射频消融联合腔镜微创保乳治疗早期乳腺癌的医学美学评价

目的评价射频消融（radiofrequency ablation,RFA）联合腔镜微创保乳治疗早期乳腺癌的医学美学效果。方法选择早期乳腺癌（T1-2N0-1M0）单侧单发病例,在术前常规化疗的同时,对乳腺肿瘤局部行B超引导下RFA治疗,然后行病变乳腺叶段切除和腔镜下前哨淋巴结染色活检与选择性腋窝淋巴结微创清扫术。术后随访3年以上,通过问卷法自我评价医学美学效果,并与传统保乳手术进行比较。结果直径≤3cm[平均（2．10±0．83）cm,最小1．20cm,最大3．00cm]的早期乳腺癌单侧单发共23例,肿瘤完全消融率95．6％（22／23）,成功完成微创保乳术22例。RFA联合腔镜微创保乳治疗不仅瘢痕微小,而且乳房外形和腋窝形态明显优于传统手术,患者自我评分满意率100％,医学美学评分优良率95．5％（21／22）。结论RFA联合腔镜微创保乳治疗早期乳腺癌可获得更好的医学美学效果。     

Treatment of invasive breast carcinoma with ultrasound-guided radiofrequency ablation

BACKGROUND: Radiofrequency ablation (RFA) is a minimally invasive thermal ablation technique. This study reports the safety and efficacy of RFA as a minimally invasive strategy for breast cancers <3 cm diameter in postmenopausal women. METHODS: Twenty-two postmenopausal women (aged 60 years or older) with clinical T-1N0 core biopsy proven breast cancers were studied. Thermocoagulation was undertaken using a sonographically guided RF probe under local anesthesia and sedation. The ablated tumor was resected between 1 and 2 weeks later. Endpoints were technical success, completeness of tumor kill, marginal clearance, skin damage, and patient reports of pain and procedural acceptability. RESULTS: The procedure was well tolerated and cosmesis was excellent. Pathology revealed a central ablation zone surrounded by hyperemia. Coagulative necrosis was complete in 19 of 22 patients. Disease at the ablation zone margin was found in 3 patients and 5 patients had disease distant to the ablation zone consisting of multifocal tumors (2), in-transit metastasis (1), and extensive ductal carcinoma in situ with microinvasive carcinoma (2). Ninety-five percent of patients would be willing to have RFA again. CONCLUSIONS: Radiofrequency ablation can be safely applied in an outpatient setting with acceptable patient tolerance. By itself, RFA cannot be considered effective local therapy. Trials to evaluate RFA complemented with breast irradiation are justified.     

射频消融术对乳腺癌的临床研究

乳腺癌是女性常见的恶性肿瘤,严重危害女性健康.近年来,乳腺癌的发病率越来越高,且越来越年轻化,随着乳腺癌普查工作的广泛开展,早期乳腺癌的诊断率明显升高,使乳腺癌患者的预后得到了显著的改善.日前绝大部分乳腺癌患者要求小仅要彻底地切除肿瘤,同时也要保证生活质量,减少心理压力,并达到较好的美容效果,因而过去常规治疗(手术加放化疗、雌孕激素)已不能满足患者的追求,而乳腺癌的射频消融治疗也就成为一种较好的治疗方法.本文简要地从射频消融治疗的原理、治疗方法、当今治疗现状、术后并发症等方面进行阐述.     

宫腔镜射频热凝固内膜去除术治疗功能失调性子宫出血的意义

目的探讨宫腔镜检查在射频热凝固（RF）子宫内膜去除两种术式中治疗功能失调性子宫出血（功血）中的意义。方法收集2001年1月至2011年1月就诊、经先前药物治疗无效的功血患者2100例为研究组,以45岁为界分为两组：A组（≥45岁,平均48岁,共927例）是以闭经为治疗目的,采用全部子宫内膜凝固（A—RF术式）;B组（〈45岁,平均37岁,共1173例）是以月经减量为目的,根据术前宫腔镜检查提供的信息,采用选择性部分内膜凝固（B．RF术式）。所有患者具备术前宫腔镜检查和诊断性刮宫病理诊断等临床资料。除对所有患者术后即时宫腔镜检查了解内膜去除情况外,还对部分患者RF后6—7个月再次进行宫腔镜检查,以明确宫腔表面远期变化。结果本组术前宫腔镜检查发现功血合并不完全子宫纵膈79例,占3．8％（79／2100）、黏膜下子宫肌瘤56例,占2．7％（56,2100）。有效率：RF治疗功血3个月内（近期）总有效率为96．7％（2031／21001,其中A组为97．0％（899／927）,B组为96．5％（1132／1173）。术后即时宫腔镜检查和内膜病理显示：A组内膜全部全层凝固性坏死,B组见部分正常内膜遗存。术后3月后不同时间段随访宫腔镜显示受热凝固的内膜被纤维结缔组织替代。主要并发症是术后1。2个月阴道少量不规则流血,占8．0％（168／2100）和3个月后月经量仍多,占5．2％（109／2100）。经宫腔镜检查分别显示为机化内膜组织脱落不全和内膜遗留过多,分别行清宫和再次RF后达到目的疗效。本组患者无经RF后又改子宫切除者。结论辅以宫腔镜检测使RF治疗功血更加直观、安全、有效和微创化,既可以达到闭经,也可以控制减少月经量,受RF作用的子宫内膜热凝固坏死使子宫出血停止,内膜组织纤维化改变是RF治疗功血远期有效和防止复发的重要机制。     

