氩氦刀冷冻消融治疗肺癌的研究进展

肺癌的治疗方法包括传统外科手术、微创手术、分子靶向药物治疗、化学治疗、放疗等,其中氩氦刀冷冻消融治疗属于微创手术,是一种较为安全、有效的瞬时局部治疗肿瘤的方法,其消融范围可控、可监测,对周围正常组织损伤较小,具有降低肿瘤负荷、缓解肿瘤压迫或直接侵犯引起的疼痛、改善患者生活质量的作用.本文对肺癌的发病状况和常见治疗方法及氩氦刀冷冻消融治疗肺癌的研究进展作一综述.     

肝脏肿瘤氩氦冷冻消融治疗现状

氩氦冷冻消融术是在医学影像引导下,以液态氩气、氦气为工质,经氩氦刀头输出高压氩气后便组织迅速降温形成冰球,当输出氧气时,冰球在数分钟内解冻并迅速升温,从而造成肿瘤细胞毁损。目前该技术广泛应用于临床肿瘤的治疗,并随着医学科学的进步在不断发展,本文就肝脏肿瘤氩氦刀临床治疗现状做一综述。     

氩氦刀冷冻消融治疗原发性肝癌的临床研究

[目的]探讨氩氦刀冷冻消融综合治疗中晚期肝癌的疗效。[方法]96例中晚期原发性肝癌分3组观察。第一组用氩氦刀冷冻消融联合TACE治疗37例；第二组单纯用氩氦刀冷冻消融32例：第三组单纯用TACE27例。氩氦刀冷冻消融采用B超／或CT引导经皮穿刺肝肿瘤，共计对97个病灶使用203把氩氦刀二次循环冷冻。[结果]氩氦刀冷冻术后有94.2％（65/69）的患者精神状态得到改善，腹部疼痛症状减轻，恢复快。氩氦刀超低温冷冻联合TACE的近期疗效和12、24个月的生存率明显优于另外两组，中位生存期延长（P＜0．05）。[结论]氩氦刀联合TACE是治疗肝癌有效的方法之一，可望提高肝癌患者生存期和改善生命质量，为丧失手术机会的晚期肝肿瘤患者开辟了一条新的治疗途径。     

氩氦刀冷冻消融治疗肿瘤

1998年美国研制一种新型超低温介入冷冻消融治疗设备，在实体肿瘤治疗中显示一定的优势。文章就其在肿瘤治疗中的应用及临床须注意问题作一综述。     

经皮穿刺氩氦刀冷冻治疗转移性肝癌22例

目的:探讨氩氦刀冷冻治疗转移性肝癌的疗效及临床意义.方法:2001年7月～2002年12月转移性肝癌患者22例在B超引导下行经皮穿刺氩氦刀冷冻治疗肝脏肿瘤术.术后患者定期复查血清肿瘤标记物、B超检查及CT或MRI.结果:术后12个月存活率为81.8%,术后18个月存活率为63.6%,术后24个月存活率为22.7%,术后并发症包括1例急性肾功能衰竭,4例胸腔积液,1例腹腔局部积液,全部病例均有一过性肝功能损害.结论:美国CryocareTM氩氦刀冷冻治疗中晚期转移性肝癌是一种微创、相对安全、疗效可靠的新方法.对于失去手术治疗机会且TAE疗效不好的中晚期转移性肝癌是一种有效的治疗方法.     

氩氦刀冷冻肝癌时间与冰球关系的临床研究

氩氦刀是美国低温手术系统(CryocareTMsurgi-cal system)的简称,它具有冷冻速度快、靶向性好、创伤小等优点。其治疗肿瘤的原理是利用高压氩气在超导刀尖端快速膨胀时要吸收周围的热量(焦耳-汤姆逊原理),使周围组织温度迅速下降,导致肿瘤细胞内外冰晶形成,细胞破裂、死亡,以及肿瘤微静脉、微动脉内膜损伤、血栓形成,肿瘤细胞因缺血、缺氧而死亡[1]。我们对氩氦刀治疗原发性肝癌时冷冻时间与冰球大小的关系进行了研究,为临床确定最佳的冷冻时间提供理论依据,现将结果报告如下:1资料与方法1.1仪器设备氩氦刀采用美国Endocare公司制造的Cryoc…     

