特殊部位小肝癌超声引导下微波消融与手术切除的对比研究

【摘要】 目的 对比研究超声引导下经皮微波消融（MWA）与手术切除治疗特殊部位原发性小肝癌的疗效。 方法 分析240例特殊部位原发性小肝癌患者的资料,对比超声引导下MWA组与手术切除组近、远期疗效。 结果 MWA组与手术切除组围手术期均未出现严重并发症,对比两组肿瘤首次完全消除率、复发率,差异均无统计学意义（P=0.072,P=0.233）。MWA组患者术后肝功能、术中出血量、手术时间、术后体温、术后住院天数以及住院费用均优于手术切除组（P＜0.05）。MWA组与手术切除组1、3、5年总生存率分别为96.6%、86.4%、64.2%,95.1%、88.0%、70.3%,P=0.852。1、3、5年无瘤生存率分别为84.4%、62.8%、42.9%,81.3%、62.0%、57.7%,P=0.341。 结论 超声引导下MWA治疗特殊部位原发性小肝癌与手术切除具有相似的生存疗效,相比于手术切除更经济微创、简便易行。     

不可逆电穿孔技术在肝癌消融治疗中的应用

焦德超  王朝艳  李兆南  田川  张全会  韩新巍 《介入放射学杂志》2021,30(11):1128-1132

微波消融联合经皮椎体成形术治疗椎体转移性肿瘤的疗效观察

目的探讨微波消融(MWA)联合经皮椎体成形术(PVP)治疗椎体转移性肿瘤引起疼痛的临床疗效。方法入住椎体转移性肿瘤患者80例,随机分为研究组和对照组各40例,对照组采用PVP术,研究组采用MWA联合PVP术治疗,观察并记录两组患者术前、术后3 d、术后1周、术后1个月、术后3个月和术后6个月疼痛视觉模拟评分(VAS),镇痛药物使用评分(AUS)和肿瘤患者生活质量评分(QLS),分析患者疼痛症状缓解情况,同时比较两组患者骨水泥注入量、渗漏节数、X线曝光时间和手术费用。结果80例患者手术均成功,两组患者术前、术后3 d、术后1周、术后1个月、术后3个月VAS、AUS和QLS比较差异无统计学意义(P>0.05),骨水泥注入量、渗漏节数、X线曝光时间比较差异无统计学意义(P>0.05),术后6个月VAS、AUS和QLS比较差异有统计学意义MWA联合PVP组较对照组为优(P<0.05),同组患者手术前后比较差异有统计学意义(P<0.05),手术费用比较差异有统计学意义(P<0.05)。结论MWA联合PVP术治疗椎体转移性肿瘤,能有效缓解患者的疼痛,减少镇痛药物的使用,提高患者的生活质量,但手术费用偏高。     

低频超声辐照载5-氟尿嘧啶的纳泡靶向治疗裸鼠射频消融后残留肝癌的效果

目的 探讨低频超声辐照载5-氟尿嘧啶(5-FU)的纳泡对射频消融治疗后裸鼠残留肝癌的治疗效果.方法 取6～8周龄BALB/c裸鼠60只,用人肝癌HepG2细胞构建裸鼠肝癌模型,经射频消融约80％后,将其随机分为生理盐水组、载5-FU的纳泡(5-FU)组、非低频超声辐照载5-FU的纳泡(非低频超声+5-FU)组、低频超声...     