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。     

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。     

进展期胰腺癌射频消融治疗的安全性研究

目的 探讨射频消融对进展期胰腺癌治疗的安全性.方法 回顾性分析2002年1月至2007年12月间对70例不能切除的进展期胰腺癌病人行射频消融治疗发生的并发症资料.结果 所有病人都有短期的发热症状,部分有一过性的血清淀粉酶升高,无腹腔出血、腹腔感染、急性胰腺炎发生,胰瘘2例,上消化道出血1例,血管并发症1例,术后总的并发症发生率为5.71%(4/70),但其中导致死亡2例,发生率为2.86%(2/70).结论 对于进展期胰腺癌射频治疗是安全可行的,但由于可能出现致命性严重并发症,必须要慎重.     

肝癌全身麻醉射频消融术后应用舒更葡糖钠逆转神经肌肉阻滞的回顾性研究

目的：探讨CT引导肝癌全身麻醉(全麻)射频消融术后、应用舒更葡糖钠逆转神经肌肉阻滞的作用。方法：回顾性分析2019年11月至2022年2月我院220例全麻肝癌射频消融术病人资料。根据不同逆转神经肌肉阻滞类型,即肌松拮抗剂分为：舒更葡糖钠组(S组)108例和新斯的明组(N组)112例。两组病人均采取全凭静脉麻醉,麻醉诱导和维持方式相同。S组术毕静脉给予舒更葡糖钠(2 mg/kg)拮抗肌松,N组静脉给予新斯的明(2 mg)+阿托品(0.5～1 mg)拮抗肌松。比较两组病人自主呼吸完全恢复时间、气管拔管时间、麻醉恢复室(postanesthesia care unit,PACU)停留时间和术后住院时间;以及拔管后10 min CT检查肺不张发生率,术后24 h肝功能,术后肺部并发症发生情况。结果：与N组比较,S组自主呼吸完全恢复时间、气管拔管时间与PACU停留时间明显缩短(P<0.05),拔管后10 min肺不张发生率[35例(32.4%)比59例(52.7%)]及术后肺部并发症发生率[4例(3.7%)比11例(9.8%)]明显降低(P<0.05)。两组术后24 h肝功能指标均较...     

肾脏多极射频消融的初步研究

目的 研究多极射频对正常肾组织和肾肿瘤组织的消融效果，探讨腹腔镜下行肾脏射频消融的可行性。方法 采用WE7568多极射频肿瘤消融仪。动物实验中，比较B超和腹腔镜引导下多极射频肾组织消融技术的优劣。并于治疗后1、14、30和90d行B超、CT及病理组织学检查。比较“干”与“湿”、离体与在体射频消融实验结果。肾肿瘤患者5例，肿瘤平均直径3．2cm，经开放手术游离肾脏，射频消融肿瘤后切除，行病理检查。结果 离体条件下肾脏射频消融破坏灶的范围大于在体破坏灶。间质内注射高渗盐水可以增大破坏灶范围。操作中可采用由浅入深推进的方法形成完整楔形治疗灶。病理急性期表现为凝固坏死，慢性期为纤维化和钙化。CT显示治疗灶密度增高且不被造影剂强化，B超显示治疗灶回声增强。近期和远期并发症有血尿和肾盂积水。结论 射频消融术治疗4cm以下的肾脏小肿瘤具有简单、安全、有效和微创的优点。位于上极、前侧和内侧的肾肿瘤，可采用腹腔镜辅助下肾脏穿刺射频消融术。     

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.     

