无水酒精注射术联合射频消融术与单纯射频消融术治疗小肝癌的疗效比较

目的比较无水酒精注射术（PEI）联合射频消融术（RFA）治疗方案与单纯RFA治疗小肝癌的疗效。方法回顾分析我院2006年1月～2008年1月进行的68例小肝癌射频消融治疗患者的临床资料。68例中37例行PEI联合RFA术,31例行单纯RFA术。比较两组肿瘤完全消融率,复发率,复发时间,术后1、2、3年生存率等情况。结果 PEI联合RFA组肿瘤完全消融率91.89%,局部复发率10.81%,局部复发时间（14.22±3.48）月,1、2、3年的生存率分别为89.19%、81.08%和72.97%。单纯RFA组肿瘤完全消融率70.97%,局部复发率32.26%,局部复发时间（9.15±2.68）月,1、2、3年的生存率87.10%、77.42%和48.39%。PEI联合RFA组在肿瘤完全消融率、局部复发率、复发时间、术后3年生存率方面好于单纯RFA组。结论 PEI联合RFA治疗小肝癌疗效优于单纯RFA治疗,在小肝癌的治疗中有重要临床应用价值。     

多电极组合穿刺在较大肝癌射频消融中的应用

目的 总结应用多电极组合布针+多位点叠合射频消融(RFA)治疗较大肝癌(肿瘤最大直径>4 cm)的疗效,探讨电极针应用数量和布针方式与疗效的关系.方法 2006年2月到2008年12月,共对113例失去手术机会的较大肝癌患者实施了超声引导下经皮肝RFA.所有肿瘤按大小分成A、B、C、D 4组.A组肿瘤直径4.0-5.0 cm;B组肿瘤直径5.1-6.0 cm;C组肿瘤直径6.1～7.0 cm:D组肿瘤直径7.1-9.3 cm.根据肿瘤不同直径决定应用的电极针数量及消融位点数目.术后随访评估治疗后肿瘤凝固性坏死结果及局部复发状况.结果 RFA后2个月内首次复查,A、B、C、D 4组患者的完全消融率分别为88.4%,78.6%,63.6%和40.O%,总体完全消融率为79.7%.随访3～36个月,A、B、C、D组的局部复发率分别为5.5%,10.O%,28.6%和50.O%,总体局部复发率为10.5%.残留以及局部复发的肿瘤根据不同情况接受再次RFA、TACE或放疗.结论 多电极组合布针+多位点叠合RFA治疗较大肝癌疗效确切,简单实用,但最好结合其他治疗方式以提高完全消融率.     

膈顶部原发性肝癌的射频消融

目的 探讨膈顶部原发性肝癌射频消融(RFA)的治疗转归.方法 2006年2月至2008年3月,共有251例原发性肝癌患者接受了超声引导下的经皮RFA,其中42例56个肿瘤位于膈顶部,定义为A组.另有209例368个肿瘤位于非膈顶部,定义为B组.结果 初次RFA后,A、B两组的完全消融率、局部复发率及并发症发生率分别为85.7%比86.6%;9.5%比11.5%和7.1%比4.7%.差异均无统计学意义(P>0.05).将B组按肿瘤具体部位进一步分为肝实质内、包膜下、空腔脏器旁以及肝门部肿瘤,再与A组比较,显示上述5个不同部位肿瘤完全消融率两组间差异有统计学意义(P<0.05).膈顶部和非膈顶部直径<3 cm,3～5 cm和>5 cm肿瘤的完全消融率分别为90.2%,76.9%,50%和96.6%.78.1%.69.2%,两组同等直径范围肿瘤的完全消融率差异无统计学意义(P>0.05).A、B两组1年无复发生存率分别为62.3%和59.2%,总生存率分别为90.O%和92.O%.2年无复发生存率分别为56.6%和52.4%,总生存率分别为82.7%和84.2%.A、B两组1、2年无复发生存率和总体生存率之间差异无统计学意义(P>0.05).结论 尽管膈顶部肿瘤位置的特殊性影响着RFA后疾病转归,但与其他部位肿瘤相比,膈顶部肿瘤在治疗效果、治疗风险、局部复发以及生存预后方面均不逊色,膈顶部肿瘤并非RFA的禁忌证.     