微波消融联合经导管动脉化疗栓塞术治疗肝细胞癌生存预测

【摘要】 目的 探讨影响微波消融（MWA）联合TACE治疗肝细胞癌（HCC）患者总生存期（OS）的预测因素，并对患者OS进行有效预测。方法 回顾性分析2013年1月至2017年3月行MWA联合TACE治疗的HCC患者59例。以OS为基础，针对13项潜在因素，采用单因素分析（Log- rank检验）及Cox多因素回归分析探讨影响OS的预测因素，并采用R软件构建预后列线图（nomogram）以预测OS，使用Harrell’s c statistic评价其准确性。 结果 59例患者的中位OS（mOS） 为（24.0±11.6） 个月，中位肿瘤进展时间为（10.3±5.9）个月。单因素分析及Cox多因素回归分析显示门静脉癌栓（PVTT）、甲胎蛋白（AFP）≥400 ng/mL、最大肿瘤直径≥7 cm是影响OS的预测因素。预后计算图（nomogram）的准确度评价Harrell’s c statistic为0.81。 结论 PVTT、AFP≥400 ng/mL、最大肿瘤直径≥7 cm是影响MWA联合TACE治疗HCC患者OS的预测因素，预后计算图可准确预测患者的OS。     

经皮微波消融联合125I粒子植入治疗纵隔恶性肿瘤的疗效观察

【摘要】 目的 对比经皮微波消融（MWA）联合125I放射性粒子植入与单纯MWA治疗纵隔恶性肿瘤的近期疗效和安全性。方法 回顾性分析67例接受治疗的纵隔恶性肿瘤患者的临床资料,其中36例患者采用单纯MWA治疗（单纯MWA组）,31例患者采用MWA联合125I放射性粒子植入治疗（联合治疗组）。根据增强CT对比观察术后3个月两组的疗效。对比观察术后1个月内出血、气胸、胸水等相关并发症发生情况。结果 两组患者治疗后1个月内相关并发症发生率差异无统计学意义（P＞0.05）;治疗后3个月,联合治疗组有效率为83.9%,单纯MWA组为55.6%,差异有统计学意义（P＜0.05）。结论 与单纯MWA相比,MWA联合125I放射性粒子植入治疗纵隔肿瘤,疗效明显提高,且不会增加相关并发症发生率,值得临床推广应用。     

CalliSpheres载药微球联合碘化油治疗大肝癌14例

【摘要】　目的?观察CalliSpheres载药微球联合碘化油治疗大肝癌的近期临床疗效及安全性。方法?回顾性分析2017年7月至2018年6月行TACE治疗的14例大肝癌患者,术中使用CalliSpheres载药微球联合碘化油治疗,采用mRECIST标准评价治疗效果,比较患者术前与术后肝功能及AFP变化,分析不良反应与并发症发生情况。结果?14例患者均接受CalliSpheres载药微球联合碘化油治疗,技术均获成功;随访6个月以上,患者术后1、3和6个月的疾病缓解率分别为85.7%、78.6%和64.3%,疾病控制率分别为92.9%、92.9%、78.6%;术后1个月AFP明显下降,与术前比较差异有统计学意义（P＜0.05）;术后7 d患者ALT和总胆红素（TBIL）明显升高,白蛋白（ALB）有所下降,与术前比较差异有统计学意义（P均＜0.05）;术后1个月肝功能指标基本恢复至术前基线水平,与术前比较差异均无统计学意义 （P＞0.05）;术后不良反应主要表现为轻度腹痛、低热、恶心、呕吐,但经对症处理后均在1周内得到缓解。结论?CalliSpheres载药微球联合碘化油治疗大肝癌有良好的近期疗效,安全可行,在达到与DEB-TACE相似效果的同时能减少载药微球剂量,从而减轻患者经济负担,其远期疗效仍待进一步研究。     

载药微球的理化特性及其在肝癌介入治疗中的应用进展

【摘要】 载药微球化疗栓塞术（DEB- TACE）是不可切除肝癌的一种介入治疗技术,具有栓塞肿瘤血管和缓释化疗药物的双重特性。目前用于临床的载药微球主要有DC/LC Beads微球、HepaSphere微球、CalliSpheres微球以及Tandem微球,它们的理化特性各有不同。本文就上述载药微球的理化特性、临床应用、并发症和相关不足作一综述。     

