多针双电极射频适形消融治疗肝癌16例报告

目的 探讨多针双电极射频适形消融治疗肝癌的原理和近期疗效。方法 采用多针双电极射频消融肝肿瘤16例,全部采用超声引导下经皮穿剌,单纯射频消融治疗15例,射频消融联合瘤内无水酒精注射术治疗1例。结果 全组有12例患者治疗1次后影像学检查见肿瘤完全消融,4例首次射频治疗后1个月影像学检查见肿瘤消融不完全,2例再次行射频消融后肿瘤完全消融。甲胎蛋白阳性者6例治疗后全部转为阴性。结论 多针双电极射频不仅能增大消融范围,而且可以根据肿瘤形态适形消融肿瘤,是1种新的有效射频消融技术。     

单纯肺转移性肝癌病灶的治疗

目的　分析比较三维适形放疗和放射介入栓塞治疗 4 2例原发性肝癌切除术后单纯肺转移性肝癌病灶的临床疗效。方法　对近 5年 2 6例采用三维适形放疗技术治疗原发性肝癌切除术后单纯肺转移肝癌病人的临床表现及近期疗效进行归纳总结 ,并与同期 16例采用放射介入治疗病人进行比较分析。结果　随访 18个月 ,三维适形放疗组肺转移肝癌病灶有效控制率、缩小率、消失率分别是 10 0 %、5 7.6 9%和 38.4 6 %。同期介入治疗组肺转移性肝癌有效控制率、缩小率、消失率分别是 6 2 .5 0 %、5 0 .0 0 %和 18.75 % ,P <0 .0 1。结论　三维适形放疗能够有效地控制和杀灭原发性肝癌切除术后出现的肺转移性肝癌病灶 ,延长病人的存活时间 ,且副作用小 ,耐受性好 ,疗效明显优于放射介入栓塞治疗。     

经皮消融配合三维适形放疗治疗原发性肝癌的疗效分析

目的：观察经皮消融配合三维适形放疗治疗原发性肝癌的疗效.方法：45例原发性肝癌随机分成综合组和对照组.综合组21例,采用经皮消融三维适形放疗,对照组单用经皮消融.结果：综合组的局控率为85.7%,而对照组为58.3%,两者有显著性差异.1,2,3年的生存率综合组和对照组分别是81%,62.5%,25%;71.8%,33%,8%.两者差异有统计学意义.结论：原发性肝癌三维适形放疗结合经皮消融疗效较好.     

经皮消融配合三维适形放疗治疗原发性肝癌的疗效分析

目的:观察经皮消融配合三维适形放疗治疗原发性肝癌的疗效.方法:45例原发性肝癌随机分成综合组和对照组.综合组21例,采用经皮消融三维适形放疗,对照组单用经皮消融.结果:综合组的局控率为85.7%,而对照组为58.3%,两者有显著性差异.1,2,3年的生存率综合组和对照组分别是81%,62.5%,25%;71.8%,33%,8%.两者差异有统计学意义.结论:原发性肝癌三维适形放疗结合经皮消融疗效较好.     

射频凝固电极在肝癌切除或消融治疗中的应用

目的评价射频凝固电极消融技术在肝切除术中应用的可行性、安全性及疗效。方法采用射频凝固电极射频消融技术进行肝癌切除手术共16例,其中腹腔镜下射频消融后肝切除术9例,腔镜下射频消融6例（共13个瘤体,平均最大肿瘤直径3．0-4-1．0em）,小切口腹腔镜辅助右肝V、Ⅷ段肝癌切除1例。观察术后并发症情况,肿瘤复发情况。结果16例均顺利完成肝癌切除或消融治疗。未出现严重并发症。肝癌消融灶完全坏死率为92．3％。随访8～20个月（平均14个月）,于术后3、6个月各发现1例肝脏出现新病灶,1例消融部位肿瘤残留。肝癌切除患者未出现新病灶。死亡1例。结论腹腔镜下手术或开腹术中射频凝固电极消融技术在肝癌切除或消融治疗中应用安全可行,效果好。选择远离肝门区肿瘤进行治疗时效果更佳。     