氩氦刀冷冻消融治疗肺癌的临床体会

目的探讨氩氦刀冷冻消融治疗肺癌的疗效。方法回顾性分析采用氩氦刀靶向冷冻消融治疗的12例肺癌患者的临床资料,观察疗效及并发症。结果所有患者均顺利完成手术,术中CT扫描显示总有效率为81．25％,术后3个月CT扫描显示总有效率为68．75％,术后6个月CT扫描显示总有效率仍为68．75％。术后2例（16．67％）出现恶心呕吐,2例（16．67％）出现轻度咳嗽,1例（8．33％）出现痰中带血,1例（8．33％）出现疼痛,3例（25．00％）出现发热,1例（8．33％）出现胸腔积液,1例（8．33％）出现皮下气肿,1例（8．33％）合并肺部感染,经对症处理后均缓解。结论氩氦刀冷冻消融术治疗肺癌疗效显著,副反应小,可改善患者的生存质量,提高生存率。     

氩氦刀冷冻消融对Ⅲ／Ⅳ期原发性肝癌患者肝功能的影响

目的评估冷冻消融对Ⅲ/Ⅳ期原发性肝癌患者肝功能的损害情况。方法前瞻性研究21例Ⅲ/Ⅳ期原发性肝癌患者冷冻消融前后肝功能各项指标的变化,进行统计学分析。结果在冷冻消融后,总胆红素(TB IL)、直接胆红素(DB IL)、间接胆红素(IB IL)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、碱性磷酸酶(ALP)、谷酰转肽酶(GGT)及总胆汁酸(TBA)均较冷冻前升高,总蛋白(TP)、白蛋白(ALB)、胆碱酯酶(CHE)在冷冻后下降,其中总胆红素、白蛋白、胆碱酯酶的冷冻前后变化差异有显著性(P<0.05,P<0.05,P<0.01)。结论冷冻消融治疗对Ⅲ/Ⅳ期原发性肝癌患者肝功能具有一定损害,应严格把握治疗适应证。     

氩氦刀冷冻消融联合化疗治疗晚期非小细胞肺癌253例

[目的]探讨经皮穿刺氩氦刀冷冻消融联合化疗治疗晚期非小细胞肺癌治疗效果。[方法]对253例ⅢB和Ⅳ期非小细胞肺癌患者分为两组:一组149例单纯接受经皮穿刺氩氦刀靶向冷冻消融治疗,另一组104例氩氦刀冷冻消融联合紫杉醇加卡铂化疗,以胸部CT动态观察治疗前后的变化,随访患者生存时间。[结果]两组手术后即刻冰球覆盖肿瘤面积分别为92%和94%。术后1个月左右CT影像变化,两组之间无显著性差异(P>0.05);术后3个月,联合治疗组CT检查结果临床受益率高于单纯冷冻组。两组中位生存时间分别为10.08±1.02个月和15.10±3.84个月,差异有显著性(P<0.01)。[结论]CT引导下经皮穿刺氩氦刀冷冻消融联合化疗治疗晚期非小细胞肺癌的疗效优于单纯氩氦刀冷冻消融治疗。     

氩氦刀冷冻消融治疗老年早期非小细胞肺癌的临床疗效观察

目的:观察氩氦刀冷冻消融治疗老年早期非小细胞肺癌的疗效及安全性。方法:非小细胞肺癌（NSCLC)患者28 例,经病理或细胞学确诊,不愿接受手术或无手术适应证的早期（I期及部分II期）的70岁以上老年患者,全部行CT引导氩氦刀冷冻消融术,观察局部病灶变化、疗效、并发症及生存情况。结果:术后1个月复查CT,按实体瘤评价标准缓解率（CR+PR)为71.4%（20/28）。术后3个月及6个月评价疗效（CR+PR)分别为67.9%和64.3%。1~2年随访过程中7例（25.0%）出现转移,其中5例患者出现纵隔淋巴结转移,2例患者出现远处转移,死亡2例,21例（75.0%）患者未见肿瘤复发或转移征象。所有患者均未出现严重并发症。结论:氩氦刀冷冻消融治疗老年早期非小细胞肺癌疗效较好,安全性高,是老年早期NSCLC治疗的新选择,具有较好的临床应用前景。     

