肝癌微波热凝固疗法研究

肝癌微波热凝固疗法研究中国医科大学第一临床学院普外一科（沈阳，１１０００１）王凤山何三光刘永锋对于不能切除的中晚期肝癌及切除后复发的肝癌，近年来临床上开展了微波热凝固疗法（ＭＴＣ）并取得了良好的效果［１，２］。本实验应用大鼠进行肝脏局部微波热凝固，研...     

经皮微波热凝固联合^125I放射性粒子植入治疗晚期肺癌

目的探讨经皮微波凝固治疗（percutaneous microwave coagulation therapy,PMCT）联合^125I放射性粒子植入治疗晚期肺癌的临床疗效及可行性。方法22例晚期肺癌（鳞癌15例,腺癌7例）,瘤体最大径5-12 cm,在CT引导下行PMCT联合^125I放射性粒子植入治疗。病灶位于胸壁上或大血管、大气道周围的部分划为粒子治疗区域,其他病灶的大部分区域为PMCT区域。结果22例PMCT均为1次手术、多点治疗,共植入^125I粒子712颗,平均每例植入32.4颗粒子。术后2个月并发症包括少量咯血（7例）、气胸（4例）、PMCT术后发热（17例）、肺部炎症（11例）、少量胸腔积液（6例）及粒子移位（2例）。PR 15例,SD 5例,PD 2例,有效率68.2%（15/22）。15例术前疼痛者治疗后疼痛完全消失（11例）或明显减轻（4例）。22例随访4-18个月,平均7个月,PR、SD的病灶均未见增大。结论PMCT联合^125I粒子植入治疗病灶≥5 cm的晚期肺癌疗效肯定、微创、安全。     

超声引导下经皮微波凝固治疗肝癌20例临床分析

目的分析超声引导下经皮微波凝固(percutaneous microwave coagulation therapy,PMCT)治疗原发性肝癌的疗效。方法20例原发性肝癌患者均为单发结节,行PMCT治疗。结果除1例因肿瘤残留加行PMCT外,余19例均行一次整体覆盖原位灭活凝固治疗。术后均有轻微上腹痛、发热,可自行消失。1例穿刺点皮肤轻度烫伤,无其他并发症。随访3~15个月,B超示19例患者(95%)肿块内血流信号消失,增强CT或MRI显示18例(90%)治疗后无强化,3月后15例(75%)AFP转正常水平,肿块缩小率85%,随访期间总生存率90%。结论PMCT一次整体原位灭活治疗肝癌方法简单、省时、安全,疗效肯定,值得推广。     

经皮微波凝固治疗不能切除肝癌及其疗效分析(附108例报告)

目的 探讨经皮微波凝固治疗不能切除肝癌的方法并观察其疗效。方法 1999年10月至2001年4月运用UMC—1型超声引导微波凝固治疗仪治疗108例不能切除肝癌，肿瘤直径3—18cm，其中≤5cm者7例，1个肿瘤者56例，2个以上肿瘤者52例，伴门静脉主支癌栓23例。在B超引导下，穿刺至肿瘤部位，每次输出功率60W，作用时间300s，每100s间歇20s。肿瘤直径＜3cm者经行1—2次微波治疗，≥3cm以上者行多点多次(＞2次)治疗。结果 68例AFP阳性病人中32例(42％)降至正常，14例(20．6％)AFP有不同程度下降；治疗后3个月肿瘤直径平均缩小3．0cm；术后6个月、1年、2年生存率分别为80．7％、62．9％及35．1％，108例中18例因肿瘤缩小获二期切除。结论 不能切除的中晚期肝癌可用经皮微波凝固治疗，其安全、方便、易行，疗效佳。     

超声引导经皮微波凝固治疗肝癌的临床研究

目的 探讨超声引导下经皮微波凝固治疗肝癌的临床价值，方法 51例肝癌病人的83个结节采用输出功率为60W．作用时间为240～300秒的微波治疗，结果 平均随访期为23个月，80．7%(67／83)病灶缩小．85．5%(59／69)的病灶内血流消失．CT平扫显示所有病灶密度降低，其中81．6%(40／49)病灶无明显强化．21例治疗前甲胎球蛋白升高的病人．治疗后全部明显下降．其中17例降至正常。17例病人治疗后再次活检．15例呈完全性坏死。结论 超声引导下经皮微波治疗肝癌是一种安全、有效的治疗方法。     