肝癌射频消融个体化治疗进展

射频消融治疗已成为肝癌最常用的非手术治疗方法,其创伤小、见效快,可以重复治疗,在临床有很好的应用前景,但射频消融术后较高的复发率仍是临床关注的焦点。肝癌射频消融治疗要进行充分的术前评估,通过三维适形、数字建模及多种疗法的联合应用,制定个体化的治疗方案及策略,从而有效降低复发,提高疗效。     

无水酒精注射联合射频消融治疗射频消融困难部位的肝癌

目的：探讨无水酒精注射联合射频消融治疗射频消融困难部位肝癌的疗效。方法：回顾性分析靠近结肠、胆囊、大中血管、膈肌等存在射频困难区肝癌患者31例,在采用射频治疗后残余病灶行无水酒精补充治疗,评价病灶坏死率及术后并发症。结果：31例患者的47个病灶当中共有33个病灶位于射频困难部位,肿瘤完全坏死率为72.7%（24/33）。无腹腔内出血,胆囊穿孔,结肠穿孔等严重并发症出现。结论：射频困难部位的肝癌病灶采用射频补充无水酒精注射治疗效果良好,未见严重的射频或酒精注射相关并发症发生,可在肝癌的综合治疗中推广应用。     

无水酒精注射联合射频消融治疗射频消融困难部位的肝癌

目的:探讨无水酒精注射联合射频消融治疗射频消融困难部位肝癌的疗效.方法:回顾性分析靠近结肠、胆囊、大中血管、膈肌等存在射频困难区肝癌患者31例,在采用射频治疗后残余病灶行无水酒精补充治疗,评价病灶坏死率及术后并发症.结果:31例患者的47个病灶当中共有33个病灶位于射频困难部位,肿瘤完全坏死率为72.7%(24/33).无腹腔内出血,胆囊穿孔,结肠穿孔等严重并发症出现.结论:射频困难部位的肝癌病灶采用射频补充无水酒精注射治疗效果良好,未见严重的射频或酒精注射相关并发症发生,可在肝癌的综合治疗中推广应用.     

用三维适形放疗治疗肝癌切除术后肺转移病灶的指征和疗效

目的　归纳总结采用三维适形放疗治疗原发性肝癌切除术后单纯肺转移病灶的指征和疗效。方法　回顾性分析近 3年 2 1例采用三维适形放疗技术治疗原发性肝癌切除术后单纯肺转移病灶的适应证、方法及疗效 ,并与同期1 2例采用放射介入治疗病人进行比较分析。结果　本组病例中采用三维适形放疗 2 1例 ,随访 1 8个月 ,肺转移癌有效控制率、缩小率、消失率分别是 1 0 0 %、62 .0 %和 38.1 %。血清甲胎蛋白经历了术后的正常 -升高 -降低 -再升高 -再正常的过程。而同期介入治疗组 1 2例 ,随访 1 8个月 ,肺转移癌有效控制率、缩小率、消失率分别是 58.3 %、41 .7%和 1 6 .7% ,P <0 .0 1。结论　三维适形放疗能够明显地控制和杀灭原发性肝癌切除术后出现的肺转移病灶 ,延长病人的存活时间 ,其疗效优于介入治疗组。仅存在肺部转移病灶而无肝内复发和转移 ,是采用三维适形放疗的指征     

希罗达联合三维适形放疗在肝癌中的应用

 原发性肝癌是我国常见的恶性肿瘤之一，首选的治疗手段是手术切除病灶，但大多数患者就诊时已经属于中晚期，丧失手术切除机会。非手术治疗当中，三维适形放疗已广泛应用于治疗中晚期肝癌。肝癌单纯适形放疗疗效较差，我院从2003年1月~2005年6月始用希罗达联合适形放疗治疗35例原发性肝癌患者，现将治疗疗效报告如下：     

Percutaneous Radiofrequency Ablation Guided by Contrastenhanced Ultrasound in Treatment of Metastatic Hepatocellular Carcinoma after Liver Transplantation