Radiofrequency ablation of early breast cancer followed by delayed surgical resection--a promising alternative to breast-conserving surgery

To examine the radiofrequency ablation (RFA) reliability in early breast cancer, we performed RFA followed by delayed surgical resection on 41 patients with invasive or non-invasive breast carcinoma less than 2 cm. MRI scans were obtained before ablation and resection. Excised specimens were examined pathologically by haematoxylin-eosin and nicotinamide adenine dinucleotide-diaphorase staining. 40 patients completed 1 RFA session, which was sufficient to achieve complete tumour cell death. Overall complete ablation rate was 87.8% (36/41). There were no treatment-related complications other than that of a superficial burn in 1 case. After RFA, the tumour was no longer enhanced on MRI in 25/26 (96.2%) cases. Residual cancer, which was suspected on MRI in 1 case, was confirmed pathologically. MRI could be an applicable modality to evaluate therapeutic effect. RFA could be an alternate local treatment option to breast-conserving surgery for early breast cancer.     

Evaluation of a bipolar-cooled radiofrequency device for ablation of bone metastases: preclinical assessment in porcine vertebrae

Background contextCancer spread to the spine affects bone stability and can lead to pathologic fracture and neurologic impairment. Radiofrequency ablation (RFA) recently has gained popularity in treating skeletal tumors. Conventional RFA devices use a monopolar design, which limits the ability to comprehensively treat large tumors in bony tissues and may pose risks to adjacent critical normal neurologic tissues when applied to vertebrae. New bipolar-cooled radiofrequency (BCRF) may generate larger controlled lesions without the same degree of risk to adjacent structures.PurposeThe purpose of this study was to evaluate the feasibility, efficacy, and safety of RFA with the use of a new bone-specific, BCRF probe in a porcine vertebral model and to evaluate the ability of magnetic resonance (MR) imaging to represent histologic outcomes of RFA treatment.Study designBasic science: preclinical in vivo study.MethodsRFA was evaluated in three noncontiguous lumbar vertebrae in six Yorkshire pigs (25–30 kg). Via a transpedicular approach for probe placement, two vertebrae received BCRF treatment and one vertebrae served as a sham control. MR imaging and neurological assessments were conducted pre- and posttreatment as well as immediately before animal sacrifice (n=3 at day 0, n=3 at day 14). MR ablation zones were compared with hematoxylin and eosin–stained histological sections.ResultsWith BCRF, large reproducible zones of ablation were achieved, confined within the vertebrae, without damage to adjacent tissues or the spinal cord. All animals demonstrated normal consistent neurologic behavior pre- and posttreatment. External tissue temperatures around targeted vertebrae were not increased. MR imaging after 14 days was more effective in demonstrating ablation effects than images on day 0, with radiologic findings most apparent on T2-weighted sequences. Histologic analysis of samples corresponded well to the zones of ablation observed on MR images (R=0.9, p<.01).ConclusionsThe study demonstrated feasibility, safety, and effectiveness of BCRF ablation of vertebral bone. This motivates ongoing preclinical evaluation in diseased models to further explore the potential for its use in clinical treatment of metastatic vertebrae.     

Percutaneous core excision and radiofrequency thermo-coagulation for the ablation of osteoid osteoma of the spine

Percutaneous radiofrequency ablation is the treatment of choice for osteoid osteoma of the appendicular skeleton. However, difficulties in localizing the lesion in the spine and its proximity to neural elements have yet to make it the prevalent treatment for spine. This study assesses the safety and effectiveness of two percutaneous techniques for ablating osteoid osteoma of the spine. Seven patients were treated between 1998 and 2005. Four patients underwent percutaneous radiofrequency coagulation. The lesions were located at the articular processes of L3 and L4, the lamina of L3 and in the head of the 11th rib. Three patients with lesions in close proximity to neural structures (pedicle of T9, the posterolateral inferior aspect of L3 vertebral body and the inferior articular process of C5) were subjected to percutaneous core excision. Mean follow-up was 4.2 ± 1.6 years. Three out of four patients who underwent radiofrequency ablation had an immediate and sustained response. One patient with a lesion in the head of the rib failed to respond. The three patients in the group of pecutaneous core excisional biopsy demonstrated immediate relief of pain. However, one patient experienced relapse of symptoms 6 months after transpedicular core excision. CT scan suggested partial targeting of the lesion that corroborated with histologic examination revealing only reactive tissue. Subsequent percutaneous core excision was successful. Therefore, the overall success rate was 85.7%. Mean VAS improved dramatically from 9 ± 1 to 2 ± 1 after surgery (P < 0.05). No neurological or other complications were encountered. This study indicates that radiofrequency ablation of spinal osteoid osteomas is safe and reasonably effective when an intact cortical shell separates the nidus from the neural elements. Percutaneous core excision can obviate the risk of thermal damage for lesions located in close proximity to the neural elements. Effectiveness of treatment can also be evaluated by CT scan and histological examination. Difficulties in targeting the nidus can lead to treatment failure. The minimal morbidity and the effectiveness of these minimally invasive procedures make them a valid alternative in the treatment of spinal osteoid osteoma.     

