肝动脉化疗栓塞术加或不加射频消融治疗中晚期原发性肝癌的临床研究

目的探讨经肝动脉化疗栓塞(TACE)联合超声引导下射频消融(RFA)治疗原发性肝癌的疗效。方法对2013年1月至2014年5月行 TACE 联合 RFA 治疗的81例中晚期原发性肝癌病人资料进行回顾性分析,并与同期单独行 TACE 的99例中晚期原发性肝癌病人进行疗效比较。结果TACE 联合 RFA 治疗的中晚期原发性肝癌病人疗效明显好于单纯行 TACE 组病人,TACE联合 RFA 组在肿瘤的疾病控制率(93.8%)、完全缓解率(13.6%)及部分缓解率(44.4%)均优于单纯行 TACE 组(76.8%、5.1%、30.3%),P <0.05;AFP 下降水平也优于单纯行 TACE 组(P <0.05)。结论TACE 联合 RFA 治疗中晚期原发性肝癌疗效好,可做临床推广。     

介入联合放射治疗与介入治疗原发性大/巨大肝癌的比较

目的探讨经肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)联合放射治疗(放疗)治疗原发性大/巨大肝癌的疗效。方法 2013年1月~2014年6月我科对30例原发性大/巨大肝癌行TACE联合三维适形或调强放疗,肿瘤放疗剂量达60 Gy/30次(治疗组),与同期35例原发性大/巨大肝癌行单纯TACE(对照组)进行比较。结果治疗组有效率63.3%(19/30),显著高于对照组37.1%(13/35)(χ~2=4.433,P=0.035)。治疗组1、2、3年生存率分别是76.7%、53.3%和23.3%,对照组分别是62.9%、25.7%和11.4%,治疗组累积生存率显著高于对照组(χ~2=3.967,P=0.046)。治疗组二期手术切除率为26.7%(8/30),显著高于对照组5.7%(2/35)(χ~2=3.957,P=0.047)。2组毒副作用可耐受。结论TACE联合放疗是原发性大/巨大肝癌的一种有效方法,毒副作用可耐受,可延长生存期。     

TACE与TACE联合PEI、RF治疗肝脏转移癌的疗效比较

目的评价肝动脉化疗栓塞(TACE)与TACE联合经皮无水乙醇注射(PEI)或射频消融(RF)治疗肝脏转移癌的不同临床疗效。方法67例肝转移癌分为单纯TACE组46例和联合治疗组21例(其中联合PEI组7例,联合RF组14例)。两组治疗结束后通过随访、CT复查及血液分析进行评价。结果单纯TACE组的肿瘤总缩小率和肿瘤完全坏死率分别为46.8%和20.7%,联合治疗组分别为78.9%、49.2%(P均<0.05),单病灶组、无转移灶组及联合治疗组的2年生存率高于多病灶组、有转移组和单纯TACE组(P均<0.05)。结论综合介入治疗转移性肝癌较单纯TACE可以使病灶得到有效控制,减少肿瘤的复发或转移,延长患者的生存期。     

肝动脉栓塞化疗联合经皮乙酸消融双介入治疗巨块型肝癌的护理

目的 探讨肝动脉栓塞化疗(TACE)联合经皮乙酸消融(PAI)双介入治疗巨块型肝癌的护理方法.方法 对38例巨块型肝癌患者首次行常规TACE治疗后l周复查,根据碘油的填充情况,对碘油稀疏和缺损区域进行PAI治疗,间隔30～45 d重复小剂量TACE治疗.结果 治疗后38例患者肿块均缩小,肝动脉造影示肿瘤血管消失20例(52.63%),甲胎蛋白恢复正常31例(81.58%).发生不良反应27例(71.05%).1、2、3年生存率分别为97.37%、84.21%、34.21%.结论 TACE联合PAI双介入治疗巨块型肝癌的疗效较好.术前细致的心理护理和周密的术前准备,术中准确配合、密切观察患者反应并及时配合医生作出相应处理.术后加强不良反应的观察和护理是保证治疗效果的主要措施.     