CT引导经皮微波凝固治疗肝癌并发症的临床分析

目的分析CT引导经皮微波凝固治疗（PMCT）肝癌的相关并发症发生的原因、治疗及其预防方法。方法对68例肝癌患者接受CT引导PMCT治疗后的并发症的临床资料进行回顾性分析。结果肿瘤直径为2.013.8 cm,平均6.2 cm,其中64例接受PMCT前接受肝动脉化疗栓塞（TACE）。68例患者共接受120例次PMCT治疗,术中主要不良反应是迷走神经亢进反应。发生手术相关并发症7例次,包括肝脓肿和针道种植各2例次,气胸、心血管意外和巨大胆汁瘤合并感染各1例次;6例次并发症治愈,1例次种植肿瘤进展。结论CT引导PMCT治疗肝癌的并发症少且可以防治,并发症与穿刺路径、次数、凝固范围以及围手术期处理等有关。     

超声引导经皮穿刺微波消融治疗肺癌

目的 探讨超声引导经皮穿刺微波消融治疗周围型肺癌的疗效及可行性。方法 对17例周围型肺癌的23个肿瘤结节行超声引导微波消融治疗,先用60W、100s,然后30～40W、300～600s,直径≥3cm的肿瘤一次多点凝固。结果 微波消融治疗后肿瘤结节均有缩小,内部血流信号消失（14个结节）或减少（9个结节）;增强CT检查16个肿瘤结节无强化,7个部分强化;4例活检治疗区肿瘤完全坏死。微波消融治疗后1个月8例临床症状消失,9例症状减轻。15例随访6～47个月,平均23个月,9例存活,无严重并发症发生。结论 超声引导微波消融治疗周围型肺癌安全、可行、有效。     

CT引导下经皮微波消融治疗老年患者周围型非小细胞肺癌

目的 观察CT引导下经皮微波消融治疗（PMCT）对老年周围型非小细胞肺癌（NSCLC）患者的有效性及安全性。方法 回顾性分析接受CT引导下PMCT治疗的34例老年周围型NSCLC患者,其中肿瘤直径≤3 cm（小病灶）16例,3 cm<直径≤5 cm（中病灶）11例,>5 cm（大病灶）7例。术后随访,分别于3、6、12、24个月采用改良实体瘤疗效评价标准（mRECIST）评估疗效,并统计生存率。结果 对34例患者的34个肺内病灶均消融完全,术中及术后均未见严重并发症。术后3、6、12及24个月累计疾病控制率（DCR）分别为100%（34/34）、97.06%（33/34）、91.18%（31/34）及85.29%（29/34）;术后6、12及24个月生存率分别为100%（34/34）、94.12%（32/34）及85.29%（29/34）。术后24个月,小、中、大病灶患者累计DCR分别为100%（16/16）、81.82%（9/11）及57.14%（4/7）,生存率分别100%（16/16）、90.91%（10/11）和42.86%（3/7）,小、中病灶患者累计DCR及生存率均高于大病灶患者（P均<0.05）。结论 CT引导下PMCT治疗老年患者周围型NSCLC疗效确切,安全性高。     

微波凝固术治疗尖锐湿疣130例

尖锐湿疣是由人乳头瘤病毒感染引起的一种性传播疾病,传染性强,治疗方法多样,但疗效不一.我们1998年6月-2004年6月采用微波组织凝固术治疗130例,效果良好,现报告如下.     

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。     

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目的 探讨经皮微波凝固疗法（PMCT）对小肝癌结节的疗效。方法 PMCT治疗直径＜3cm的肝细胞癌（HCC）27例共44结节。观察局部疗效、生存率及复发情况。结果 肿瘤完全消融率达95．5％，1年、2年和3年生存率为96．2％、81．4％和81．4％。局部复发率为2．3％，远处复发率为59．3％。结论 PMCT对直径3cm以下的肝癌结节效果满意，创伤小，简便经济，具有很高的临床实用价值。     

Intraoperative microwave coagulation therapy for large hepatic tumors

We report new surgical techniques for intraopera-tive microwave coagulation therapy (IMCT), conducted in three patients with large liver neoplasms with poor liver function or difficult tumor location. Anterolateral thoracotomy was performed for tumors in the right lobe to obtain a good operative field. Four electrode needles were inserted for microwave irradiation, with settings of 60 W, 45 s for coagulation and 1 s for dissociation. Clamping of the hepatoduodenal ligament was performed during IMCT. We began the coagulation at the bottom of the tumor, irradiating the tumor and the surrounding parenchyma to create regional necrosis with a safe margin. With these methods, we treated two women diagnosed with large hepatocellular carcinoma with liver cirrhosis and a man with liver metastasis from rectal cancer. The postoperative course of these patients was uneventful. A marked low-density area was seen in the region of therapy and no enhanced findings were observed on enhanced computed tomography postoperatively. However, in one patient, transcatheter embolization (TAE) was performed 1 month postoperatively because recurrence was noted on the bottom of the tumor. Thus, IMCT destroys the peripheral part of the tumor that may remain viable after TAE, but combination therapy with TAE is preferable, especially when a viable part exists within tumors. IMCT is an active, safe, and nontoxic therapeutic modality for large hepatic tumors, and is particularly applicable in patients with large hepatocellular carcinomas and poor liver function. Received: April 30, 1999 / Accepted: June 16, 2000     

