肝癌的冷冻治疗

目前，手术切除仍是治愈肝脏恶性肿瘤的唯一方法，但临床能满足手术切除条件的病人只占少数，即使联合应用其他方法，肝恶性肿瘤的生存率仍很低，近年，肝恶性肿瘤的冷冻治疗取得了长足的进步，一些报告中冷冻的效果已与手术切除相近。     

冷冻治疗肝癌

近30年来,冷冻外科治疗良恶性肿瘤已有不少报道。但大多数是用于皮肤、直肠、前列腺、妇科、头颈部肿瘤的治疗。1973年,我所开展液氮冷冻治疗肝癌的实验与临床研究。1978年日本报道小系列冷冻治疗肝癌。美国哈佛大学近年开展肝脏冷冻实验,1991年报道冷冻治疗22例肝痛。迄今,冷冻外科作为一门具有许多独特性能的外科局部治疗新技术,在肝癌治疗中日益受到重视。     

超声引导经皮冷冻治疗原发性肝癌

目的 探讨经皮穿刺深度冷冻治疗原发性肝癌的方法,安全性及临床应用的初步经验。方法 11例原发性肝癌患者,超声引导下穿刺至肝内肿瘤表面,LCS—2000冷冻机5mm冷冻头插至肿瘤中心冷冻。结果 11例病人冷冻治疗后恢复均顺利,无手术死亡及肝破裂、出血、胆瘘、穿刺窦道种植转移等并发症,穿刺部位愈合良好,5例肿瘤缩小≥50％,1例肿瘤完全消 失。结论 超声引导下经皮冷冻治疗肝癌是一种安全、有效、微创的治疗新方法。     

冷冻外科治疗肝癌

冷冻治疗肝癌113例,其中原发性肝癌(PLC)107例、转移性肝癌(SLC)6例。用盘形冷冻头治疗位于肝浅表肿瘤,单针或多针冷冻头插入瘤体内治疗位于肝深部肿瘤术中B超监测冷冻范围。全组无手术死亡。107例PLC患者冷冻后5年和10年生存率分别为22.0％、8.2％,其中32例PLC≤5cm患者则分别为48.8％、17.1％。6例SLC患者冷冻后平均生存25.2个月(2～90个月)。本文提示:冷冻对手术不能切除肝癌是一种安全、有一定疗效的局部治疗方法。     

液氮局部冷冻治疗肝癌

液氮局部冷冻治疗肝癌１５２例，其中原发性肝癌（ＰＬＣ）１４５例，转移性肝癌（ＳＬＣ）．例，１４５例ＰＬＣ中，Ⅰ期４６例（３１．７％），Ⅱ期９１例（６２．８％），Ⅲ期８例（５．５％）。全组无手术死亡。１４５例ＰＬＣ患者冷冻后１、３、５年生存率分别为６９．２％、４９．２％、３４．８％；其中ＰＬＣ≤５ｃｍ４１例患者则分别为９１．０％、７６．５％、６４．２％。７例ＳＬＣ患者冷冻后平均生存２２．３个月（４～１１２个月）．文中提示，冷冻治疗肝癌是一种安全可行的局部治疗方法。冷冻治疗小肝癌，可达根治目的；对较大肝癌，冷冻可作为综合治疗的一个手段。     

冷冻外科在肝癌治疗中的应用

利用液态氮作为冷冻剂的冷冻治疗可以应用于各期肝癌的治疗,其作用机理包括低温直接引起组织破坏及提高机体免疫功能,目前,由于多种探头机器的应用,使得治疗方式也多种多样,如在开腹直视下进行,也可经皮穿刺在超声引导下进行。冷冻治疗具有使用方便,并发症少,疗效确切等优点。随着新的探头和冷冻的开发,冷冻外科在肝癌的治疗中将具有广阔的前景。     

