超声引导微波消融治疗老年晚期肾癌的临床疗效

目的探讨超声引导微波消融治疗老年晚期肾癌的临床疗效。方法选择老年晚期肾癌患者9例9个病灶,年龄72~84〔平均(79.67±4.03)〕岁,肿块最大径6.7~11.0 cm,平均(8.50±1.53)cm,所有患者术前均行肿块穿刺活检,病理结果均为肾透明细胞癌。对9例晚期肾癌患者在超声引导下行经皮穿刺微波消融术,术中术后超声造影评估肿瘤消融区范围,并对比术前与术后6个月患者KPS评分、VAS评分、体重等指标。结果与术前比较,消融术后6个月9个病灶肿瘤体积显著缩小,KPS评分显著升高,VAS评分显著降低,体重增加(P<0.05)。结论超声引导下微波消融治疗老年晚期肾癌的短期疗效显著,对提高患者生活质量有帮助,具有一定的临床价值。     

超声引导经皮消融治疗肝细胞癌的临床运用

超声引导经皮消融治疗肿瘤的临床应用日益广泛,它在肝细胞癌(HCC)的治疗中最为成熟和作用最为显著有其内在原因.首先,肝脏及其局部病变在超声下显像良好,人路容易,疗效确实;其次,HCC的治疗难点一是患者多有肝功能损害,难以耐受侵袭度大的治疗方式,二是肿瘤有高度的复发倾向,需要反复多次治疗.经皮消融治疗的微创性、简便性恰好能对应这些难点.     

超声引导下经皮微波消融治疗近胃肠道肝细胞癌的疗效评价

目的 评价经皮微波消融结合温度监测及无水乙醇注射治疗近胃肠道肝细胞癌的安全性及临床疗效.方法 对263例患者共计319个肿瘤进行经皮微波消融治疗,其中101个距胃肠道≤5 mm的肿瘤为近胃肠道组,218个距肝表面、胃肠道和肝内一、二级分支管道＞5 mm肿瘤为对照组.近胃肠道组对无手术切除史患者肿瘤边缘温度控制在最高54～60℃,对有手术切除史患者边缘温度控制在最高50℃,对该组62个病灶近胃肠道边缘肿瘤组织内注射无水乙醇治疗.用独立样本t检验进行两组间均值比较,用秩和检验进行非参数分析,用卡方检验进行率的比较,用KaplanMeier法绘制局部肿瘤进展曲线,用Log-Rank检验分析两组不同随访时间局部肿瘤进展率之间的差异.结果 近胃肠道组96个肿瘤(95.0%)及对照组208个肿瘤(95.4%)获得完全消融.所有肿瘤局部进展均发生在术后12个月内,近胃肠道组与对照组第6个月局部肿瘤进展率分别为6.9%、7.3%,第12个月分别为11.9%、8.3%.两组均无并发症发生,无胃肠道及胆道损伤发生.结论 在严格温度监测下,微波消融联合无水乙醇注射可以安全治疗邻近胃肠道肝细胞癌并取得较好的完全消融效果.

Abstract：

Objective The purpose of the study was to prospectively evaluate safety and assisted with ethanol injection for hepatocellular carcinoma abutting gastrointestinal tract.Methods 263 patients with 319 hepatic tumors that underwent percutaneous microwave ablation with curative intention were included.101 lesions located less than 5 mm from gastrointestinal tract were in gastrointestinal group.218 lesions located more than 5 mm from hepatic surface,gastrointestinal tract and first or second branch of hepatic vessels were in control group.The temperature of marginal ablation tissue proximal to gastrointestinal tract was monitored and controlled to fluctuating between 45℃ and 59C for more than 10 min for tumors in the gastrointestinal group.Ethanol (1-21 ml) was injected into marginal tissue in 62 of 101 lesions of the G1 group.Results 96 of 101 tumors (95.0%) in the gastrointestinal group and 208 of 218 tumors (95.4%) in the control group achieved complete ablation (P = 0.89).Local tumor progression for all the tumors were in the first year and the 6-,12- month local tumor progression rate in the gastrointestinal group and the control group were 6.9%,11.9% and 7.3%,8.3%,respectively (P=0.21).There were neither immediate nor periprocedural complications in both groups.There was no delayed complication of gastrointestinal and bile ducts injury.Tumor seeding happened in one (1.1%) of the gastrointestinal group and three (1.8%) of the control group (P=0.92).Conclusion Under strict temperature monitoring,microwave ablation assisted with ethanol injection is safe and achieves a high complete ablation rate for hepatocellular carcinoma adjacent to gastrointestinal tract.     