肝动脉化疗栓塞联合瘤内注射无水乙醇对中晚期肝癌的疗效分析

目的评估肝动脉化疗栓塞(TACE)联合CT引导下经皮穿刺瘤内无水乙醇注射术(PEI)对中晚期肝癌的疗效。方法74例经证实为原发性中晚期肝癌随机分成3组,其中35例采用TACE PEI治疗(TACE PEI组),22例单纯采用TACE治疗(TACE组),17例单纯采用PEI治疗(PEI组)。动态监测肝功能、甲胎蛋白变化,CT或B超下瘤体大小变化,胃纳的变化以及腹部体征。结果3组疗效存在明显差异,TACE PEI组的显效率 有效率明显高于单纯TA-CE组和单纯PEI组,且不良反应发生率低于单纯TACE组和单纯PEI组。结论TACE联合无水乙醇治疗中晚期肝癌,安全可行,较单独使用TACE或PEI治疗达到了更好的局部治疗效果,提高了患者生存质量,延长了存活时间。     

金龙胶囊联合介入治疗原发性肝癌150例临床分析

目的 分析比较原发性肝癌患者接受金龙胶囊联合肝动脉化疗栓塞术(TACE)与单纯介入治疗的效果差异.方法 唐山市人民医院自2003年3月至2012年10月共采用介入疗法治疗原发性肝癌147例.患者随机分为两组,联合治疗组74例接受金龙胶囊联合TACE治疗,单纯介入组73例仅行TACE.比较两组患者的疗效及不良反应发生情况.结果 联合治疗组患者的疗效、治疗后生活质量、肝功能Child-Pugh分级改善情况均优于单纯介入组,在小于5 cm的肿瘤效果显著,两者差异有统计学意义(P＜0.05).白细胞计数上,联合治疗组较单纯介入组改善明显,差异有统计学意义(P＜0.05).结论 金龙胶囊联合介入治疗原发性肝癌效果明显,优于单纯介入治疗,尤其是对肿瘤小于5 cm的小肝癌效果显著.     

肝动脉化疗栓塞术联合CT引导下经皮肝穿刺无水乙醇注射对巨块型肝癌的疗效分析

探讨肝动脉化疗栓塞术(TACE)联合CT引导下经皮肝穿刺无水乙醇注射(PEI)对于巨块型肝癌的临床疗效.将88例巨块型肝癌患者随机分为联合治疗组与单纯治疗组,联合治疗组患者给予TACE联合CT引导下PEI治疗,单纯治疗组患者仅给予TACE治疗.治疗前后比较两组患者的AFP、肿瘤大小,比较两组患者的临床疗效及生存情况.TACE联合CT引导下PEI治疗能够提高巨块型肝癌患者的临床疗效及生存率,值得临床应用.     

肝动脉化疗栓塞联合射频消融术治疗中晚期肝癌的疗效

目的评价TACE联合射频消融(RFA)治疗中晚期肝癌的疗效。方法回顾性分析72例中晚期肝癌患者,其中35例行TACE联合RFA治疗(联合组),37例行单纯TACE治疗(对照组)。术后随访,比较两组短期疗效、治疗后肝功能、血清甲胎蛋白、并发症以及远期生存率。结果联合组术后总有效率(29/35,82.86%)明显高于对照组(20/37,54.05%;P=0.009)。联合组和对照组术后血清甲胎蛋白降至(102.19±32.13)μg/L、(218.46±49.87)μg/L(P0.001)。联合组1、2、3年生存率分别82.86%、54.29%、34.29%,中位生存期25个月;对照组分别为54.05%、32.43%、13.51%,中位生存期16个月;两组生存率差异有统计学意义(P=0.009)。联合组及对照组治疗后肝功能均有一过性改变,术后2周基本恢复,两组比较差异无统计学意义(P均0.05)。结论 TACE联合RFA治疗中晚期肝癌是有效的综合介入治疗方法。     

实时超声造影在肝癌介入术中的应用价值

目的 探讨实时超声造影在肝癌微创介入治疗中的应用价值.方法 63例肝癌患者在分别接受经肝动脉化疗栓塞术(TACE)、射频消融(RFA)和微波消融(MCT)治疗中及治疗后,采用实时超声造影对其中76个病灶检查,并与常规超声、CT、数字剪影血管造影(DSA)比较.结果 TACE组21个病灶治疗后1个月, 超声造影显示13个病灶有部分残留,与DSA结果 一致.RFA组和联合治疗组(TACE和RFA,TACE和MCT)共55个病灶在首次接受RFA及MCT治疗后即刻行彩色多普勒超声(CDFI)检查,检出6个病灶部分残留,而超声造影检出24个病灶部分残留.介入治疗后最后一次随访中,超声造影显示有20个病灶部分残留、55个病灶治疗完全、1个病灶判断不明确,与最终诊断比较,在诊断准确性上,超声造影明显优于CDFI(P=0.039),超声造影与增强CT比较,差异无统计学意义(P=0.930).结论 实时超声造影可以增加检测肝癌的血流信号强度,有助于确定介入治疗范围,尤其对于在介入治疗短期内需多次确定疗效者以及消融治疗中即刻评价疗效者,更具优势.     