This study evaluated the advantages and applications of contrast-enhanced ultrasound (CEUS)-supportedpercutaneous radiofrequency ablation (RFA) in the treatment of metastatic hepatocellular carcinoma after livertransplantation, based on clinical details. CEUS-supported percutaneous RFA was adopted to treat 12 patientswith hepatic metastatic carcinomas after liver transplantation. The diameters of the metastatic carcinomas variedfrom 1 cm to 5 cm, and the foci were discovered after 3 months to 12 months. Each focus was diagnosed andlocalised by CEUS for RFA once or twice. Curative effects were evaluated by CEUS or contrast-enhanced CTafter the treatment. The re-examination results at 2 weeks post-treatment showed that the foci of 11 patients wereablated completely, whereas one patient with the largest focus required retreatment by RFA because of a partialresidue. No local recurrence was found one month later in the re-examination. CEUS-supported percutaneousRFA in the treatment of hepatic metastatic carcinoma after liver transplantation has the advantages of accuratelocalisation, good efficacy, easy operation, and minimal invasion without any complications. Therefore, it canbe recommended as the preferred therapy for hepatic metastatic carcinoma after liver transplantation.     

肝动脉化疗栓塞术联合射频消融术治疗小肝癌的研究进展

原发性肝癌是世界性常见的恶性肿瘤之一,肝癌的早发现早治疗已成为临床研究的重点。射频消融术(RFA)在国内外已成为公认的对小肝癌治疗有效的一种手段,尤其对于直径小于3cm的小肝癌患者,治愈率已经达到甚至超过外科切除治疗。在治疗直径大于3cm的小肝癌患者,单一的RFA治疗复发率相对较高。肝动脉化疗栓塞(TACE)对小肝癌的治疗效果早已获得承认,但也存在一定的缺点。TACE术后改变了原有的动脉供血系统,侧支循环容易建立,病灶坏死率较低,复发率较高,多次TACE治疗会加重肝功能的损害。TACE与RAF联合能在小肝癌患者治疗中取长补短,提高治疗的安全性、有效性,以及对患者的远期疗效。本文主要对肝动脉化疗栓塞术联合射频消融术治疗小肝癌的现状及其进展做一综述。     

Risk factors for distant recurrence of hepatocellular carcinoma in the liver after complete coagulation by microwave or radiofrequency ablation

BACKGROUND: In patients with hepatocellular carcinoma (HCC), recurrences in the distant liver often are observed after curative treatment. Microwave coagulation therapy (MCT) and radiofrequency ablation (RFA) have been developed as less invasive alternatives than surgical resection for small HCCs. In the current study, risk factors for distant recurrence of HCC were analyzed in patients in whom complete coagulation was achieved. METHODS: Ninety-two patients with HCCs < 3 cm in greatest dimension were treated by MCT or RFA percutaneously or laparoscopically. Eighty-four patients in whom complete coagulation was achieved without recurrence in the same subsegment as the primary nodule were included in this study. Distant recurrences were observed in 22 patients. Fifteen possible risk factors for a distant recurrence were analyzed. RESULTS: When comparing the patients with a recurrence of HCC nodules in the remnant liver to those without recurrence, the authors observed a statistically significant difference only in serum alpha-fetoprotein. The distant recurrence-free survival was analyzed by the Kaplan-Meier method. A statistically significant difference was observed in hepatitis C virus (HCV) infection as an etiopathic agent of underlying liver diseases (P < 0.005) and in the number of the primary HCC nodules (P < 0.05, log-rank test). A multivariate stepwise Cox hazard model revealed that HCV infection and the number of primary HCC nodules were statistically independent risk factors. CONCLUSIONS: Patients who had more than two HCC nodules accompanied by HCV infection had a high incidence of recurrence of HCC in the remnant liver, even when coagulation by microwave or ablation by radiofrequency was complete.     