超声引导下微波消融治疗早期泡型肝包虫病患者疗效初步研究*

目的 探讨采用超声引导下微波消融治疗早期泡型肝包虫病患者的疗效。方法 2018年6月～2019年10月我院诊治的早期泡型肝包虫病患者50例,采用随机数字表法将患者分为对照组(n=25例)和观察组(n=25例)。在对照组,采用常规开腹手术,在观察组,采用超声引导下微波消融治疗,术后随访1年。结果 观察组治疗总有效率为92.0%,显著高于对照组的80.0%(P<0.05);术后1 w,观察组血清总胆红素水平为(16.7±1.6)μmol/L,与对照组【(14.2±1.4)μmol/L,P>0.05】比,差异无统计学意义,血清丙氨酸氨基转移酶水平为(140.8±52.4)U/L,显著低于对照组【(194.7±63.2)U/L,P<0.05】,血清GGT水平为(95.1±10.2)U/L,显著低于对照组【(102.4±11.3)U/L,P<0.05】,而血清ALB水平为(35.7±3.4)g/L,显著高于对照组【(32.9±3.5)g/L,P<0.05】;在随访期间,观察组并发症发生率为4.0%,显著低于对照组的36.0%(P＜0.05)。结论 采用超声引导下微波消融治疗早期泡型肝包虫病患者可获得很好的临床疗效,可显著降低并发症发生率,值得临床进一步研究。     

超声引导微波消融治疗老年肝癌及并发症防范

目的总结超声引导经皮微波消融(PMWA)治疗老年肝癌的效果及并发症的防范措施。方法对207例65岁老年肝癌患者374个病灶按肿瘤大小和数量分为两组,肿瘤直径4 cm且少于3个病灶称为A组;肿瘤直径4 cm多于3个病灶或者单个病灶6 cm称为B组,两组均进行超声引导PMWA治疗,术后观察疗效和并发症,以超声造影或增强核磁检查病灶无强化为完全消融,治疗后定期随访6~60个月,对有肿瘤进展或复发者行再次消融治疗。结果全组病例经皮微波消融术后1个月增强检查显示完全消融326个病灶,占87.2%(326/374),A、B两组的1、2、3、4、5年存活率为分别为:A组95.3%、84.6%、82.5%、79.2%、68.8%;B组62.5%、55.6%、31.2%、27.3%、0.0%,两组差异有统计学意义(P=0.021)。B组术后出现严重并发症4例,占1.07%(4/374),包括2例腹腔出血,2例肝脓肿。无胃肠及胆管损伤、胆瘘、针道种植。结论 PMWA是治疗老年肝癌的有效方法,肿瘤大小和个数、肝功能基础是影响术后生存期的重要因素,消融针型和功率及时间组合是防止胃肠、胆道、膈肌损伤的有效措施,术后全身支持、抗腹腔感染等综合治疗可减少致命并发症。     

老年肾细胞癌患者的CT诊断研究

目的 探讨老年肾细胞癌的CT影像特点及其病理分期与CT表现的相关性。方法 选择30例术前行CT检查并经手术病理证实为肾细胞癌患者,比较其病理分期与CT影像的关系。结果 （1）老年肾细胞癌CT表现为肿块突出肾轮廓,边缘模糊,形状不规则,肿块内密度不均匀,不完整包膜。部分肿块有液化、坏死。（2）肿瘤大小与病理分期之间无显著性差异（P＞0．05）。（3）密度均匀与不均匀,有液化、坏死与无液化、坏死这间其病理分期无显著性差异（P＞0．05）。（4）CT表现为边缘模糊,无包膜者有着较高这病理分期（P＜0．05）。结论 老年肾细胞癌患者的CT表面与病理分期密切相关,病理分期增高,CT表面为边界不清和无包膜肿物。     

腹腔镜联合超声引导微波消融治疗肝脏恶性肿瘤的体会

目的探讨腹腔镜技术联合超声引导在微波消融肝脏恶性肿瘤治疗中的应用价值。方法回顾性分析我院2008年2月至2015年3月行腹腔镜联合超声引导微波消融的48例肝脏恶性肿瘤患者的临床资料。结果所有患者均成功接受腹腔镜联合超声引导微波消融治疗,手术过程顺利,手术时间30~160 min,平均(84.8±38.4)min;术中失血量10~100 mL,平均(48.0±28.9)mL;术后住院5~10 d,平均(7.4±1.7)d;术后无出血、胆汁瘘、消化道穿孔及膈肌损伤等严重并发症发生;术后发热18例,予以退热治疗后好转;出现血红蛋白尿5例、发生肺内感染2例,均经保守治疗后好转,术后恢复良好,围手术期无死亡病例。随访4~48个月,平均(24.3±14.3)个月,术后1个月经复查41例患者达到完全消融,完全消融率为85.4%(41/48),7例不完全消融的患者经第2次微波消融后达到完全消融。结论腹腔镜联合超声引导微波消融治疗肝脏恶性肿瘤安全、有效,具有可行性。     