微波消融联合肝动脉栓塞化疗治疗肝癌46例分析

目的 探讨微波消融联合肝动脉栓塞化疗术(TACE)治疗原发性肝癌(PHC)的临床疗效.方法 82例PHC患者随机分为两组,单纯TACE组36例(对照组),微波消融+TACE 46例(治疗组).观察两组治疗后3个月的临床疗效和AFP变化情况及1、2、3年生存率.结果 对照组和治疗组AFP由治疗前的(479.3±96.2) μg/L和(491.2±103.1)μg/L降为治疗后的(115.3±49.3) μg/L和(78.1±38.9)μg/L.1、2、3年生存率:治疗组为78.3％、54.3％、34.8％;对照组为61.1％、36.1％、19.4％.治疗组未发生严重并发症.结论 微波消融联合TACE是治疗PHC的一种新的安全有效的治疗方法,可以延长PHC患者的生存期.     

经导管肝动脉化疗栓塞术联合微波消融治疗肝癌的精准护理研究

目的：探讨精准护理在经导管肝动脉化疗栓塞术（TACE）联合微波消融（MWA）治疗肝癌患者中的应用效果。 方法：将我院介入血管外科2016年11月至2017年10月收治60例TACE联合MWA治疗的肝癌患者,按前后时间顺序分为对照组（30例）和观察组（30例）,对照组采取常规护理,观察组在对照组的基础上,采用精准护理方法,对比两组患者术后尿储留、恶心呕吐、腰酸背痛、失眠发生率,健康知识知晓率和护理满意率。 结果：观察组患者的术后尿储留、恶心呕吐、腰酸背痛、失眠发生率明显低于对照组（P<0.05）;健康知识知晓率和护理满意率高于对照组（P<0.05）。 结论：精准护理方法运用于TACE联合MWA治疗肝癌患者中,可显著降低术后不良反应的发生,增加介入治疗术后整体舒适度,提高健康知识知晓率和护理满意率。     

TACE联合CT引导下微波消融治疗肝细胞肝癌的临床应用

目的：探讨经肝动脉化疗栓塞术（TACE）联合CT引导下微波消融治疗肝细胞肝癌的临床疗效。 方法：选择通过临床诊断证实的肝细胞肝癌患者45例,行TACE治疗后序贯给予CT引导下的病灶局部微波消融治疗,检测患者治疗后3、6、12、24个月的血液甲胎蛋白（AFP）水平变化情况,分析总结术后不同时间的肿瘤局部控制情况和患者生存率。 结果：45例肝细胞肝癌患者术后3、6、12、24个月血AFP下降有效率为100%（45/45）、100%（45/45）、93.3%（42/45）、91.1%（41/45）;病灶局部控制率依次为：100%（45/45）、100%（45/45）、97.8%（44/45）、88.8%（40/45）;生存率分别为：100%（45/45）、100%（45/45）、93.3%（42/45）、91.1%（41/45）。TACE治疗后患者出现发热、疼痛、均出现食欲下降、呕吐、肝功能异常等表现,对症处理后基本恢复。微波消融后患者有2例患者术后出现胸腔积液,经对症处理后积液消失。45例患者均未发生治疗相关性死亡病例。 结论：TACE联合CT引导下微波消融治疗肝细胞肝癌,CT下定位精确,显像明显,治疗效果较佳,是提高肿瘤局部控制率并延长患者生存期的有效方法。     

Ultrasound-guided percutaneous thermal ablation of hepatocellular carcinoma using microwave and radiofrequency ablation

