大肠癌肝转移射频消融后局部复发影响因素的分析

目的 探讨射频消融（radiofrequency ablation,RFA）治疗大肠癌肝转移后局部肿瘤复发的风险因素。方法 回顾性研究213例347个肿瘤实施RFA治疗后局部复发的临床资料,对可能影响RFA局部治疗效果的临床因素进行统计学处理。结果 175例（82.2%）298个肿瘤（85.9%）得到CT或MRI随访资料。大肠癌肝转移灶RFA后肿瘤局部复发率为36.9%（110/298）,局部复发的平均时间为16.4月（2～57个月）。单因素分析显示肝脏转移灶的部位、大小和射频针类型与肿瘤射频后的局部复发相关（P值分别为P=0.000,P=0.021和P=0.026）,但Cox多因素分析则显示只有瘤大小和转移灶部位是大肠癌肝转移射频消融后局部复发的独立预后因素（χ^2=8.522,P=0.000;χ^2=1.321,P=0.022）。结论 肝脏肿瘤的大小和部位是RFA治疗效果的独立影响因素,正确的电极选择和布针是获得肿瘤完全坏死的关键。     

射频消融辅助肝切除在结直肠癌肝转移中的应用

目的：探讨射频消融（RFA）辅助肝切除治疗结直肠癌肝转移（CLM）的疗效。 方法：回顾17例CLM行开腹RRFA辅助肝切除患者临床资料,分析手术时间、出血量、有无输血、腹腔引流量及术后并发症发生率,并比较患者手术前后肝功能及凝血功能变化。 结果：所有患者手术均成功完成,手术时间55~237 min,平均（93±19）min;术中出血量235~650 mL,平均（280±40）mL。术中及术后无1例输血,术后3 d内腹腔引流量170~370 mL,1例（5.9%）发生胆瘘。患者术后24、72 h丙氨酸转氨酶（ALT）和天冬氨酸转氨酶（AST）较术前明显增高（均P<0.05）,但术后120 h均恢复至术前水平;而手术前后总胆红素（TBIL）水平与凝血酶原时间（PT）未发生明显变化（均P>0.05）。 结论：RFA辅助肝切除治疗CLM安全可行,并可有效降低出血风险。     

Infectious complications in combined colon resection and ablation of colorectal liver metastases

Background

The multifactorial incidence of infectious complications carries considerable consequences for patients undergoing more extensive surgery with intent to cure metastatic colorectal cancer. Advances in ablation techniques have emerged as an efficacious method in regional control for liver metastasis from colorectal cancer; however, the degree of increased risk of infectious complications when ablation is performed in combination with colon resection has not been defined.

Methods

An analysis of a single institution's prospective database from August 1998 to December 2012 was performed for patients undergoing colon resection. Patients were stratified into a colon resection combined with either microwave ablation (MWA) or radiofrequency ablation (RFA) compared to a colon resection only group. Variables included baseline clinicopathologic data, type of operation, complication grade, and infectious outcome. Fisher exact test, Student t test, and analysis of variance were used to detect significance levels of P values less than .05.

Results

A total of 132 patients with colon cancer of various origins were identified. The group of colon resection combined with RFA and/or MWA was 53 patients (34 male:19 female) and was compared to a matched group of 79 patients (40 male:39 female) who underwent colon resection alone. Median age (58 vs 60 years; P = .209), complication rate (60.7% vs 62.5%; P = .722), infection rate (28.7% vs 35.4%; P = 1.0), mean blood loss (352.7 vs 468.4 mL; P = .452), mean blood transfused (1.36 vs .76 U; P = .247), and receipt of neoadjuvant chemotherapy (47.1% vs 51.85%; P = .724) were all similar between the ablation group and colon only group, respectively. Transfusion rate was higher in the ablation group (39.6% vs 18.9%; P = .016). Overall complication rate was 60.6%, with 32.6% infections. One mortality was observed in each group. High-grade (grade, III to V) complications (35.8% vs 18.9%; P = .0112) and liver-specific complications (n = 4; P = .024) were significantly increased in the combined ablation group.

Conclusions

Combining MWA or RFA techniques with colon resection for liver metastasis appears to have similar infectious and overall complication rates when compared to performing an isolated resection of the primary colon cancer alone, although there may be a higher degree of complication seen in the more aggressive approach for curative intent in patients with colorectal liver metastasis.     