腹腔镜超声与经皮超声引导微波消融治疗复发性肝癌的临床效果比较

目的 比较腹腔镜超声与经皮超声引导微波消融治疗复发性肝癌的临床效果.方法 回顾性分析2015-06～2018-02四川省医学科学院·四川省人民医院东院收治的90例复发性肝癌的临床资料,将腹腔镜超声引导微波消融的患者作为观察组,经皮超声引导微波消融的患者作为对照组,每组45例,比较两组术中出血量、手术时间、术后住院时间、...     

超声引导下微波消融对甲状腺良性结节的治疗作用分析

目的 观察并探讨超声引导下微波消融治疗甲状腺良性结节的临床效果与作用.方法 选取我院接诊的82例甲状腺良性结节患者,随机分为实验组与对照组,分别实施超声引导下微波消融术治疗与传统手术治疗,对两组患者的生活质量评分、肿瘤坏死因子α、超敏C反应蛋白、白介素-6、白细胞计数进行观察与对比.结果 实验组患者术后的生活质量评分显著高于对照组,且TNF-α、hs-CRP、IL-6、WBC指标均显著优于对照组,组间差异具有统计学意义(P<0.05).结论 在甲状腺良性结节患者临床治疗中应用超声引导下微波消融术具有显著临床效果,值得推广.     

微波消融对老年原发性肝癌患者肝功能的影响

目的比较老年组与中青年组原发性肝癌(HCC)患者微波消融治疗后肝功能、胆碱酯酶、白蛋白等实验室检测指标的变化。方法回顾性地研究2013年1月1日至2013年12月31日于解放军总医院介入超声科行超声引导下微波消融治疗的单发HCC患者343例,其中老年组(年龄60岁)131例,中青年组(年龄≤60岁)212例。结果老年组患者微波消融治疗后白细胞(WBC)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TB)均较治疗前明显升高,血清白蛋白(A1b)及胆碱酯酶(ChE)较治疗前明显下降(P0.01),中青年组HCC患者微波消融治疗后WBC、ALT、AST、TB显著升高(P0.01),而消融治疗后ChE轻度升高及Alb轻度下降,但与治疗前相比差异无统计学意义(P0.05)。将两组患者消融治疗前后WBC、ChE、ALT、AST、A1b、TB的差值进行组间比较,发现中青年组患者ALT升高较老年组患者明显(P=0.048),余指标消融治疗前后改变两组之间差异均无统计学意义(P0.05)。结论微波消融治疗后两组患者均出现反映肝功能的指标明显升高,反映肝脏储备功能的ChE和Alb在老年患者较中青年患者下降更加明显,说明老年患者肝脏储备功能更差。     

老年人甲状腺良性结节微波消融可行性及围手术期安全性的临床分析

目的探讨超声引导下老年人甲状腺良性结节微波消融治疗的可行性及围手术期的安全性。方法回顾分析2009年7月至2015年10月期间滨州医学院烟台附属医院超声医学科收治的接受微波消融治疗的老年甲状腺良性结节患者471例(共1000枚结节)的临床资料。记录术中及术后所发生的不良反应及相应的治疗措施,术后通过超声造影判断消融范围。结果所有患者均在局麻下顺利完成消融治疗,其中完全消融者453例(共979枚结节),18例(21枚结节)因达胸骨后而进行了大部分消融。单结节消融时间为(150±103)s。结节无微循环灌注区范围与术前结节体积大小基本一致[(8.45±16.26)vs(8.66±15.61)cm~3,P0.05],表明肿瘤组织灭活完全、无明显残留,结节达到完全消融。所有患者耐受性良好,无因术中不良反应及疼痛而终止手术者,疼痛分级0~5分者432例,术后发生急性左心衰1例、支气管痉挛1例。结论超声引导下经皮微波消融治疗老年甲状腺良性结节安全可行,值得临床推广。     

Efficacy and safety of microwave ablation and radiofrequency ablation in the treatment of hepatocellular carcinoma: A systematic review and meta-analysis