超声引导下微波治疗术后复发肝癌

目的探讨超声引导行微波治疗肝癌术后复发癌块的疗效。方法用常规超声和超声造影以及CT对17例肝癌术后复发病例经超声引导下微波治疗,进行疗效观察。结果微波治疗后17例26个病灶,一次消融率达84.6%(22/26),余4个病灶再次微波治疗后完全消融。结论超声引导下微波治疗肝癌术后复发肝癌,疗效好,受创伤小,操作简便,可重复,是一种有效的治疗方法。     

微波治疗肝血管瘤的现状

【摘要】〓简述目前微波固化治疗肝血管瘤的进展,主要介绍了微波固化的原理、治疗方式、并发症及防治、适应症等,为肝血管瘤微波固化规范治疗奠定基础。作为肝血管瘤重要的微创技术之一,微波消融的规范化将有助于其临床应用的推广及发展。     

Liver abscess formation after microwave coagulation therapy applied for hepatic metastases from surgically excised bile duct cancer: report of a case

We report the case of a liver abscess associated with microwave coagulation therapy (MCT). A 67-year-old man underwent a pylorus-preserving pancreatoduodenectomy for bile duct cancer in August 1998. In June 1999, abdominal computed tomography (CT) showed three low-density areas in his liver. With a diagnosis of multiple metastatic liver tumors, we applied MCT to each liver tumor. The patient presented with fever after therapy. Abdominal CT showed a hepatic abscess, which was treated by percutaneous transhepatic abscess drainage under ultrasonography. A bacteriological examination of the pus material revealed the presence of Enterococcus faecalis and Candida albicans. Treatment resulted in a rapid resolution of symptoms. Our case indicated that care should be exercised in using MCT for the treatment of liver tumors in patients who have undergone reconstructive surgery of the biliary tract. Received: June 13, 2001 / Accepted: November 20, 2001     

Thoracoscopy-assisted magnetic resonance guided microwave coagulation therapy for hepatic tumors

BACKGROUND: Microwave coagulation therapy (MCT) has become a safe and effective modality with which to treat hepatic tumors; MCT can be applied percutaneously, laparoscopically, thoracoscopically, and during laparotomy. When combined with magnetic resonance (MR) imaging, MCT can be used to treat hepatic tumors located in the subdiaphragmatic area that are difficult to approach by ultrasound, because of the overlaying lower lung field. METHODS: To determine the usefulness of thoracoscopy-assisted interventional MR-MCT (T-IVMR-MCT, n = 73), we compared patients with hepatic tumors that were treated with percutaneous IVMR-MCT (P-IVMR-MCT, n = 69) and with T-IVMR-MCT. RESULTS: None of patient background, complication and recurrence rate, or length of hospital stay significantly differed between the 2 groups. CONCLUSIONS: IVMR-MCT is a useful modality for treating hepatic tumors. Especially when tumors are located at the hepatic dome, T-IVMR-MCT was minimally invasive, while it appears to improve targeting of peridiagmatic hepatic lesions and has a complication profile similar to P-IVMR-MCT.     

Thoracoscopic transdiaphragmatic microwave coagulation therapy for a liver tumor

Background: Microwave coagulation therapy (MCT) for hepatocellular carcinoma, which induces tumor coagulonecrosis, is now recognized as an efficient treatment. However, when a tumor is located just below the top of the diaphragmatic dome, laparotomical MCT requires a large incision, and percutaneous MCT is sometimes impossible. Patients and Methods: The patients were four men and two women. There were four cases of hepatocellular carcinoma and two cases of liver metastasis from colorectal cancer. All tumors were located below the top of the diaphragmatic dome. Thoracoscopic transdiaphragmatic MCT (TTMCT) was performed under general anesthesia using an endotracheal double-lumen tube. Identification of the tumor site in the liver was performed using an ultrasonic probe under thoracoscopic observation. After the diaphragm above the tumor was opened, a needle electrode to transmit microwaves was inserted directly into the tumor. Microwave irradiation was repeated to coagulate the entire lesion. After completion of TTMCT, the diaphragm was closed thoracoscopically. Results: TTMCT was successfully administered to cancerous lesions in all six patients. The postoperative course was uneventful, and the average postoperative hospitalization period was 10.5 days. None of the patients has shown any recurrence during a follow-up period of 4–23 months. Conclusions: TTMCT was performed without any difficulty using the thoracoscopic surgical technique, and its therapeutic outcome was satisfactory. This is effective for tumors located just below the top of the diaphragmatic dome.