腹腔镜结直肠癌切除术联合射频消融治疗肝转移癌

目的 探讨腹腔镜结直肠癌切除术+同期RFA治疗肝转移癌的临床价值.方法 2001年12月至2006年7月成都市第三人民医院对22例结直肠癌合并同时性肝转移的患者施行腹腔镜结直肠癌切除术+同期RFA治疗肝转移癌,术后通过增强CT检查评价消融灶固化效果.采用X2检验分析疗效.结果 本组22例患者中8例肝转移癌为多发,16例有合并症.对31个肝转移癌进行RFA治疗,未发生相关并发症;术后平均住院时间为(14±5)d,无手术死亡.5例因消融不完全进行重复RFA,4例消融灶复发(2例重复RFA);6例死亡(2例死于消融灶复发).消融灶复发率为18%(4/22),病死率为27%(6/22).肝转移癌直径≥2.0 cm者RFA后消融灶复发率高于直径＜2.0 cm者(x2=5.867,P＜0.05).结论 腹腔镜结直肠癌切除术+同期RFA治疗肝转移癌,为多发性肝转移癌、合并基础疾病、高龄、手术耐受差和肿瘤切除困难的结直肠癌患者提供了治疗的机会.     

经皮与开腹射频治疗肝癌的合理选择

目的：探讨射频（RFA）治疗肝癌不同途径的合理选用。方法：41例肝癌病人分为2组进行经皮射频（PRFA）治疗和开腹射频（IRFA）治疗,并对结果进行比较。结果：PRFA治疗18例病人共32个肿瘤结节,IRFA治疗23例病人共43个结节,PRFA和IRFA并发症率分别为33．3％和4．3％（P＜0．05）,随访平均10个月,PRFA组7个病灶复发（4个病人）,复发率21．9％（7／32）,而IRFA组仅1个结节复发,复发率2．3％（1／43,P＜0．025）,结论：RFA治疗肝癌途径的选用应根据病应位置,结节的大小和肝硬化程度等综合考虑而定,IRFA并发症少,治疗彻底,效果优于PRFA。     

腹腔镜射频消融治疗肝癌体会

【摘要】〓目的〓探讨腹腔镜下射频消融(LRFA)治疗肝癌的效果。方法〓回顾性分析2010年10月~2013年12月,采用LRFA方法治疗各类肝癌26例,肿瘤位于肝脏Ⅲ、Ⅳ、Ⅴ、Ⅷ段或膈顶以及邻近胆囊胃肠等空腔脏器部位,直径2.2~11.0 cm,单病灶18例,多病灶8例,共39个病灶。肝功能Child A或B级。结果〓26例均顺利完成LRFA治疗,消融时间12~112 min,平均48 min;术后出现腹水2例,胸腔积液1例,无肝衰竭、出血、胆道损伤等并发症。术后1个月B超、CT扫描检查,17例肿瘤不同程度坏死,4例部分液化,5例发现多发病灶及门静脉癌栓消融无效。结论〓LRFA易于操作,并发症少,对特殊部位的肝癌是一种可选择的治疗手段。     

射频消融在胃癌肝转移中的临床应用

胃癌肝转移是胃癌的晚期阶段,也是导致胃癌患者死亡的主要原因。射频消融因其安全性高、创伤小、可多次治疗等成为胃癌肝转移综合性治疗方案中可供选择的手段之一。本文对胃癌肝转移射频消融治疗疗效、射频消融联合其他治疗的疗效、影响射频消融预后的因素等进行综述。     

集束电极射频毁损术治疗不能切除的大肝癌

目的探讨集束电极射频毁损术治疗不能切除的原发性大肝癌的临床价值.方法 B超引导经皮穿刺38例,术中穿刺5例.治疗后复查发现肿瘤残存或复发者可重复治疗. 结果 43例(肿瘤直径平均7.3 cm),行射频毁损术治疗62次,平均每次6点.术前AFP>400 μg/L者56.3%(18/32)治疗后降至正常.术后CT检查76.7%(33/43)肿瘤完全毁损.常见的并发症有发热、疼痛、肝功能受损,无严重并发症或与操作相关的死亡.1年存活79.3%(23/29). 结论集束电极射频毁损术治疗不能切除的大肝癌,可使大范围的肿瘤发生热坏死,是一种安全有效的治疗方法,为无法切除的大肝癌开辟了一条新的治疗途径.     

