in Russia. The experiments were performed on cadaver prostates (3 macropreparations of human prostate 50-80 cm3 in volume). The samples were exposed to laser radiation after their immersion into 5% glucose solution. Laser worked with impulse frequency 30 Hz, power 30-50 W, time of exposure 20-50 s. In exposure 30-40 or 20 s recommended power is 30 or 40-50 W, respectively. The resultant coagulation necrosis covers 2.8-2.9 cm3, carbonized layer is absent. The above mode was used in 10 operations in 65-85-year-olds. The duration of the intervention was 10-15 min maximum. The sites were 3-5 in the lateral lobe and 2 in the middle lobe of the prostatic gland. The outcomes were followed up for 12 months. The comparison of the mean control values with those before the procedure provided the following picture after 12 months: preoperative IPSS 21.9 vs 9.3 scores postoperatively; residual urine 140 vs 30 cm3; maximum urination rate 6.7 ml/s vs 13.5 ml/s, respectively. For interstitial laser coagulation we think it valid to use high laser power and short exposure because short duration of the operation, complete hemostasis, minor lesion of the urothelium, unnecessary long-term drainage of the urinary bladder minimize the risk of intra- and postoperative complications.     

Magnetic resonance-guided percutaneous microwave coagulation therapy for liver metastases of breast cancer in a case

Real-time magnetic resonance (MR) imaging enables the application of percutaneous microwave coagulation for high-risk patients with metastatic liver tumours. The tumours, local vessels and bile ducts can be observed clearly in three-dimensional sections and a sufficient surgical margin can be confirmed on the MR image even during the coagulation procedure. MR-guided percutaneous microwave coagulation therapy is effective for treatment of not only primary liver tumours but also metastatic breast cancers in the liver, which are not diffuse but discrete, and difficult to treat with only chemo-and endocrine therapy. We report a 44-year-old Japanese woman who underwent modified radical mastectomy for right breast cancer (T1c N0 M0 Stage I). Three years after the operation, she developed two metastatic liver tumours and was treated by MR-guided percutaneous microwave coagulation, achieving a complete response (CR) without any recurrence for 15 months as of the present. The most beneficial aspect of MR-guided percutaneous microwave coagulation is its safety. It is only minimally invasive and can be repeated. This therapy, therefore promises to prolong the disease free period. Additional clinical trials will be valuable to delineate the effectiveness and safety of MR-guided percutaneous microwave coagulation therapy for controlling the liver metastases of breast cancer.     

超声引导经皮微波消融对紧邻胆囊肝癌的临床研究

目的探讨超声引导下经皮微波消融（PMCT）紧邻胆囊肝癌的有效性和安全性。方法2006年6月～2007年9月,31例患者的37个紧邻胆囊的恶性肿瘤行PMCT,本组病灶直径为0．8～5．9cm,平均3．2±1．7cm。随访患者2—16个月,平均随访期为7．1±4．3个月。并观察肿瘤灭活情况、肝功能、副作用及并发症。结果所有患者均未出现与操作相关的较严重并发症。其中术后17例患者发热,7例出现腹痛,17例出现发热,3例出现恶心、呕吐。肿瘤完全灭活率为89．1％;2例患者的3个结节分别于治疗后1个月、3个月、12个月出现肿瘤局部复发。结论PMCT对紧邻胆囊的肝癌病灶是一种安全、可行、有效的非手术治疗手段。