氩氦刀冷冻治疗肝癌对患者免疫功能的影响

目的:探讨肝癌患者经氩氦刀治疗前后免疫功能的变化.方法:选取2003年7月-2009年10月均经病理诊断的原发性肝癌或转移性肝癌88例.病例选择标准:患者预期生存期大于3个月,治疗期间均未接受氩氦刀以外的其他治疗.氩氦刀治疗前1周及治疗后1周收集标本,测T淋巴细胞核仁银染面积与核周银染面积的比值.结果:术后3-12个月复查B超示肿瘤明显缩小,部分患者肿瘤消失.肝癌患者在氩氦刀治疗后外周血T淋巴细胞核仁银染面积与核周银染面积的比值比治疗前明显升高(P＜0.05).结论:肝癌患者经氩氦刀治疗后可以增强机体免疫功能,提高抗肿瘤能力.     

晚期非小细胞肺癌氩氦刀冷冻消融联合化疗疗效和安全性Meta分析

目的化疗在晚期非小细胞肺癌(non small cell lung cancer,NSCLC)治疗中扮演着重要角色,但单一化疗的疗效已达到平台期,越来越多临床研究着眼于氩氦刀冷冻消融联合化疗。本研究系统评价氩氦刀冷冻消融联合化疗在晚期NSCLC中的疗效及安全性。方法全面检索PubMed、Embase、Cochrane Library、中国知网、万方、维普和中国生物医学数据库,检索期限从建库截至2019-06-01。收集评价氩氦刀联合化疗治疗晚期NSCLC的临床试验研究,由2名研究员独立进行质量评价及资料提取,采用Cochrane协作网提供的Revman5.3进行Meta分析。结果共纳入3项随机对照试验(randomised controlled trial,RCT)和11项临床对照试验(controlled clinical trial,CCT)研究,共计1 356例患者。Meta分析显示,氩氦刀联合化疗能够提高晚期NSCLC的客观缓解率(RR=1.60,95%CI:1.42~1.80,P<0.000 01)和疾病控制率(RR=1.19,95%CI:1.12~1.26,P<0.000 01),延长生存期(HR=0.50,95%CI:0.31~0.81,P=0.005)和无进展生存期(HR=0.45,95%CI:0.30~0.67,P<0.000 1),改善生活质量(RR=1.63,95%CI:0.1.30~2.04,P<0.000 1),提高免疫功能(CD4^+淋巴细胞,MD=5.11,95%CI:3.84~6.38,P=0.000 7;CD4^+/CD8^+,MD=0.30,95%CI:0.14~0.45,P=0.000 2)。安全性方面,氩氦刀联合化疗相比单纯化疗,在骨髓抑制、肝肾功能异常、胃肠道反应、脱发、发热和神经毒性发生率方面差异均无统计学意义,P>0.05。结论氩氦刀冷冻消融联合化疗能提高晚期NSCLC的近期和远期疗效,改善生活质量和免疫功能,并具有良好的安全性。     

Status spongiosus in the course of treatment of malignant gliomas

Two cases of fatal encephalopathy which appeared in the course of treatment of malignant gliomas are described. CT scan showed diffuse, low density, non-enhanced lesions of the white matter. Pathological findings showed that the CT scan aspects corresponded to status spongiosus without demyelination. We were unable to find similar reports in the literature.     

Intra-arterial cisplatin for the treatment of malignant gliomas

Summary Cisplatin (DDP) is a chemotherapeutic agent that has shown efficacy against primary CNS malignancies. Intraarterial (IA) administration of DDP to patients with brain tumors should produce higher peak levels of drug than intravenous (IV) administration of an identical dose and reduce systemic toxicity. Twelve patients with malignant glioma were entered into the study. All had failed irradiation, 11 had failed IA BCNU. Each patient received IA DDP, 58–100 mg/m², into the internal carotid artery at four to six week intervals. One of 12 patients had a partial response of 6 months. The remaining 11 patients had progressive disease [10] or severe complications [1]. Toxicity included seizures in four patients, weakness and/or aphasia in four patients, coma in two patients, and visual deterioration in two patients. IA DDP has very limited efficacy in patients with malignant gliomas after failure of nitrosoureas and is associated with an unacceptable level of toxicity. IA DDP may be more effective when used as initial chemotherapy of malignant gliomas.     