MRI引导肺癌射频消融治疗的临床应用

【摘要】 目的 探讨MRI在肺癌射频消融（RFA）治疗过程中定位及引导的安全性和可行性。方法 26例患者应用MRI引导进行肺癌病灶定位并完成RFA治疗，观察定位的准确性及成功率，分析治疗对生存期的影响，同时观察MRI引导RFA治疗的不良反应发生率等安全性指标，进一步评价MRI在引导RFA治疗中的价值及可行性。结果 26例肺癌患者全部定位成功， 13例出现并发症，其中气胸8例、胸水8例，合并肺炎、皮下组织积气及术中咳血各1例。所有病灶1～4年局部控制率分别为87.2%、69.9%、48.1%、24.8%；1～5年生存率分别为86.5%、66.2%、66.2%、66.2%、22.1%。结论 MRI引导肺癌RFA定位准确、操作安全、无辐射损伤，大部分患者的局部肿瘤控制效果较好，生存期延长，是一种临床操作安全可靠的局部肺肿瘤治疗方法。     

肝动脉栓塞化疗联合射频及无水乙醇注射治疗中晚期肝癌的评价

目的 探讨肝动脉化疗栓塞(TACE)联合射频消融(RFA)及无水乙醇注射(PEI)治疗中晚期肝癌的评价.方法 78例中晚期肝癌患者随机分为联合组(39例)和对照组(39例),联合组行序贯TACE→RFA+PEI→TACE治疗.对照组仅行TACE治疗2～5次.治疗1个月后全部病例复查肝脏彩色多普勒超声、CT,观察患者肿瘤缩小程度、甲胎蛋白水平变化和随访1、2年生存率.结果 联合组甲胎蛋白转阴率,肿瘤缩小率及1、2年生存率分别为81.3%、87.2%、97.4%、76.9%,明显高于对照组的56.3%、64.1%、79.5%、53.8%(P值均<0.05).结论 TACE联合RFA及PEI治疗中晚期肝癌安全有效.可明显改善疗效并延长生存期.     

肝肿瘤射频消融电极针研究进展

射频消融(RFA)是目前广泛应用于肝肿瘤治疗的微创、有效方法,适用于不愿或不宜外科手术治疗患者.近20余年来RFA技术取得了长足的发展与进步.作为主要治疗工具,射频电极针对RFA疗效具有很大影响.该文就目前临床常用或处于研发阶段的射频电极针,如多针尖可扩展电极针、灌注电极针、内冷却电极针及双电极针等的特点进行总结,比较它们的优势与不足,展望进一步研究方向,以提高RFA治疗肝肿瘤效果.     

单针灌注电极射频消融治疗肝脏肿瘤疗效分析

目的 评价CT引导下单针灌注电极在肝脏肿瘤射频消融(RFA)治疗中的临床价值.方法 2008年1月-2008年12月,在CT引导下对24例患者37枚肝脏肿瘤采用RITA UniBlate射频电极进行RFA治疗,其中单个肿瘤者14例,2枚肿瘤者7例,3枚肿瘤者3例;肿瘤最大径≤3 cm者24枚,3.1～5 cm者8枚,>5 cm者5枚;随访期12个月.结果 治疗后完全消融肿瘤22枚(22/37,59.5%),其中病灶长径小于3 CB者19枚(19/24,79.2%),3.1～5 cm者2枚(2/8),大于5 cm者1枚(1/5);未完全消融肿瘤15枚(15/37,40.5%).随访12个月仍存活者15例(15/24,62.5%);死亡患者9例(9/24,病死率37.5%).10例AFP阳性患者中,术后5例下降至正常水平,3例虽有下降但仍高于正常,2例持续升高.RFA治疗后1例患者肝脏包膜下少量出血;患者均有不同程度发热和上腹部疼痛.结论 CT引导下RITA UniBlate单针灌注电极RFA治疗创伤小、并发症发生率低,近期疗效确切,是肝脏肿瘤安全有效的局部治疗方法;对直径小于3 cm的肿瘤1次消融有较高的完全消融率;对大于3 cm的肿瘤,需行多点重叠消融并结合其他消融治疗方法以实现肿瘤病灶的完全消融.     

TACE联合射频消融与单独射频消融治疗结节型肝癌临床对比分析

目的 评价单独射频消融(RFA)与肝动脉化疗栓塞术(TACE)联合RFA两种方法治疗结节型肝癌的有效性.方法 143例肝内病变直径为3 ～5 cm肝癌患者(RFA组76例,TACE+ RFA组67例),通过CT扫描和AFP水平测定进行随访.两组病例的局部肿瘤进展率分析采用Kaplan-Meier法,以Cox回归模型进行多元预后因素分析.结果 143例经RFA或TACE+ RFA治疗后平均随访42个月(2～127个月),RFA组有73％的患者出现局部肿瘤进展,TACE+ RFA组有38％的患者出现局部肿瘤进展;RFA组1、3、5、7年局部肿瘤进展率分别为48％、74％、87％和90％,TACE+ RFA组1、3、5、7年局部肿瘤进展率分别为8％、38％、53％和68％,两组的差异具有统计学意义(P＜0.01).RFA组有2例(2.6％)治疗后出现腹腔出血和肝段梗死等并发症;TACE+ RFA无一例发生相关并发症.多因素分析表明,治疗方式(RR,0.677;P=0.041)、Child-Pugh分级(RR,1.504;P=0.04)是影响患者生存率的独立危险因素.结论 TACE+ RFA治疗结节型肝细胞癌较单独应用RFA治疗安全有效,可以更好地控制肝内病变;同时多因素分析表明,治疗方式和Child-Pugh分级是影响患者生存率的独立危险因素.     