肝癌射频消融治疗严重或少见并发症分析

目的分析射频消融(radiofrequency ablation,RFA)治疗肝癌的严重或少见并发症. 方法回顾分析2002年1月～2004年12月272例肝癌RFA治疗的严重或少见的并发症资料. 结果 272例肝癌行RFA 301次,严重或少见并发症10例,发生率为3.32% (10/301),其中2例导致死亡,病死率为0.66%(2/301).10例并发症包括:腹腔出血1例,感染2例(腹膜炎合并败血症1例,胆汁瘤继发肝脓疡1例),上消化道出血3例(其中1例为胆道出血),肝动静脉瘘1例,血气胸1例,食管胸膜瘘1例,肿瘤针道播散1例. 结论 RFA严重并发症依次为上消化道出血、感染、腹腔出血等.     

射频消融对比手术切除治疗孤立性结直肠癌肝转移肿瘤的Meta分析

目的:比较射频消融(RFA)和手术切除对孤立性结直肠癌肝转移的疗效.方法:计算机检索国内外多个数据库,收集RFA和手术切除治疗孤立性结直肠癌肝转移的临床对照试验,按Cochrane系统评价方法对纳入研究的质量进行评价,用RevMan 5.0软件对资料进行Meta分析.结果:最终纳入9个研究,共1 259例患者,其中RFA 440例,手术切除819例.Meta分析结果显示,RFA患者较手术切除患者5年生存率明显降低(P=0.02),术后总体复发率(p=0.01)和局部复发率均明显增高(P=0.003);两者在治疗直径＜3 cm的肿瘤上术后5年生存率无明显差异(P=0.43).结论:手术切除治疗孤立性结直肠癌肝转移疗效优于RFA,但肿瘤直径＜3 cm时,可考虑采用RFA.     

Irinotecan- vs oxaliplatin-based regimens for neoadjuvant chemotherapy in colorectal liver metastasis patients: A retrospective study

BACKGROUNDNeoadjuvant chemotherapy (NC) improves the survival outcomes of selected patients with colorectal liver metastasis (CRLM). The benefits of irinotecan-based regimens in these patients are still under debate.AIMTo compare the benefits of irinotecan- and oxaliplatin-based regimens in patients with resectable CRLM.METHODSFrom September 2003 to August 2020, 554 patients received NC and underwent hepatectomy for CRLM. Based on a 1:1 propensity score matching (PSM) model, 175 patients who received irinotecan were matched to 175 patients who received oxaliplatin to obtain two balanced groups regarding demographic, therapeutic, and prognostic characteristics.RESULTSChemotherapy was based on oxaliplatin in 353 (63.7%) patients and irinotecan in 201 (36.3%). After PSM, the 5-year progression-free survival (PFS) and overall survival (OS) rates with irinotecan were 18.0% and 49.7%, respectively, while the 5-year PFS and OS rates with oxaliplatin were 26.0% and 46.8%, respectively. Intraoperative blood loss, operating time, and postoperative complications differed significantly between the two groups. In the multivariable analysis, carbohydrate antigen 19-9, RAS mutation, response to NC, tumor size > 5 cm, and tumor number > 1 were independently associated with PFS.CONCLUSIONIn NC in patients with CRLM, irinotecan is similar to oxaliplatin in survival outcomes, but irinotecan is superior regarding operating time, intraoperative blood loss, and postoperative complications.     

结直肠癌肝转移瘤热消融治疗国际专家共识分享

肝转移是结直肠癌致死的最主要原因,手术切除是其首选治疗方式。然而,临床可手术切除的肝转移瘤仅占全部肝转移瘤的10%~25%,对不可切除的肝转移瘤通常采用系统化疗和/或局部消融治疗。近年来热消融技术的治疗效率和安全性日益提高,术后患者5年生存率高于单纯化疗。2013年国际消融专家组发布了结直肠癌肝转移瘤热消融治疗国际专家共识,基于射频消融相关应用的长期随访文献,总结热消融治疗在结直肠癌肝转移瘤治疗中的具体推荐及相关适应证。本文对该共识的主要内容进行介绍与分享。     

Percutaneous and laparoscopic approaches of radiofrequency ablation treatment for liver cancer