Radiofrequency thermal ablation of hepatocellular carcinoma liver nodules can activate and enhance tumor-specific T-cell responses

Radiofrequency thermal ablation (RFA) destroys tumoral tissue generating a local necrosis followed by marked inflammatory response with a dense T-cell infiltrate. In this study, we tested whether hepatocellular carcinoma thermal ablation can induce or enhance T-cell responses specific for hepatocellular carcinoma-associated antigens. Peripheral blood mononuclear cells derived from 20 patients with hepatocellular carcinoma were stimulated before and a month after RFA treatment with autologous hepatocellular carcinoma-derived protein lysates obtained before and immediately after RFA treatment. The effect of thermal ablation on memory T-cell responses to recall antigens [tetanus toxoid, protein purified derivative (PPD), Escherichia coli] was also assessed. T-cell reactivity was analyzed in an IFN-gamma enzyme-linked immunospot assay and by intracellular IFN-gamma staining. Treatment was followed by a significant increase of patients responsive either to tumor antigens derived from both the untreated hepatocellular carcinoma tissue (P < 0.05) and the necrotic tumor (P < 0.01) and by a higher frequency of circulating tumor-specific T cells. T-cell responses to recall antigens were also significantly augmented. Phenotypic analysis of circulating T and natural killer cells showed an increased expression of activation and cytotoxic surface markers. However, tumor-specific T-cell responses were not associated with protection from hepatocellular carcinoma relapse. Evidence of tumor immune escape was provided in one patient by the evidence that a new nodule of hepatocellular carcinoma recurrence was not recognized by T cells obtained at the time of RFA. In conclusion, RFA treatment generates the local conditions for activating the tumor-specific T-cell response. Although this effect is not sufficient for controlling hepatocellular carcinoma, it may represent the basis for the development of an adjuvant immunotherapy in patients undergoing RFA for primary and secondary liver tumors.     

Radio-frequency ablation therapy for metastatic liver tumors from colorectal carcinoma

Radio-frequency ablation therapy (RFA) as a treatment for metastatic liver tumors from colorectal carcinoma was examined. METHODS: Ten patients with a total of 30 liver metastases from colorectal carcinoma were treated using a Cool-tip RF system from March 2003 to December 2004. RESULTS: Patients had a mean age of 69.8 years and the mean diameter of the metastatic lesions was 29.5 mm (range, 5-82). Two patients had received RFA therapy 2 times, and another 2 patients had received 3 times. Critical complications were not seen, though 5 therapies were performed using CT-guided trans-pulmonary puncture. The rate of partial recurrence was 23.1% and the average observation period was 14.8 months. The partial recurrence had occurred within the mean period of 6.2 months. Although after multimodal therapy was given, it is suggested that repeated RFA for the liver metastasis would improve survival rates. CONCLUSION: RFA is a safe and effective treatment for metastatic liver tumors from colorectal carcinoma as multimodal therapy.     

Radiofrequency ablation in patients with primary breast carcinoma: a pilot study in 26 patients

BACKGROUND: The authors performed a pilot trial of ultrasound-guided percutaneous radiofrequency ablation (RFA) in patients with T1 and T2 breast tumors 1) to confirm complete coagulative necrosis of tumor tissue and 2) to determine the safety and complications related to this treatment. METHODS: Twenty-six patients with biopsy-proven, invasive breast carcinoma underwent RFA of their breast tumors followed by immediate resection. Treatment was planned to ablate the tumor and a 5 mm margin of surrounding breast tissue. Tumor viability after RFA was assessed by hematoxylin and eosin and nicotinamide adenine dinucleotide vital staining. RESULTS: Twenty patients (77%) had T1 tumors, and six patients (23%) had T2 tumors. The mean greatest dimension of tumors that were treated with RFA was 1.8 cm (range, 0.7-3.0 cm). The mean treatment time for two-phase RFA treatment was 15 minutes and 23 seconds (range, from 6 minutes and 25 seconds to 24 minutes and 54 seconds). Coagulation necrosis of the tumor was complete in 25 of 26 patients (96%): One patient had a microscopic focus of viable tissue adjacent to the needle shaft site. A single patient (1 of 26 patients; 4%) had a complication related to RFA: a full thickness burn of the skin overlying a tumor that was immediately beneath the skin. CONCLUSIONS: This pilot experience with RFA in the treatment of patients with early-stage, primary breast carcinoma revealed that 1) coagulative necrosis of the entire tumor occurred in 96% of the patients, and 2) the treatment was safe, with only a 4% complication rate. The authors have initiated a trial of RFA alone (no resection) for patients with T1 and T2 breast tumors that will include sentinel lymph node mapping and postablation irradiation.     