射频消融联合肝动脉化疗栓塞治疗肝癌的应用

以超声、CT等为主要引导方式的经皮射频消融(RFA)等局部热消融技术在肝癌治疗中发挥了重要的作用.然而,对血供丰富的较大肝癌疗效受限.经肝动脉化疗栓塞(TACE)可有效减少肝癌的血供,并具有创伤小,适应证广,并发症少等特点,成为肝癌患者姑息治疗及术前、术后新辅助治疗的有效手段之一.因此,富血供肝肿瘤RFA治疗前应用TACE,通过栓塞肿瘤供血动脉造成肿瘤缺血,进而减少血流带走热量,可扩大消融范围提高RFA疗效,是肝癌RFA联合治疗常用的方法.本文针对RFA联合TACE治疗肝癌的应用现状及疗效进行综述.     

CT引导下经皮射频消融治疗较大原发性肝癌的临床应用

目的 探讨CT引导下经皮射频消融(RFA)治疗较大原发性肝癌的疗效.方法 对27例TACE治疗效果欠佳的较大原发性肝癌患者行CT引导下经皮RFA治疗,肿瘤大小5.4-11.0 cm,平均6.2 cm.单发病灶23例,2个病灶4例,共31个病灶.AFP阳性22例.术后通过增强CT及AFP检测评价疗效,所有病例随访2～20个月.结果 射频治疗后1个月随访显示,31个肿瘤中14个(45.2%)肿瘤完全坏死,内部及边缘无明显强化;17个肿瘤部分坏死.22例AFP阳性患者,AFP明显降低15例(68.2%),不变3例(13.6%),升高4例(18.2%).并发症中3例出现表皮烫伤,1例顽固性呃逆,1例肝内出血,1例肝脓肿,1例术后出现严重低蛋白血症,术后2个月死亡.患者中位生存期为9.8个月,1年累计生存率29%.结论 对于不可切除的较大原发性肝癌,RFA是较有效的局部介入治疗方法,合理应用RFA治疗,可提高患者生活质量并延长患者的生存时间.     

肿瘤射频消融:电极的类型和消融灶的特点

在早期,由于受射频电极周围被消融组织炭化和气化的影响,射频消融(RFA)范围小于1.8 cm,难以满足临床对实体性肿瘤RFA治疗的要求.随着RFA设备和电极的不断改进,消融范围不断扩大,更好地满足了临床上对肿瘤RFA治疗的需要,为不能或不愿外科手术的恶性肿瘤患者提供了新的治疗手段.本文就射频电极的类型及消融灶的特点做一...     

射频技术在临床中的应用

近20年来,射频(radiofrequency,RF)技术以其微创、靶向、疗效好,不良反应少等特点应用于临床各种疾病的治疗有了巨大的发展。从治疗实体肿瘤,逐渐发展到治疗实质器官的良性病变如脾亢、前列腺增生,以及在心血管系统、骨骼系统、消化系统、妇科疾病、治疗疼痛以及医学美容等多个领域得到广泛应用并取得了较好的疗效。本文就其治疗原理、不同机型及特点以及在临床方面的应用作一综述。     

Assessment of cerebral microembolism during percutaneous radiofrequency ablation of lung tumors using diffusion-weighted imaging