Background/Purpose. Radiofrequency ablation (RFA) and microwave coagulation therapy (MCT) have been gaining acceptance as a standard method in the management strategy of liver cancer, for reasons of minimally invasive techniques and effective results. We present our experience of RFA and MCT in patients with liver cancer, and analyze retrospectively the advantages and disadvantages of both of the percutaneous and laparoscopic approaches. Methods. Thirty-two consecutive patients (23 men and 9 women) with 19 hepatocellular carcinomas (HCC), 12 metastatic liver cancers, and recurrent cholangiocellular carcinoma (CCC), were enrolled in this study. Out of these 32 patients, as a prior laparotomy, 19 underwent hepatectomy, colectomy, gastrectomy or cholecystectomy, and 15 were treated with the laparoscopic approach, 17 treated with the percutaneous approach, and 2 treated with the combined approach of those two. All of these procedures were carried out under general anesthesia with ultrasound guidance. Seven and 30 days after these procedures, an assessment helical computed tomography was done. Results. No sign of the residual tissues was noted in all patients except only one case. Conclusions. The percutaneous approach was thought to be a more practical and less invasive method regardless previous laparotomy. For the laparoscopic approach, tumors located at the hepatic surface or margin were preferable candidates.     

Improved survival after resection of colorectal liver metastases

Background: The goal of this study was to determine if staging with intraoperative ultrasound (IOUS), assessment of porta hepatis lymph nodes, and evaluation of resection margins can improve selection of patients likely to benefit from resection of colorectal liver metastases. Methods: A retrospective evaluation was performed on patients undergoing celiotomy with intent to resect colorectal liver metastases. Patients were considered unresectable if extrahepatic disease was identified by peritoneal exploration or if IOUS demonstated greater than four lesions or the inability to achieve negative margins. Tumor-negative margins were confirmed by pathologic evaluation. Actuarial 5-year survival was calculated using the method of Kaplan and Meier. Results: Median follow-up is 25 months. Of the 151 patients undergoing operative exploration, 107 (71.0%) underwent liver resection (all margins tumor negative). Three operative deaths occurred in this group (2.8%). The disease of 30 patients (19.8%) was considered unresectable due to extrahepatic involvement, and that of 14 patients (9.2%) was demonstrated by IOUS to be unresectable. Five-year actuarial survival was 44% for the resected group and 0% for the unresectable patients (p<0.0001). Conclusions: IOUS, portal node assessment, and pathologic margin evaluation improves the selection of patients likely to benefit from resection of colorectal liver metastases. Presented at the 47th Annual Cancer Symposium of The Society of Surgical Oncology, Houston, Texas, March 17–20, 1994.     

超声引导下经皮射频消融治疗恶性肿瘤肝转移

目的探讨超声引导下经皮射频消融(RFA)治疗恶性肿瘤肝转移的应用价值。方法回顾性分析2009年12月—2015年5月于我院接受超声引导下经皮RFA治疗的109例恶性肿瘤肝转移患者的临床及影像学资料。结果 109例肝转移癌患者中,单发31例(31/109,28.44%),多发78例(78/109,71.56%);肝转移病灶来源于结直肠、肺、乳腺、胃、胰腺、卵巢及前列腺的恶性肿瘤。共198个肝转移癌病灶中,直径3cm者151个(151/198,76.26%),直径≥3cm者47个(47/198,23.74%)。治疗后1个月,187个(187/198,94.44%)病灶完全灭活,11个(11/198,5.56%)病灶存在残余活性。与治疗前比较,治疗后1个月患者肿瘤标志物指标明显改善(P均0.05)。术中及术后并发症发生率6.42%(7/109)。结论对于非手术适应证恶性肿瘤肝转移患者,超声引导下经皮RFA治疗相对安全、有效,短期内可局部控制肝内转移癌的活性。     

Comparative study of resection and radiofrequency ablation in the treatment of solitary colorectal liver metastases

Background

We compared outcomes in patients with solitary colorectal liver metastases treated by either hepatic resection (HR) or radiofrequency ablation (RFA).

Methods

A retrospective analysis from a prospective database was performed on 67 consecutive patients with solitary colorectal liver metastases treated by either HR or RFA.

Results

Forty-two patients underwent HR and 25 patients underwent RFA. The 5-year overall and local recurrence-free survival rates after HR (50.1% and 89.7%, respectively) were higher than after RFA (25.5% and 69.7%, respectively) (P = .0263 and .028, respectively). In small tumors less than 3 cm (n = 38), the 5-year survival rates between HR and RFA were similar, including overall (56.1% vs 55.4%, P = .451) and local recurrence-free (95.7% vs 85.6%, P = .304) survival rates. On multivariate analysis, tumor size, metastases treatment, and primary node status were significant prognostic factors.