Percutaneous radiofrequency ablation therapy for patients with hepatocellular carcinoma during occlusion of hepatic blood flow. Comparison with standard percutaneous radiofrequency ablation therapy

BACKGROUND: The therapeutic efficacy of radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) is limited by the small volume of coagulation necrosis obtained at each activation of the RF system and the sometimes irregular burn shape due to the proximity of large vessels that have a cooling effect. To improve the efficacy of RFA, the authors designed RFA with balloon occlusion of the hepatic artery (balloon-occluded RFA). In this study, we investigated the efficacy of balloon-occluded RFA and compared the coagulation diameters obtained with balloon-occluded RFA and standard RFA. METHODS: We retrospectively studied 31 patients with 42 HCC lesions measuring less than 4 cm in the greatest dimension. We performed balloon-occluded RFA for 12 patients (n = 15 nodules) and standard RFA for 19 patients (n = 27 nodules). Initial therapeutic efficacy was evaluated with dynamic computed tomography scan performed 2 weeks after one treatment. RESULTS: There were no significant differences in the ablation conditions such as the frequency of a fully expanded electrode, the number of needle insertions, application cycles, or treatment times between the two groups. However, the greatest dimension of the area coagulated by balloon-occluded RFA was significantly larger (greatest long-axis dimension, 36.6 +/- 3.8 mm; greatest short-axis dimension, 30.1 +/- 6.0 mm; n = 15 lesions) than that coagulated by standard RFA (greatest long-axis dimension, 26.7 +/- 6.4 mm; greatest short-axis dimension, 23.1 +/- 5.0 mm; n = 27 lesions; greatest long-axis dimension, P < 0.001; greatest short-axis dimension, P < 0.001). CONCLUSIONS: Balloon-occluded RFA is superior to standard RFA for the treatment of many hepatocellular lesions, especially when larger volumes of coagulation are required.     

不宜切除小肝癌射频与射频联合全身化疗的随机对照初步研究

目的 研究射频联合化疗治疗不宜切除小肝癌的临床安全性以及对肝癌原位复发率的影响。方法 ≤3cm不宜切除的原发性肝癌患者38例,其中27例1年随访资料完整。根据射频与射频联合全身化疗的随机分组方案入选标准,射频组12例,射频联合全身化疗组15例。在超声引导下行多电极射频治疗。化疗方案为：表阿霉素50mg,d1,3,静推;顺铂40mg,d1,3,静滴;氟脲嘧啶500mg,d1,2,3,静滴。观察患者术后1,4,7d的肝功能、血常规和并发症,术后1,6,12个月复查GT(增强),评价两组患者治疗的安全性及原位复发率。结果 两组射频术后1个月,均无原位复发。射频联合全身化疗组6,12个月的原位复发率较单射频组明显下降,差异有显著性。两组均无严重并发症,肝功能、血常规变化差异无显著性。结论 对≤3cm不宜切除的原发性肝癌患者,射频联合全身化疗是安全的,并能降低肝癌原位复发率。     

Combination of percutaneous radiofrequency ablation with transarterial chemoembolization for hepatocellular carcinoma： observation of clinical effects

Objective： To observe the clinical effect of radiofrequency ablation （RFA） combined with transcatheter arterial chemoembolization （TACE） for advanced hepatocellnlar carcinoma （HCC）. Methods： A total of 92 eases of advanced primary liver cancer underwent TACE and RFA treatment from June 2005 to 2011 at the Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College. A total of 88 cases with complete clinical treatment and follow-up data were divided into two groups： 43 patients treated with TACE （TACE group） and 45 patients that received TACE combined with RFA treatment （TACE ＋ RFA group）. After clinical data assessment, tumor size and survival status were not significantly different between the groups as determined by stratified analysis. Results： Before and after surgery, spiral CT radiography and color comparison observed ablation conditions. The tumor necrosis rates after treatment （CR ＋ PR） were 67.4% （29/43） and 91.1% （41/45） for the TACE and combined treatment groups, respectively, and the difference was statistically significant （P〈0.05）. The quality of life was significantly improved for patients undergoing TACE ~ RFA compared with the control group. Survival duration was not significantly different in patients undergoing TACE ~ RFA compared with the control group. Conclusions： In this study, the effect of RFA combined with TACE treatment was better than TACE alone in treating advanced HCC.