AIM: To investigate the therapeutic efficacy of thermal ablation for treatment of hepatocellular carcinoma (HCC) using microwave and radiofrequency (RF) energy application. MATERIALS AND METHODS: A total of 190 nodules in 97 patients (84 male, 13 female; mean age 53.4 years, range 24-74 years) with HCC were treated with microwave or RF ablation in the last 4 years. The applicators were introduced into the tumours under conscious analgesic sedation by intravenous administration of fentanyl citrate and droperidol and local anaesthesia in both thermal ablation procedures. The patients were then followed up with contrast-enhanced computed tomography (CT) to evaluate treatment response. Survival was analysed using the Kaplan-Meier method. RESULTS: Complete ablation was obtained in 92.6% (176/190) nodules. The complete ablation rates were 94.6% (106/112) in microwave ablation and 89.7% (70/78) in RF ablation. The complete ablation rates in tumours/=4.0 cm were 93.1, 93.8 and 86.4%, respectively. Local recurrence was found in 9.5% nodules and the rates in tumours/=4.0 cm in diameter were 3.4, 9.9 and 31.8%, respectively. In the follow-up period, 7.1% nodules ablated by microwave and 12.8% by RF presented local recurrence. The 1, 2 and 3-year distant recurrence-free survivals were 47.2, 34.9 and 31.0%, respectively. Estimated mean survival was 32 months, and 1, 2 and 3-year cumulative survivals were 75.6, 58.5, and 50.0%, respectively. One and 2 years survivals of Child-Pugh class A, B and C patients were 83.8 and 70.4%, 78.2 and 53.2%, 36.3 and 27.3%, respectively. CONCLUSION: Thermal ablation therapy by means of microwave and RF energy application is an effective and safe therapeutic technique for hepatocellular carcinoma. Large tumours can be completely ablated, but have a significantly higher risk of local recurrence at follow-up.     

Factors predicting outcomes of microwave ablation of small hepatocellular carcinoma

Purpose

The aim of our study was to evaluate factors influencing effectiveness of percutaneous microwave ablation (MWA) in patients with small hepatocellular carcinoma (HCC) (<3 cm).

Materials and methods

Between December 2007 and August 2015, 49 patients with 65 previously histological typed HCC were treated in a total of 61 sessions. Tumours were subdivided into central (>3 cm from the capsule) (n = 22) and peripheral (<3 cm from the capsule) (n = 43). Imaging follow-up was performed at 1, 3, 6, and 12 months after treatment, then annually. Mean follow-up period was 18 months (range 1–55). Location of the lesion, age, sex, and underlying disease of the patients was analyzed and related with efficacy.

Results

Technical success was obtained in all cases. Residual disease was registered in 21 lesions (32.3 %): 13 were peripheral and 8 were central. Twelve of them were retreated with percutaneous MWA. Local recurrence was recorded in 8 lesions (12.3 %): 5 were retreated with MWA. No significant difference in terms of effectiveness was observed in lesions located in a central position and those situated in the peripheral position. Age, sex, and underlying disease not influenced results. Only one major complication was observed. The rate of minor complications was 24.5 %. Mortality at 30 days was 0 %.

Conclusions

Our results encourage the role of MWA in the treatment of small HCC. More numerous series and randomized studies are necessary to state the role of MWA and to select cases in which MWA may be more effective and safer than RFA.

     

Ultrasound-guided microwave ablation of hepatocellular carcinoma: Initial institutional experience

BackgroundMicrowave ablation (MWA) is a new treatment modality for hepatocellular carcinoma (HCC) at our institution. The aim of this study is to evaluate the safety, procedure time and rate of complete ablation of this new modality.Material and methodsHospital medical ethics committee approval and informed consent were obtained. A total of 98 nodules in 72 patients (59 male, 13 female; mean age 57 (±4.6) years, range 50–70 years) with HCC were treated with microwave ablation at our institution from June 2010 to February 2011. A 14 G cooled shaft Amica probe was introduced into the tumors under analgesic sedation and by US guidance. The patients were then followed up with contrast enhanced computed tomography (CT) and serum α-fetoprotein levels.ResultsOne month after therapy, complete ablation was obtained in 96% (94/98) nodules. The complete ablation rate in tumors ?3 cm and those >3 cm were 98%, and 94%, respectively. MW ablation success was higher with nodules ?3 cm (57/58, 98.3%) in comparison to nodules >3 cm (37/40, 92.5%): however, the difference was non-significant (P = 0.301). No complication occurred related to the ablation procedure, only minor complications post-ablation, as pain in (3/72) patients, mild fever in (48/72) patients, and discharge from wound in (2/72) patients. No local recurrence was detected, however, new lesions at other sites of the liver occurred in 11 (15%) patients.ConclusionSonographically guided percutaneous microwave ablation proved to be safe, fast, and effective for treatment of hepatocellular carcinoma.     