TACE术后超声引导下经皮无水乙醇注射术联合微波消融治疗特殊部位肝癌

目的评价TACE术后超声引导下经皮无水乙醇注射术(PEI)联合微波消融治疗邻近胆囊、膈肌、心脏、胃肠道、肾脏、大血管等重要组织器官(距离≤0.5 cm)的特殊部位早期及中期原发性肝癌的安全性及疗效。方法对40例特殊部位早期及中期原发性肝癌患者于TACE后1周行超声引导下PEI联合微波消融,在肿瘤邻近重要组织器官一侧注入无水乙醇,同时行低功率(40～50 W)、短时间(4～5 min)微波消融;观察不良反应及并发症情况,并随访评价疗效。结果术后未发生严重不良反应及并发症,仅部分患者出现肝区疼痛(17/40,42.50%)、发热(15/40,37.50%)、恶心及呕吐(12/40,30.00%),均经对症治疗后好转;2例术后出现少量胸腔积液,后积液自行吸收。出院后1个月肿瘤完全消融率为97.50%(39/40)。随访至出院后12个月,4例发生肿瘤局部进展。结论超声引导下PEI联合微波消融是治疗特殊部位早期及中期原发性肝癌安全、有效的方法。     

阻断肿瘤血供后微波凝固治疗肝癌的临床研究(附120例临床分析)

目的探讨阻断肿瘤血供后微波凝固治疗肝癌的疗效。方法120例经组织学证实的肝癌病人，104例为原发性肝癌，16例为转移癌，共289个肿瘤结节，分为两个治疗组：（1）经导管动脉化疗栓塞（TACE）后1～2d内行超声引导下微波热凝固治疗（PMCT）70例；（2）手术中暂时阻断肝门血流后行肝癌微波热凝固治疗（MCT）50例。结果治疗中B超监测微波凝固范围显示：单电极60w、180S时，TACE＋PMCT组和术中阻断肝门血流＋MCT组肿瘤凝固体积分别为20～92CITI。和18～85cm^2，明显超过单纯的微波热疗时8～15cm^2。的凝固体积；治疗后随访6～36个月，98例病人AFP转为正常水平，占81．7％；59例病人再活检，其中肿瘤完全坏死者为48例，占81．4％；TACE＋PMCT组有66例肿瘤不同程度缩小（94.2％）；术中阻断肝门血流＋MCT组有43例肿瘤不同程度缩小（86％）；两组半年，1，2年生存率分别为96．5％、89．3%、79．9％和95．5％、85．5％、63．3％。结论无论是TACE联合PMCT，还是术中阻断肝门血流联合MCT治疗肝癌，两种方法均可显著地增强微波热疗的局部作用，扩大肿瘤凝固坏死范围，从而更加有效地杀灭肝癌细胞。     

腹腔镜下应用微波技术治疗肝癌

目的探索微创性治疗肝癌的新途径。方法１９９５年８月～１９９６年１０月应用腹腔镜和微波技术,对２例周边型肝癌病人行微波凝固止血后肿瘤切除,５例不能手术切除的肝癌病人行肿瘤病灶微波固化治疗。结果２例肝切除者,１例术后６个月复发,但２例存活时间均达２０个月。微波固化者存活时间６～１６个月。结论微波凝固止血可有效地控制肝切面的渗血,从而减少了腹腔镜切肝的风险和困难。微波固化可使２ｃｍ范围内的肝组织凝固坏死,肝癌细胞失活。对于不可切除的晚期肝癌或伴有严重肝损害不宜手术切除的肝癌,是一种简便、安全、微创而有效的治疗方法。     

Risk of Hepatic Artery Complications After Liver Transplantation in Patients Who Received Pretransplant Transarterial Chemoembolization Therapy: A Single-Center Experience