New treatment strategies for malignant gliomas

Malignant gliomas are the most prevalent type of primary brain tumor in adults. Despite progress in brain tumor therapy, the prognosis of malignant glioma patients remains dismal. The median survival of patients with glioblastoma muhiforme, the most common grade of malignant glioma, is 10-12 months. Conventional therapy of surgery, radiation and chemotherapy is largely palliative. Essentially, tumor recurrence is inevitable. Salvage treatments upon recurrence are palliative at best and rarely provide significant survival benefit. Therapies targeting the underlying molecular pathogenesis of brain tumors are urgently required. Common genetic abnormalities in malignant glioma specimens are associated with aberrant activation or suppression of cellular signal transduction pathways and resistance to radiation and chemotherapy.     

New treatment strategies for malignant gliomas

Malignant gliomas are the most prevalent type of primary brain tumor in adults. Despite progress in brain tumor therapy, the prognosis of malignant glioma patients remains dismal. The median survival of patients with glioblastoma multiforme, the most common grade of malignant glioma, is 10-12 months. Conventional therapy of surgery, radiation and chemotherapy is largely palliative. Essentially, tumor recurrence is inevitable. Salvage treatments upon recurrence are palliative at best and rarely provide significant survival benefit. Therapies targeting the underlying molecular pathogenesis of brain tumors are urgently required. Common genetic abnormalities in malignant glioma specimens are associated with aberrant activation or suppression of cellular signal transduction pathways and resistance to radiation and chemotherapy. Several low molecular weight signal transduction inhibitors have been examined in preclinical and clinical malignant glioma trials. The efficacy of these agents as monotherapies has been modest, at best; however, small subsets of patients who harbor specific genetic changes in their tumors may display favorable clinical responses to defined small molecule inhibitors. Multitargeted kinase inhibitors or combinations of agents targeting different mitogenic pathways may overcome the resistance of tumors to single-agent targeted therapies. Well designed studies of small molecule kinase inhibitors will include assessment of safety, drug delivery, target inhibition and correlative biomarkers to define mechanisms of response or resistance to these agents. Predictive biomarkers will enrich for patients most likely to respond in future clinical trials. Additional clinical studies will combine novel targeted therapies with radiation, chemotherapies and immunotherapies.     

恶性胶质瘤的综合治疗现状

恶性胶质瘤是常见的肿瘤,其死亡率和致残率均很高,手术、放疗及化疗的综合治疗已经成为恶性胶质瘤治疗常规。近年来,术后放疗及化疗出现了许多进展。本文就恶性胶质瘤的综合治疗现状及进展作一综述。     

New treatment strategies for malignant gliomas

Malignant gliomas are the most prevalent type of primary brain tumor in adults. Despite progress in brain tumor therapy, the prognosis of malignant glioma patients remains dismal. The median survival of patients with glioblastoma multiforme, the most common grade of malignant glioma, is 10–12 months. Conventional therapy of surgery, radiation and chemotherapy is largely palliative. Essentially, tumor recurrence is inevitable. Salvage treatments upon recurrence are palliative at best and rarely provide significant survival benefit. Therapies targeting the underlying molecular pathogenesis of brain tumors are urgently required. Common genetic abnormalities in malignant glioma specimens are associated with aberrant activation or suppression of cellular signal transduction pathways and resistance to radiation and chemotherapy. Several low molecular weight signal transduction inhibitors have been examined in preclinical and clinical malignant glioma trials. The efficacy of these agents as monotherapies has been modest, at best; however, small subsets of patients who harbor specific genetic changes in their tumors may display favorable clinical responses to defined small molecule inhibitors. Multitargeted kinase inhibitors or combinations of agents targeting different mitogenic pathways may overcome the resistance of tumors to single-agent targeted therapies. Well designed studies of small molecule kinase inhibitors will include assessment of safety, drug delivery, target inhibition and correlative biomarkers to define mechanisms of response or resistance to these agents. Predictive biomarkers will enrich for patients most likely to respond in future clinical trials. Additional clinical studies will combine novel targeted therapies with radiation, chemotherapies and immunotherapies.     

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。