冷冻治疗320例肝癌的并发症分析及处理

目的探讨冷冻治疗作为不可切除的中晚期肝肿瘤局部消融疗法的安全性。方法 320例不能手术切除的肝癌患者在CT、B超下行氩氦刀经皮冷冻治疗,观察其并发症的发生,并采取相应的处理措施。结果肝癌冷冻治疗出现一般并发症程度较轻,对症处理即可恢复。严重并发症包括肝衰竭、肝破裂等,重在预防。结论氩氦刀冷冻治疗不可切除的实质性肝癌是一种简单、有效且相对安全的方法,但要注意预防并发症的发生。     

冷冻治疗肝癌的临床观察

目的：为冷冻为主综合治疗肝癌的疗效。方法：应用ＬＳＣ－２０００型冷冻机对５３例肝癌分别采取冷冻加手术切除；冷冻加肝动脉、门静脉置管化疗；冷冻加手术切除和肝动脉、门静脉管化疗。结果：全组无手术死亡及严重并发症；冷冻后１、２年和３年生存率分别为７３．６％、６２．５％和５２．８％。其中１２例≤５ｍｍ的小肝癌分别９１．７％、８３．３％和７５％。结论：冷冻综合治疗为中、晚期肝癌提供了一个有效的治疗途径；冷冻     

Percutaneous cryosurgery for liver tumors]

A new cryoprobe developed in our department makes it possible to perform percutaneous cryoablation for small liver tumors. This cryoprobe is placed into each lesion using an ultrasonic guidance technique. In this study there were 10 patients with hepatocellular carcinoma and 5 patients with liver metastases from colorectal carcinoma. In 6 cases the tumor size was below 2 cm, in 6 cases between 2 and 3 cm, and in 3 cases over 3 cm. Using a cryoprobe of 3 mm in diameter, each lesion was frozen using liquid nitrogen for 15 or 20 minutes then thawed for 10 minutes, and repeated. The ice ball was found to enlarge to 3 cm in 20 minutes and 5 cm in 60 minutes experimentally. Six cases were CR, 5 PR, 2 NC and 2 PD. After cryoablation, liver function did not change and there were no complications. However, as the size of the ice ball was small (about 3 cm), this method was insufficiently effective in some cases. Percutaneous cryoablation using this probe should be performed for tumors smaller than 3 cm.     

The results of liver cryosurgery for synchronized liver metastasis from colorectal cancer

We examined our results of liver cryosurgery for synchronized liver metastasis from colorectal cancer. Twelve patients whose prognosis after the cryosurgery was clear were eligible. All of the patients received not only a resection of the colorectal primary lesion, but they also received a cryosurgery for liver metastases under the same laparotomy. These patients had been treated in this manner from 1981 to 1987. Ten of the 12 patients died from recurrent cancer. The range in survival time of 12 cases was from 6 months to 117 months, and the average survival length was 25.4 months. The examination of the results suggested that there were no cryosurgery induced anti-immunological response observed among the patients. The survival lengths of the patients with untreated cancer were good.     

Clinical evaluation of cryosurgery in the treatment of primary liver cancer. Report of 60 cases

Cryosurgery with liquid nitrogen was employed for the treatment of 60 patients with primary liver cancer (PLC) at the Liver Cancer Research Unit, Zhong Shan Hospital, Shanghai Medical University, the People's Republic of China, from November 1973 to August 1987. Of 60 patients, subclinical stage amounted to 35% (21/60), moderate stage 55% (33/60) and late stage 10% (6/60). There were 21 cases with small PLC (less than or equal to 5 cm). The postoperative course was uneventful in all of the 60 patients. These was no operative mortality, and there was no complications such as rupture of tumor, secondary bleeding, bile leakage, or abdominal infection. The 1-year, 2-year, 3-year, 4-year, and 5-year survival rates were 51.7% (30/58), 33.9% (19/56), 20.8% (11/53), 15.6% (7/45), and 11.4% (5/44), respectively, for the whole series. Among the 21 patients with tumor nodules less than or equal to 5 cm in diameter, the 1-year, 2-year, 3-year, 4-year, and 5-year survival rates were 76.2% (16/21), 61.9% (13/21), 50.0% (9/18), 41.2% (7/17), and 37.5% (6/16), respectively. These results indicate that hepatic cryosurgery is a promising, safe, and simple treatment for neoplastic disease of liver. Cryosurgery with liquid nitrogen can be considered the surgery of choice for nonresectable PLC in patients without jaundice, ascites, and noncompensated liver function, and the whole tumor mass can be involved in the frozen area.     

