超声引导射频消融联合无水酒精注射治疗特殊部位肝癌的效果观察

目的探讨超声引导射频消融(RFA)联合无水酒精注射(PEI)治疗特殊部位肝癌的方法与疗效。方法对进行了超声引导射频消融联合无水酒精注射治疗的41例特殊部位肝癌患者的49个瘤体的临床数据进行回顾性总结分析。49个瘤体的治疗方法:43个经皮超声引导PEI+RFA,3个腔镜超声引导PEI+RFA,3个开腹超声引导PEI+RFA。PEI+RFA的方法:超声引导实时监控下对肿瘤的RFA高危侧,即特殊部位侧进行至少5 mm以上的完整覆盖的PEI,然后对肿瘤行RFA治疗,RFA治疗的布针保持在特殊部位肿瘤内距离比邻器官或管道的5 mm处。疗效评价:术后一月进行肝脏超声造影或增强CT扫描评价术后消融率。结果经皮PEI+RFA的43个瘤体的完全消融率为93.02%(40/43),腔镜及开腹PEI+RFA 6个瘤体的完全消融率均为100%(6/6),全部患者均无邻近器官损伤及腹腔大出血等严重并发症,部分患者有轻度的术后疼痛、低烧等轻微不良反应,无需特殊处理。全部患者治疗后7 d康复出院。结论超声引导PEI+RFA可很好地解决特殊部位肝癌消融治疗的彻底性和安全性,是特殊部位肝癌的效果确切、安全可行的治疗方法。开腹和腹腔镜下消融可提高消融的彻底性。     

射频消融治疗原发性肝癌

原发性肝癌是目前医疗界的难题之一。肿瘤局限于肝脏并非都适合手术切除。原发性肝癌多中心起源的特性，使肝癌切除后肿瘤复发率远高于其它肿瘤^[1]。另外，肿瘤邻近大的血管及胆管，并存的肝硬化而致的肝功能不全均不能保证根治性切除。为解决这一问题各国学者一直在探寻新的治疗方法。现在应用较多的是局部射频消融技术。     

超声引导下激光与射频消融治疗小肝癌的临床疗效差异

目的探讨激光消融与射频消融治疗不同大小和不同位置小肝癌的临床疗效是否存在差异。方法选择56例接受了激光消融治疗和57例接受了射频消融治疗的小肝癌患者,根据其癌灶直径大小和位置进行分组,以是否完全消融作为评价指标,对激光和射频消融的疗效进行分析,判断其是否存在差异。统计方法选用χ~2检验。结果对于不同大小的小肝癌和非高危位置的小肝癌,激光消融和射频消融均有较好的疗效,且疗效差异不存在统计学意义(P0.05)。但对于高危位置的小肝癌,激光消融的完全消融率为92.3%,射频消融的完全消融率为68%,差异具有统计学意义(P=0.0230.05)。此外,在不良反应的发生率上,射频消融的严重不良反应发生率要比激光消融高,且差异具有统计学意义。结论激光消融和射频消融均是治疗小肝癌的有效手段,对于不同大小小肝癌的消融都有着同样的疗效,但是对于高危位置的小肝癌以及在术后不良反应发生的情况上,激光消融则更具有优势。     

射频消融治疗老年和非老年肝癌患者的临床比较分析

手术是治疗肝癌的首选手段,但老年肝癌患者手术耐受性差,抗风险能力低,往往不能耐受手术.经皮射频消融(PRFA)作为一种有效的肝癌治疗手段已被广泛接受,PRFA具有微创、经济、重复性好的优势[1,2],使老年肝癌患者从中获益更多.本研究旨在探讨比较PRFA治疗老年与非老年肝癌患者的临床疗效及影响其预后的危险因素.     

腹腔镜超声在肝癌射频消融治疗中的临床应用

目的: 探讨腹腔镜超声技术在肝癌射频消融(radiofrequency ablation, RFA)治疗中的临床应用.方法: 2007-09/2008-04我院对15例肝癌患者的20个肝内肿瘤实施了腹腔镜超声引导下RFA治疗, 肿瘤直径2.5-7.3(平均4.5) cm. HBV(+)10例, HCV(+)1例, 合并有不同程度肝硬化11例,胆囊结石9例. 其中1个癌灶12例, 2个癌灶1例,3个癌灶2例. 术后采用超声检查及螺旋CT增强扫描评价RFA疗效.结果: 12例顺利完成腹腔镜下射频消融治疗,其中8例同时行胆囊切除术, 单个肿瘤平均射频治疗时间40.2±12.3 min, 平均总手术时间98.7±28.5 min, 平均总出血量145.3±82.8mL. 患者术中、后均未出现严重并发症. 术后随访4-12 mo, 4例射频治疗部位复发, 1例发现肝内新病灶, 均采用经皮射频消融进行治疗.其中有2例患者第3次定期复查时, CT诊断原发性肝癌复发, 外科医生建议行肝移植术, 其余13例随访至今均存活.结论: 在RFA治疗肝癌过程中, 腹腔镜超声引导技术已成为协助外科医生顺利完成手术必不可少的手段之一.     