BackgroundPretransplant transarterial chemoembolization (TACE) for patients with hepatocellular carcinoma (HCC) has been associated with an increased risk of hepatic artery thrombosis (HAT) after liver transplantation (LT). Innovative surgical LT and interventional vascular radiology TACE techniques may mitigate the risk of HAT. We sought to investigate the incidence of HAT after LT in patients who received pre-transplant TACE at our center.MethodsWe performed a single-center retrospective review of all LT patients, >18 years of age, from October 1, 2012, to May 31, 2018. Outcomes were compared between patients who received pre-LT TACE and those who did not. Median follow-up was 26 months.ResultsAmong the 162 LT recipients, 110 (67%) patients did not receive pre-LT TACE (Group I), while 52 (32%) received pre-LT TACE (Group II). The <30-day incidence rates of post-LT HAT were as follows: Group I = 1.8% and Group II = 1.9% (P = .9). Most hepatic arterial complications occurred >30 days after LT. Based on competing risks regression analysis, TACE was not associated with an increased risk of HAT. Patient or graft survivals were comparable between the 2 groups (P = .1 and .2, respectively).ConclusionsOur study shows a similar incidence of hepatic artery complications post-LT in patients who received TACE before LT compared with those who did not. In addition, we suggest that the surgical technique of early vascular control of the common hepatic artery during LT, in combination with a super-selective vascular intervention radiology approach, has clinical utility in reducing the risk of HAT in patients requiring pre-transplant TACE.     

腹腔镜下微波固化治疗肝海绵状血管瘤

目的 探讨腹腔镜下肝海绵状血管瘤微波固化治疗的可行性及方法.方法 回顾性分析2005年2月至2010年1月在腹腔镜下行微波固化治疗肝海绵状血管瘤40例之疗效和1年随访结果.结果 40例在腹腔镜下行微波固化肝海绵状血管瘤,无严重手术并发症.32例术后随访1年无复发,余8例失访.结论 严格掌握适应证,经腹腔镜下微波同化治疗...     

TACE联合RFA与TACE联合冷循环微波刀治疗原发性肝癌的疗效比较

目的评价比较肝动脉化疗栓塞(TACE)联合射频消融(RFA)以及TACE联合冷循环微波刀治疗原发性肝细胞癌(HCC)的效果。方法 50例患者接受TACE联合RFA,60例患者接受TACE联合冷循环微波刀治疗术。术后4周复查动态增强CT,观察疗效。采用Tyko Radinics CooltipTM systerm进行RFA,ECO-100冷循环微波肿瘤治疗系统进行微波刀治疗。结果治疗后1个月,两组患者肿瘤一次消融率分别为70.00%和87.67%,TACE联合冷循环微波刀组肿瘤完全坏死率高于TACE联合RFA组(P0.05)。结论 TACE联合采用Tyko Radinics CooltipTM进行RFA以及TACE联合ECO-100冷循环微波肿瘤治疗系统进行微波刀治疗均为原发性肝细胞癌的有效治疗方法,后者是单纯TACE疗效不佳者的较理想选择。     

Experimental application of microwave tissue coagulation to ventricular myocardium

BACKGROUND: It is difficult to create transmural lesions in a beating, normothermic perfused heart. The aim of this study was to evaluate the effect of microwave tissue coagulation on a beating heart. METHOD: We used a microwave tissue coagulator that emits microwaves of 2,450 MHz. Studies were conducted on 30 mongrel dogs weighing between 9 and 13 kg, and microwave tissue coagulation was performed at the free wall of the left ventricle in a beating heart without cardiopulmonary bypass. RESULTS: Microwave tissue coagulation created transmural degenerated lesions in the left ventricle without risk of ventricular rupture. The lesion width of microwave ablation increased from 10 to 60 seconds. Histologic examinations revealed well-demarcated areas of heat degeneration consisting of coagulation necrosis and contraction band necrosis of the myocardium. The lesion healed to hard scar tissue, which was sharply demarcated from the normal myocardium. No animals had inducible ventricular tachycardia through programmed ventricular stimulation. CONCLUSIONS: Microwave ablation with a monopolar antenna created transmural lesions with only a few proarrhythmic events occurring during ablation.     