OBJECTIVE: It is well known that radiofrequency ablation generates microbubbles in the liver. We hypothesized that microbubbles generated during percutaneous radiofrequency ablation of lung tumors flow into the pulmonary veins and are distributed to the systemic arteries, as with radiofrequency ablation of liver tumors. To assess the risk of cerebral infarction during radiofrequency ablation of lung tumors, we performed diffusion-weighted imaging and, if possible, monitored microemboli in the carotid artery during radiofrequency ablation. SUBJECTS AND METHODS: We prospectively studied 20 patients (19 men and one woman) who underwent radiofrequency ablation of lung tumors. Pre- and postoperative MRI examinations were performed in all 20 patients, and during 17 radiofrequency ablation sessions, sonography was used to monitor whether microemboli were generated. RESULTS: Radiofrequency ablation was technically feasible for the treatment of selected pulmonary tumors. Microemboli, which were believed to represent microbubbles, were seen on sonography during three of the 17 radiofrequency ablation sessions. They were rarely observed when a lung tumor was small, the treatment session was brief, and the radiofrequency emission power was low. No new area of abnormal intensity was seen on postoperative MRI in all 20 patients. Although the microemboli were observed, MRI could not confirm infarction. CONCLUSION: We concluded that cerebral infarction as a result of microbubbles generated during radiofrequency ablation of lung tumors has a low possibility of becoming a clinical problem.     

Therapeutic efficacy and safety of percutaneous radiofrequency ablation of hepatocellular carcinoma abutting the gastrointestinal tract

OBJECTIVE: The purpose of this study was to evaluate the therapeutic efficacy and safety of percutaneous radiofrequency ablation in the treatment of hepatocellular carcinomas abutting the gastrointestinal tract. MATERIALS AND METHODS: Forty-one patients with hepatocellular carcinomas abutting the gastrointestinal tract underwent sonographically guided percutaneous radiofrequency ablation. Forty-one tumors (1.2-4.3 cm in maximum diameter) had parts 5 mm or greater (or at least one quarter of their circumferences) abutting the stomach in 23 patients and the colon in 18 patients. Thirty tumors were ablated with internally cooled electrodes and 11 with multitined expandable electrodes. All patients were followed up for at least 1 year after ablation. Therapeutic efficacy and safety were evaluated with follow-up sonography and multiphase helical CT. RESULTS: At 1-month follow-up CT, three (7%) of the 41 tumors showed residual unablated tumor in the ablation zone. Of the remaining 38 hepatocellular carcinomas (93%) with no evidence of residual unablated tumor, four (11%) showed local tumor progression in the ablation zones on subsequent follow-up CT. We observed one major complication-a small perihepatic abscess-that needed specific treatment. CONCLUSION: Percutaneous radiofrequency ablation is an effective and safe technique for treating hepatocellular carcinomas abutting the gastrointestinal tract.     

射频消融治疗眼周汗管瘤的疗效观察

目的评估射频消融治疗眼周汗管瘤的临床疗效。方法 64例眼周汗管瘤患者接受刺入式射频消融治疗,手术在头式放大镜下进行,针状消融电极与射频发射器相连,刺入皮损并将射频能量传输至位于真皮层的病灶底部。治疗前后分别对患处拍照,以数码照片评分及患者满意度调查结果为观察指标。结果每例患者最多进行3次治疗,每次术后评估临床疗效,评分≥3级的患者比率依次为71.9%,83.3%和100%。医师评估与患者评价结果的一致性(第1次治疗后kappa=0.78;第2次治疗后kappa=0.82)。结论刺入式射频消融可以有效、精准、安全地治疗眼周汗管瘤。     

Adverse events during radiofrequency treatment of 582 hepatic tumors

OBJECTIVE: We describe the rates and potential risk factors of complications of radiofrequency ablation of hepatic tumors. SUBJECTS AND METHODS. Over a 5-year period, 312 patients underwent 350 sessions of radiofrequency ablation (124 intraoperative and 226 percutaneous) for treatment of 582 liver tumors including 115 hepatocellular carcinomas and 467 metastatic tumors. The chi-square test was used for a group-to-group comparison of the occurrence of adverse events. RESULTS: Thirty-seven (10.6%) adverse events and five (1.4%) deaths were related to radiofrequency treatment. The deaths were caused by liver insufficiency (n = 1), colon perforation (n = 1), and portal vein thrombosis (n = 3). Portal vein thrombosis was significantly (p < 0.00001) more frequent in cirrhotic livers (2/5) than in noncirrhotic livers (0/54) after intraoperative radiofrequency ablation performed during a Pringle maneuver. Liver abscess (n = 7) was the most common complication. Abscess occurred significantly (p < 0.00001) more frequently in patients bearing a bilioenteric anastomosis (3/3) than in other patients (4/223). We encountered five pleural effusions, five skin burns, four hypoxemias, three pneumothoraces, two small subcapsular hematomas, one acute renal insufficiency, one hemoperitoneum, and one needle-tract seeding. The 6.3% of minor complications did not require specific treatment or a prolonged hospital stay. Among the 5.7% major complications, 3.7% required less than 5 days of hospitalization for treatment or surveillance and 2% required more than 5 days for treatment. CONCLUSION: Radiofrequency ablation of liver tumors is a well-tolerated technique, but caution should be exercised when treating patients with a bilioenteric anastomosis, and radiofrequency ablation during vascular occlusion in cirrhotic livers should be avoided.     