超声引导经皮集束电极射频消融冶疗中小肝癌

目的：探讨超声引导经皮集束电极射频消融(RFA)治疗中小肝癌(直径≤5cm)的疗效。方法：利用RF-2000^TM肿癌射频治疗系统，在B超引导下对29例中小肝癌患者34个肿块进行经皮肝穿刺射频热凝冶疗，并用B超及CT检查以了解RFA治疗效果，随访观察其复发和生存情况。结果：RFA治疗后93．3％(28／30)的肿块血供消失(另4个直径≤3cm的肿块治疗前即无血供)，且94．1％(32／34)的肿块呈完全凝固性坏死。对有血供的2个肿块再次进行了RFA治疗。随防6月～3年，29例中现存活25例，半年生存率100％。存活的25例中，已有6例生存半年，7例生存1年，7例生存2年，5例生存3年。结论：集束电极RFA治疗中小肝癌创伤小，安全，疗效可靠。     

射频消融治疗心律失常的现状和进展

射频消融技术与心律转复除颤器 (1ＣＤ)使心律失常的治疗发生了革命性变化 ,正如美国著名电生理学家Ｚｉｐｅｓ指出 ,在心脏病学中射频消融心律失常是唯一真正的根治性技术。该项技术自 1986年应用于临床以来 ,取得了巨大的进展。使成千上万的心律失常病人得到了治愈。在我国射     

腹腔镜超声和经皮超声在肝癌射频消融治疗中的联合应用

目的:探讨腹腔镜超声和经皮超声在肝癌射频消融治疗中的联合应用.方法:2007-09/2008-11我院对25例肝癌患者的43个肝内肿瘤在腹腔镜超声和经皮超声引导下行射频消融治疗.肿瘤直径2.7-7.5(平均3.8)cm.本组中,HBV(+)14例,HCV(+)2例,合并有不同程度肝硬化16例,胆囊结石13例.其中1个癌灶14例,2个癌灶3例,3个癌灶4例,4例多发.术后采用超声检查及螺旋CT增强扫描评价RFA疗效.结果:25例患者顺利完成腹腔镜超声引导下射频消融治疗,有4例射频治疗部位复发和3例肝内新发病灶又采取经皮超声引导下射频消融治疗.全部病例中,11例同时行胆囊切除术,在腹腔镜超声引导下,单个肿瘤平均射频治疗时间为39.3±12.1 min,平均总手术时间95.5±25.8 min,平均总出血量148.5±84.3 mL.在经皮超声引导下,单个肿瘤平均射频治疗时间28.3±10.3 min,平均总手术时间50.2±11.5min,治疗后超声检查肝周、腹腔未见明确积液.患者术中、后均未出现严重并发症.术后随访,有3例CT提示原发性肝癌复发,外科医生建议行肝移植,其余22例随访至2008-11均存活.结论:腹腔镜超声和经皮超声在肝癌射频消融治疗中的联合应用,使患者的远期疗效比较满意.     

Intrahepatic dissemination of hepatocellular carcinoma after local ablation therapy

Background/Purpose

We aimed to clarify the histological features of and risk factors for intrahepatic dissemination after local ablation therapy (LAT) for hepatocellular carcinoma (HCC).

Methods

Between April 1992 and December 2005, 192 HCC patients underwent hepatic resection at our department, among whom were 17 patients who had local recurrences after LAT. Eight of these 17 patients had intrahepatic dissemination. The clinical and histological characteristics of these 8 surgically treated patients with intrahepatic dissemination were investigated.

Results

Histologically, numerous intrahepatic metastases were observed, mainly in the same section as the treated tumor, together with main or sectional portal vein tumor thrombi. Before the ablation therapy, the average tumor diameter was 2.1 cm, and 62.5% of the tumors were adjacent to the main or sectional portal vein. In terms of therapeutic factors, 25% of the patients had a prior needle biopsy and 62.5% had insufficient safety margins.

Conclusions

LAT for HCCs (even those less than 3 cm in diameter) adjacent less than 5 mm to the main or sectional portal vein possibly promotes intrahepatic dissemination.     