Prognostic factors for survival in patients with hepatocellular carcinoma after percutaneous microwave ablation

PURPOSE: To determine the long-term survival and prognostic factors in patients with hepatocellular carcinoma treated with percutaneous microwave ablation. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained. A database of cases of hepatocellular carcinoma in 288 patients (259 men, 29 women; mean age, 54.8 years +/- 11.4 [standard deviation]; age range, 25-82 years) with 477 histologically proved lesions who underwent percutaneous microwave coagulation therapy between May 1994 and October 2002 was retrospectively analyzed. Prognostic factors for survival were evaluated by means of univariate and multivariate analyses. RESULTS: The mean follow-up period after microwave ablation was 31.41 months +/- 20.43 (range, 5-106 months). The 1-, 2-, 3-, 4-, and 5-year cumulative survival rates among all 288 patients were 93%, 82%, 72%, 63%, and 51%, respectively. Ninety-three patients (32%) died. Local recurrence or new tumors occurred in 100 patients (35%). Age (P = .836), sex (P = .073), preablation serum alpha-fetoprotein level (P = .136), and preablation treatment (P = .256) were not related to prognosis, while tumor number (P = .004), tumor size (P < .001), Child-Pugh classification (P = .003), tumor differentiation (P = .026), and local recurrence or presence of new tumors (P = .004) significantly affected survival at univariate analysis. At multivariate analysis, only tumor size (P < .001), number of nodules (P = .005), and Child-Pugh classification (P = .01) each had a significant effect on survival. CONCLUSION: With use of microwave ablation, there is a high probability of long-term survival of patients with a single lesion of 4.0 cm or less in maximum diameter and Child-Pugh class A cirrhosis.     

低功率微波消融联合化疗栓塞治疗特殊部位肝细胞癌的临床应用

【摘要】 目的 评估CT引导下低功率微波消融（MWA）联合经TACE治疗特殊解剖部位肝癌患者的疗效、安全性与生存率。方法 选取76例HCC患者,应用TACE治疗后分为两组:研究组38例,共42个病灶（距肝被膜、胆囊或大血管＜5 mm）,行低功率MWA（40 W）;对照组38例共46个病灶（距肝被膜、胆囊或大血管≥5 mm）,行常规功率MWA（50～70 W）,比较两组术后肝功能、甲胎蛋白（AFP）、不良反应及并发症、术后3个月影像学表现以及1年生存率情况。结果 研究组中,患者的3处癌灶邻近胆囊,14处邻近大血管,25处邻近肝被膜,所有病灶均完全消融,且无严重并发症出现;研究组术后3个月局部复发率7.1%,对照组8.7%,差异无统计学意义（P=0.788）;研究组术后AFP 平均下降为（261.23±201.35） ng/mL,对照组平均下降为（278.49±189.14） ng/mL,差异无统计学意义（P=0.155）;两组ALT、AST及TBIL术后显著升高,差异无统计学意义（P＞0.05） ;研究组并发症4例（10.5%）,对照组并发症3例（7.8%）,差异无统计学意义（P=0.692）。两组术后均未出现与治疗相关的死亡病例,1年生存率差异无统计学意义（P=0.556）。 结论 低功率MWA联合TACE治疗特殊解剖部位的 HCC与安全部位同样有效和安全。