Ablación por radiofrecuencia en la enfermedad tiroidea y paratiroidea

Radiofrequency ablation is a well-known, safe, and effective method for treating benign thyroid nodules and recurring thyroid cancer as well as parathyroid adenomas that has yielded promising results in recent years. Since the Korean Society of Thyroid Radiology introduced the devices and the basic techniques for radiofrequency ablation in 2012, radiofrequency ablation has been approved all over the world and both the devices and techniques have improved.This review aims to instruct interventional radiologists who are doing or intend to start doing radiofrequency ablation of thyroid and parathyroid lesions, as well as thyroid and parathyroid specialists who provide pre- and post-operative care, in the training, execution, and quality control for radiofrequency ablation of thyroid nodules and parathyroid adenomas to optimize the efficacy and safety of the treatment.     

Radiofrequency Ablation of Renal VX2 Tumors With and Without Renal Artery Occlusion in a Rabbit Model: Feasibility,Therapeutic Efficacy,and Safety

The purpose of this study was to determine the therapeutic efficacy of radiofrequency ablation for treating renal VX2 tumors with and without renal artery occlusion in a rabbit model. Twenty-four New Zealand White rabbits were percutaneously implanted with renal VX2 tumors. Fifteen days after implantation, both kidneys were surgically exposed, and radiofrequency ablation was conducted. Group A (n = 12) was treated with renal artery occlusion, and group B (n = 12) was treated without occlusion. In each rabbit, the serum creatinine was measured to evaluate renal damage after arterial occlusion. Two days after radiofrequency ablation, computed tomography was performed to evaluate the difference in therapeutic results between the two groups. We also compared histopathologic findings after radiofrequency ablation. The mean tumor size was 2.4 cm (range, 1.2–3.1 cm). Radiofrequency ablation of renal tumors was technically feasible in all cases. Complete ablation was achieved in 11 of the 12 rabbits (92%) in group A but in only eight of the 12 rabbits (67%) in group B (P < 0.05). The average time of radiofrequency application was shorter in group A (mean, 547 s) than in group B (mean, 826 s) (P < 0.05). After radiofrequency ablation, the serum creatinine increased from 1.54 to 1.82 mg/dl in group A and from 1.46 to 1.78 mg/dl in group B. However, there was no significant difference between the two groups (P > 0.05). In conclusion, radiofrequency ablation with renal artery occlusion can decrease the duration of treatment and increase the therapeutic efficacy for renal VX2 tumors.     

Excessive Hyperthermic Necrosis of a Pulmonary Lobe after Hypertonic Saline-Enhanced Monopolar Radiofrequency Ablation

Although there has been a feasibility study of saline-enhanced radiofrequency ablation of the lung in rabbits, there has been no report on hypertonic saline-enhanced radiofrequency ablation of human pulmonary tumors or its complication. We report a case in which a large necrotic cavity was produced in the lung after hypertonic saline-enhanced radiofrequency ablation of recurrent metastatic tumor from hepatocellular carcinoma. Although hypertonic saline-enhanced radiofrequency ablation is powerful and efficient in local ablation, it is difficult to predict the exact extent of ablation, especially in the lungs. This can be dangerous, as there is a high chance of producing an ablation area much larger than expected and, hence, major complications. Special attention is required not to overablate while using this technique.     

Percutaneous CT-guided radiofrequency ablation of renal neoplasms: factors influencing success

OBJECTIVE: The objective of our study was to evaluate the success rate for radiofrequency ablation of renal tumors and to determine the risk of serious complications. CONCLUSION: No serious complications occurred after 27 CT-guided radiofrequency ablation sessions in 22 patients. In total, no residual tumor was detected on follow-up contrast-enhanced CT or MRI 1-35 months (mean, 7 months) after final tumor ablation in 20 (91%) of 22 patients. Two patients with residual viable tumor deferred further treatment. Complete tumor ablation was achieved after a single treatment session in 83% of patients, and in 8% of patients after subsequent ablation sessions. Size was the major determinant for achieving tumor eradication with a single session of ablation, with all 11 tumors 3 cm or smaller being completely ablated after one session. Tumor location, histology, and the presence of renal disease did not correlate with treatment success. Contrast-enhanced CT performed immediately after ablation is reliable to exclude residual viable tumor. CT-guided radiofrequency ablation of renal tumors is safe and has a high rate of success in the treatment of small renal tumors, with no evidence of recurrence at midterm follow-up of treated patients.