Chemoembolization for primary liver cancer.

AIMS: For most patients with primary liver cancer surgical treatment is not feasible and prognosis without treatment is poor. We aimed to assess the morbidity and efficacy of transarterial chemoembolization (TACE) with lipiodol and mitomycin C in these patients in a prospective case-control study. METHODS: From August 1996 to May 2000 22 patients with non-resectable hepatocellular carcinoma were treated with TACE. In case of radiological or tumour-marker response, treatment was repeated after 4--6 weeks, up to seven times per patient. RESULTS: Morbidity was 23% and usually minor, no patient died within 30 days of treatment. A decrease in size of the reference tumour or constant tumour-size in CT-scan were observed in 14 of 20 patients (70%) and of the 19 patients with elevated AFP-serum levels 12 (63%) had an AFP reduction following treatment. The median survival time was 14 months with a 1- and 2-year survival rate of 69% and 29%, respectively. Survival was not different in radiological or AFP responders vs non-responders. CONCLUSION: While TACE with lipiodol and mitomycin C for primary liver cancer is associated with considerable antitumoural efficacy, as demonstrated by tumour marker and radiological response, an effect on patient survival is not evident. New treatment options with an impact on survival are needed for these patients.     

原发性肝癌的系统性化疗

原发性肝癌(primary liver cancer,PLC)是最常见的恶性肿瘤之一,其中90%为肝细胞性肝癌(hepatocellular carcinoma,HCC).当前PLc的治疗有两项基木原则已被公认,一是根治性切除仍是提高长期生存率的最有效手段:二是甲一的方法难以达到最好的效果,需进行综合治疗.     

甲胎蛋白阴性肝癌早期诊断的探讨

A comparative study on 150 cases of alpha fetoprotein (AFP) nonproducing primary liver cancer (PLC) in subclinical and moderate stages and 133 cases of intrahepatic solid space-occupying lesion (SOL) other than PLC was undertaken. All were operated and proven by pathology. The results indicated that in the intrahepatic SOL patients with negative serum AFP the diagnosis of PLC could be established if any one of the following items was confirmed: (1) Definite evidence of liver cirrhosis; (2) Hypoecho or inhomogeneous echo sonodensity on ultrasonography plus positive serum HBsAg; (3) Positive 99mTc-PMT liver scan (4) No overfilling of SOL on blood pool scintiscan plus positive HBsAg; (5) No enhancement after injection of contrast medium on computed tomography plus positive HBsAg. The positive rates of the above items in PLC and non-PLC groups were: (1) 73.2% vs. 0.9%, (2) 48.1% vs. 9.6%, (3) 64.3% vs. 14.3%, (4) 27.3% vs. 3.9% and (5) 34.6% vs. 0%, respectively. Statistically, these differences were significant. In conclusion, according to the above mentioned criteria, detection rate of over 90% with over 85% specificity can be obtained for AFP negative PLC.     

原发性肝癌的外科治疗

目的 探讨原发性肝癌外科治疗的疗效。方法对1994～2003年185例原发性肝癌患者的临床资料、治疗手段及随访资料进行回顾性分析。结果1、3、5年生存率分别为82．32％、45．87％、18．43％。结论术中B超检查对小肝癌定位，大肝癌卫星灶的显示、门脉内癌栓的显示有利于术式选择。术后的综合治疗可延迟复发，延长生存期。