微波消融与肝动脉栓塞治疗肝血管瘤的对照研究

目的:比较微波消融与肝动脉栓塞治疗肝血管瘤的疗效.方法:对2009年1月-2012年4月院收治的70例肝海绵状血管瘤患者随机分为消融组(37例,在局部麻醉B超引导下穿刺定位或全麻后腹腔镜直视下穿刺肝血管瘤微波消融治疗)和栓塞组(33例,采用超选择性肝血管瘤动脉注射平阳霉素碘油乳剂栓塞治疗),对比观察两种治疗方法的效果.结果:术后6个月,消融组有9例(24.32％)血管瘤残留血供,进行第2次微波消融治疗;栓塞组有18例(54.55％)血管瘤残留血供,进行2次治疗(肝动脉栓塞治疗13例,微波消融治疗5例).术后12个月随访,消融组31例(83.78％)瘤体缩小幅度达75％以上,瘤体血供完全消失,6例(16.22％)瘤体缩小＜75％,瘤体血供大部分消失;栓塞组15例(45.45％)瘤体缩小达75％以上,瘤体血供完全消失,18例(54.55％)进行2次治疗后瘤体缩小＜75％,瘤体血供大部分消失,两组间差异有统计学意义(P＜0.01).结论:微波消融治疗肝海绵状血管瘤效果可靠,且在缩小瘤体和减少病灶血供上优于肝动脉栓塞术.     

腹腔镜下应用新型微波刀切除肝癌20例报告

目的探讨新型微波刀切除肝癌的可行性. 方法腹腔镜下应用HWB-2D型微波刀对20例周边型肝癌行肿瘤切除术. 结果 20例腹腔镜肝癌切除术均顺利完成,手术时间1.5～4 h,中位时间110 min.术中出血量20～200 ml,平均110 ml.2例分别于术后第9、13个月肝癌复发;19例随访,1年生存率为94.7%(18/19). 结论腹腔镜下应用HWB-20型微波刀行肝癌切除术,可有效地控制肝切面的出血;微波刀切割的同时可杀灭可能残留的肝癌细胞,降低了术后肝癌的复发.微波刀肝癌切除术适宜于肿瘤位于肝脏周边(II、III、IVa、V、VI段),直径＜10 cm,无周围脏器受累,是一种简便、安全、微创而有效的治疗方法.     

Comparison of the effects of in-vivo thermal ablation of pig liver by microwave and radiofrequency coagulation

Microwave and radiofrequency coagulation is frequently used for the treatment of hepatic tumors. However, differences between these types of therapy have not been clearly demonstrated so far. We performed both types of thermal ablative treatment on pig liver, and compared the size and shape of the coagulated areas produced. The effects of combining both treatments and interrupting hepatic blood flow were also evaluated. The liver of an anesthetized pig was thermally coagulated, with or without interruption of hepatic blood flow, using a needle electrode at 40 W for 150 s with 2450-MHz microwaves and/or with a 460-kHz radiofrequency current. The diameters of the coagulated areas in the liver were 20 ± 3 mm (mean ± SD; n = 4) after microwave coagulation and 28 ± 3 mm following radiofrequency coagulation when blood flow was not interrupted, whereas they were 31 ± 2 mm and 37 ± 3 mm, respectively, when blood flow was interrupted. When these treatments were combined sequentially, the diameters of the lesions were 43 ± 3 mm and 29 ± 2 mm with and without blood flow interruption, respectively. The ellipticity of the coagulated area, as measured by the largest-to-smallest ratio of its diameters, was 2.3 ± 0.4 after microwave coagulation and 1.1 ± 0.1 following radiofrequency coagulation. We conclude that radiofrequency coagulation produces a larger and more spherical coagulated area in the liver (P < 0.01) than does microwave coagulation. The lesion becomes larger (P < 0.05) with both treatments when hepatic blood flow is interrupted during the treatment. The sequential combination of these treatments produces a much larger lesion (P < 0.05) than that produced by either treatment alone. Received: November 8, 1999 / Accepted: August 12, 2000     

经肝动脉化疗栓塞-冷循环微波刀序贯治疗老年肝癌患者的疗效分析

目的探讨经肝动脉化疗栓塞-冷循环微波刀序贯治疗（TACE-PPMCT）老年肝癌患者的疗效。方法对44例60岁以上原发肝癌患者（原发灶44个伴16个转移灶）行TACE1周后,在CT引导下行PPMCT,术后1个月行CT增强和DSA造影。观察术中、术后并发症的发生情况,比较治疗前后肿瘤直径的变化、AFP水平变化;术后随访6～18个月。结果除1例患者术中出现窦性心动过缓外,未见其他术中及术后并发症。术后1个月44个原发灶中36个完全坏死（81.82%）,6个不完全坏死（13.64%）,2个部分坏死（4.54%）;16个转移灶中12个完全坏死（75.00%）。术前AFP升高的32例患者中30例术后AFP下降,其中22例降至正常;另2例术后AFP升高。随访6～18个月,生存44例,复发转移8例,其中6例为术后12个月内出现。结论 TACE-PPMCT治疗老年原发性肝癌创伤小、并发症少、安全,疗效可靠。