肝癌局部消融治疗规范的专家共识

局部消融治疗是在影像技术的引导下对肿瘤靶向定位,用物理或化学的方法杀死肿瘤细胞;影像引导技术包括超声、CT和MRI;治疗途径有经皮、经腹腔镜手术和经开腹手术三种.局部消融治疗的特点:一是直接作用于肿瘤,具有高效快速的优势;二是治疗范围局限于肿瘤及其周围组织,对机体影响小,可以反复应用.局部消融治疗在过去20年左右发展迅速,已经成为继手术切除、介入治疗后的第三大肝癌治疗手段,而且由于其疗效确切,特别是在小肝癌的治疗方面,射频消融治疗的疗效与手术切除相近,因此,被认为是小肝癌的根治性治疗手段之一.     

肝癌局部消融治疗规范的专家共识

局部消融治疗是借助影像技术的引导对肿瘤靶向定位,用物理或化学的方法杀死肿瘤组织;影像引导技术包括超声、CT和MRI;治疗途径有经皮、经腹腔镜手术和开腹手术三种。局部消融治疗的特点一是直接作用于肿瘤,     

肝癌的免疫治疗现状及前景

近年来，肝癌的免疫治疗已成为关注的研究热点，展示了广阔的临床应用前景。主要包括以下几个方面：     

Tumor markers after radiofrequency ablation therapy for hepatocellular carcinoma

BACKGROUND/AIMS: The aim of this study was to evaluate the clinical value of measurement of the AFP-L3 fraction before and after radiofrequency ablation (RFA) therapy for HCC, compared with the measurement of total AFP and des-gamma-carboxy prothrombin (DCP). METHODOLOGY: One hundred and twenty-four patients with HCCs were evaluated for their complete response with a 5-mm-thick safety margin around the tumor. Three tumor markers (AFP, DCP, AFP-L3) were measured after RFA therapy, and their clinical significance was studied. RESULTS: Multivariate analysis revealed that of the three tumor makers only AFP-L3 showed significant differences in the survival and disease-free rates. CONCLUSIONS: AFP-L3 is the most reliable tumor marker for estimating overall survival and disease-free survival in patients with HCC effectively treated by RFA in contrast to AFP and DCP.     

Radiofrequency ablation therapy for hepatocellular carcinoma in elderly patients

Background and Aim: With the aging of society, the number of elderly patients with hepatocellular carcinoma (HCC) has been increasing in Japan. The Government of Japan defines elderly as being over 65 and has divided the elderly into two stages: the first elderly stage (< 75 years old) and the second elderly stage (≥ 75). We investigated the efficacy and safety of radiofrequency ablation therapy (RFA) in patients in the second elderly stage in comparison with other HCC patients, retrospectively. Methods: Two hundred six patients with HCC, who were within the Milan criteria, with low‐grade performance status (0 or 1) and a Child‐Pugh classification of A or B were enrolled. All were treated with RFA from January 2000 to December 2008 as an initial therapy and were divided into elderly HCC group (e‐HCC group; ≥ 75, n = 63) and non e‐HCC group (< 75, n = 143), and their clinical data and survival rates were compared. Results: Age and the level of protein induced by vitamin K absence or antagonist (PIVKA‐II) were higher in the e‐HCC group as compared with the non e‐HCC group (78.3 ± 3.2 vs 64.2 ± 7.5 years, 676.3 ± 2643.7 vs 142.4 ± 442.2 mAU/mL: P < 0.01, respectively). There were no significant differences for Child‐Pugh class, tumor node metastasis stage, and Japan Integrated Stage score and in survival rates after 3, and 5 years between the groups (e‐HCC group: 82.5% and 49.7%, respectively; non e‐HCC group: 78.3% and 57.5%, respectively). There were no severe complications in the e‐HCC group. Conclusions: Elderly HCC patients, who have good performance status, should be treated in the same manner and with the same strategy as young HCC patients.     

Secondary hemocholecyst after radiofrequency ablation therapy for hepatocellular carcinoma

A 65-year-old Japanese man underwent radiofrequency ablation (RFA) therapy of a hepatocellular carcinoma. Hemobilia from the intrahepatic bile ducts adjacent to the tumor developed on the fifth day after the RFA therapy. Ultrasonograms and computed tomograms showed swelling of the gallbladder, which was filled with a clot, suggesting the diagnosis of hemocholecyst. The hemobilia resolved with conservative therapy, but a cholecystectomy was performed to manage postprandial abdominal pain. The resected gallbladder was filled with a clot, but injury or ulceration of the gallbladder was absent, suggesting that the hemocholecyst developed secondary to the hemobilia. Secondary hemocholecyst is a rare complication of RFA therapy. The number of cases of secondary hemocholecyst is likely to increase as hepatocentestic therapy becomes more common. Cholecystectomy is indicated for hemocholecyst because spontaneous liquefication and drainage of a clot in the gallbladder usually does not occur. Received: December 10, 2001 / Accepted: March 8, 2002 Reprint requests to: T. Yamamoto