早期乳腺癌射频消融术后疗效的评估方式及进展

随着乳房体检的推广和医学技术的提高,越来越多的早期乳腺癌患者得到确诊。传统的乳腺癌手术创伤大、并发症多,并且术后遗留较长瘢痕影响乳房美观。近年来乳腺癌微创手术逐步应用于临床,给早期乳腺癌患者带来了美学上的期望,射频消融正是其中一种被广泛应用的技术。本文对评估乳腺肿瘤是否完全消融的方式进行探讨和总结,探讨评估方式的发展前景。     

射频消融治疗小肝癌的螺旋CT随访观察

目的 探讨螺旋CT评价小肝癌射频消融术的疗效及随访过程的价值。方法对28例小肝癌患者行RFA治疗,分别于治疗后1个月、3个月及6个月行螺旋CT随访。结果术后1个月CT显示25例肿瘤完全坏死,其中19例肝动脉期与门静脉期均无强化,6例动脉期边缘薄环状强化;3例发现肿瘤残留表现为动脉期边缘结节状强化。25例肿瘤完全坏死者术后3个月及6个月CT随访示毁损灶较术后1个月缩小,无强化,其中2例术后6个月发现肝内异位复发。结论射频消融是小肝癌一种有效的治疗方法,螺旋CT双期增强扫描是评价其疗效及随访的有效影像检查手段。     

重视病理性完全消融提高肝癌射频消融疗效

射频消融(RFA)已成为早期肝癌特别是肝细胞癌(HCC)潜在的治愈性手段.HCC的病理特点是主癌灶周围存在范围不等的微静脉浸润(MVI)区和卫星灶.RFA时,对主癌灶行完全消融,即便是有0.5～1.0 cm的消融边界,获得的通常也只是影像学完全消融,残留的癌周MVI区和卫星灶会导致肿瘤复发,影响疗效;而对包括主癌灶、MVI区和卫星灶在内的所有肿瘤组织行完全消融,是病理性完全消融,可最大程度地预防肿瘤复发,这应该是RFA治疗HCC的理想目标.文章对局部治疗视角下HCC临床病理特点、RFA治疗HCC的机制以及获得病理性完全消融的策略进行了分析.

Abstract：

Radiofrequency ablation (RFA) has been widely utilized as a potential curative treatment modality for hepatocellular carcinoma (HCC) of early stage. Pathologically, HCC is characterized by the peritumoral microvascular invasion (MVI) and satellite lesion of various scope. Complete ablation of the main tumor, even with a 0.5- 1.0 cm ablative margin, is usually only imaging complete ablation with residual of MVI and satellite lesion, which will grow and affect the therapeutic results. While complete ablation of all the tumor tissue, including the main tumor, peritumoral MVI and satellite lesion, is the pathological complete ablation with no residual of viable tumor cell, which should be the main target of RFA for HCC. This paper summarizes the clinicopathological characteristics of HCC in the perspective of locoregional therapy, the mechanism of RFA to treat HCC, and the common strategies to obtain pathological complete ablaiton.     

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.     

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。     

支气管动脉化疗灌注联合多极射频治疗中晚期肺癌

目的评价支气管动脉化疗灌注联合多极射频治疗中晚期肺癌的临床疗效。方法对32例失去手术机会或放弃手术治疗的中晚期肺癌患者,在进行常规支气管动脉化疗灌注的同时,于首次化疗灌注后2周,在CT引导下对病灶进行多极射频治疗1次。随访并记录术后半年、1年、2年、3年的有效率与患者生存率,与单纯进行常规支气管动脉化疗灌注的38例对照组进行同期有效率与生存率的比较。结果联合治疗组术后半年、1年、2年、3年的有效率/生存率分别为:87.5%/96.9%、71.9%/81.3%、34.4%/46.9%、12.5%/21.9%。对照组有效率/生存率分别为:63.2%/78.9%、36.9%/52.6%、26.3%/36.8%、5.3%/7.9%,联合治疗组有效率与生存率均明显高于对照组,统计学有明显差异(P<0.05)。结论支气管动脉化疗灌注联合多极射频治疗中晚期肺癌,疗效明显优于单纯支气管动脉化疗灌注(P<0.05),同时可明显提高患者的生存率,是一种较为理想、安全有效的综合性治疗手段,值得推广应用。