Background:Hepatocellular carcinoma (HCC) is one of the most common malignant tumors. Surgical resection is often only possible in the early stages of HCC and among those with limited cirrhosis. Radiofrequency ablation and Microwave ablation are 2 main types of percutaneous thermal ablation for the treatment of HCC. The efficacy and safety between these 2 therapy methods are still under a debate.Objective:To compare the efficacy and safety of Radiofrequency ablation and Microwave ablation in treating HCC.Methods:PubMed, EMBASE, the Cochrane databases and Web of Science were systematically searched. We included randomized controlled trials and cohort studies comparing the efficacy and safety of Radiofrequency ablation and Microwave ablation in HCC patients. Outcome measures on local tumor progression, complete ablation, disease-free survival, overall survival, or major complications were compared between the 2 groups. The random effect model was used when there was significant heterogeneity between studies, otherwise the fixed effect model was used.Results:A total of 33 studies, involving a total of 4589 patients were identified, which included studies comprised 7 RCTs, 24 retrospective observational trials, and 2 prospective observational trial. Microwave ablation had a lower local tumor progression than Radiofrequency ablation in cohort studies (OR = 0.78, 95% CI 0.64–0.96, P = .02). Complete ablation rate of Microwave ablation was higher than that of Radiofrequency ablation in cohort studies (OR = 1.54, 95% CI 1.05–2.25, P = .03). There was no significant difference in overall survival and disease-free survival between the 2 groups. Meta-analysis showed that there was no significant difference in the main complications between Microwave ablation and Radiofrequency ablation.Conclusions:Microwave ablation has higher complete ablation and lower local tumor progression than Radiofrequency ablation in the ablation treatment of HCC nodules. There was no significant difference in overall survival between the 2 therapy methods.     

Percutaneous microwave and radiofrequency ablation for hepatocellular carcinoma: a retrospective comparative study

Background Percutaneous microwave ablation and radiofrequency ablation are two commonly used modalities for the treatment of hepatocellular carcinoma; however, comparisons of them have not been documented adequately. Methods Of 102 patients with biopsy-proved hepatocellular carcinoma, 49 (98 nodules) were treated percutaneously with microwave ablation and 53 (72 nodules) with radiofrequency ablation. The local tumor control, complications related to treatment, and long-term results of the two modalities were compared retrospectively. Results The complete ablation rates were 94.9% (93/98) using microwave ablation vs 93.1% (67/72) using radiofrequency ablation (P = 0.75), and no significant differences were found either in the ablation of tumors of 3.0 cm or less (P = 1.00) or in those of more than 3.0 cm (P = 1.00) between the two modalities. The local recurrence rates were 11.8% (11/93) using microwave ablation vs 20.9% (14/67) using radiofrequency ablation (P = 0.12), and there were no significant differences between the two modalities either in tumors of 3.0 cm or less (P = 0.36) or in those of more than 3.0 cm (P = 0.82). The rates of major complications associated with microwave ablation and radiofrequency ablation were 8.2% (4/49) vs 5.7% (3/53; P = 0.71). The disease-free survival rates in the microwave ablation group were 45.9%, 26.9%, 26.9%, and 13.4% at 1, 2, 3, and 4 years, respectively, and those in the radiofrequency ablation group were 37.2%, 20.7%, and 15.5% at 1, 2 and 3 years, respectively (P = 0.53). The 1-, 2-, 3-, and 4-year cumulative survival rates for patients who underwent microwave ablation were 81.6%, 61.2%, 50.5%, and 36.8%, respectively, and for patients who underwent radiofrequency ablation the rates were 71.7%, 47.2%, 37.6%, and 24.2%, respectively (P = 0.12). Conclusions Percutaneous microwave ablation and radiofrequency ablation are both effective methods in treating hepatocellular carcinomas. The local tumor control, complications related to treatment, and long-term survivals were equivalent for the two modalities.     

经皮微波消融术治疗合并肝硬化的原发性小肝癌患者生存分析*

目的 探讨经皮微波消融术（PMCT）治疗合并肝硬化的原发性小肝癌患者的疗效。 方法 2005年1月~2014年7月我院收治的108例合并肝硬化的原发性小肝癌患者,采用PMCT治疗40例,采用开腹肿瘤切除治疗68例。采用Cox回归分析影响患者术后生存的相关因素。 结果 治疗后3年,PMCT治疗患者总生存和无复发生存率分别为60.0%和40.0%,与手术切除治疗组的58.8%和38.2%比,无显著性差异（P>0.05）;单因素分析结果显示死亡患者肝功能分级为B级、血清甲胎蛋白水平高和白蛋白水平低者与生存患者存在显著性差异（P<0.05）;多因素Cox回归模型分析显示肝功能分级（HR=1.81,95%CI:0.97~3.38）、血清AFP（HR=1.83,95%CI:0.99~3.37）和白蛋白水平（HR=1.81,95%CI:0.98~3.36）为影响合并肝硬化的原发性小肝癌患者预后的独立危险因素（P<0.05）。 结论 采用PMCT治疗合并肝硬化的原发性小肝癌患者生存率与手术切除治疗者结果相似,患者预后与肝功能、血清AFP水平和白蛋白水平相关。