Conclusions

HR had better outcomes than RFA for recurrence and survival after treatment of solitary colorectal liver metastases. However, in tumors smaller than 3 cm, RFA can be recommended as an alternative treatment to patients who are not candidates for surgery because the liver metastases is poorly located anatomically, the functional hepatic reserve after a resection would be insufficient, the patient's comorbidity inhibits a major surgery, or extrahepatic metastases are present.     

超声引导下射频消融治疗肝转移瘤的疗效观察

目的评价超声引导下射频消融（RFA）治疗结直肠癌肝转移瘤（MLC）的疗效。方法采用超声引导下RFA治疗结直肠癌MLC患者60例134个病灶,其中91个病灶≤3.0 cm,43个〉3.0 cm。术前39例血清癌胚抗原（CEA）增高,21例正常。采用CEUS检查结合增强CT、穿刺活检及CEA值的动态变化综合评价肿瘤治疗效果。结果术后3个月复查CEA,37例增高,23例正常。术后30 min CEUS检查显示127个射频消融病灶呈无灌注区,近期有效率达94.78%（127/134）。术后1个月CEUS检查显示8个病灶局部增强,考虑复发,经超声引导下穿刺活检及细胞学检查证实而行第2次治疗。术后1个月增强CT复查显示126个（126/134,94.03%）射频消融病灶呈无灌注区,为完全坏死的转移病灶;部分坏死病灶为8个,与CEUS结果一致。结论超声引导下RFA是治疗MLC的一种安全有效的局部微创治疗方法。     

射频消融联合经皮椎体后凸成形术治疗脊柱转移癌的临床初步研究

目的 初步探讨射频消融(radiofrequency ablation,RFA)联合经皮椎体后凸成形术(percu-taneous kyphoplasty,PKP)治疗脊柱转移癌的临床疗效.方法 对2013年9月至2015年9月于广元市中心医院骨科行RFA联合PKP治疗脊柱转移癌的18例(24椎)病人的临床资料进行回顾性分析,比较其术前、术后1 d、1周及1、2、3、6个月的疼痛视觉模拟量表(visual analogue scales,VAS)评分、日本骨科协会(Japanese Orthopaedic Association,JOA)评估治疗分数、罗兰-莫里斯生活障碍问卷(Rolando-Morris dis-ability questionnaire,RMDQ)评分,同时通过术后随访复查的X线片,测量椎体前缘高度,记录骨水泥渗漏情况.结果 全部病人术后24 h内疼痛明显缓解,技术成功率为100%,均得到3个月以上随访,平均随访时间为5.2个月.术后3个月,9例(50.0%)疼痛完全缓解,7例(38.9%)止痛药用量减少或止痛药级别降低,2例(11.1%)止痛药维持原量.治疗后(术后1 d、1周及1、2、3、6个月)的VAS、JOA、RMDQ评分及椎体前缘高度均较治疗前显著改善,差异均有统计学意义(P均<0.05).结论 RFA联合PKP可明显提高病人生活质量,手术方式安全,对脊柱转移癌病人微创、有效.     

经皮射频治疗结直肠癌肝转移31例

目的 评价B超引导经皮射频（PRFA）治疗结直肠癌肝转移的疗效。方法 应用PRFA治疗结直肠癌肝转移31例共55个病灶，肿瘤直径1．5～8．5cm。应用RF2000射频仪和10电极LeVeen针，病灶〉2．5cm者予分层多点叠合毁损，〉5．0cm或多发者配合肝动脉导管化疗栓塞术（TACE）及无水酒精注射疗法（PEI），随访观察病灶影像形态表现、血清CEA变化和患者生存率。结果 PRFA后反应期3～7d，包括局部疼痛不适、发热、ALT升高等；并发肝曲结肠穿孔和腹壁穿刺道转移各1例；小肿瘤（〈3．0cm）完全坏死率达92．9％（26／28），3．1～5．0cm的肿瘤完全坏死率为73．3％（11／15），病灶〉5cm者均未完全坏死；1、2、3年生存率分别为87．1％、77．5％和54．8％。结论 PRFA是治疗结直肠癌肝转移的一种微创疗法，对〈3．0cm肿瘤疗效显著，对大肿瘤可联合TACE、PEI等进行综合治疗。