个案报道：三维适形消融治疗肝左叶胆管细胞癌1例

肝细胞癌和胆管细胞癌是常见的两种肝脏肿瘤。不能切除的未经治疗的胆管细胞癌患者预后差,尤其是发生门静脉受侵的患者。目前胆管细胞癌尚无有效的治疗手段。射频消融（radiofrequency ablation,RFA)在不能进行手术切除的肝恶性肿瘤治疗中发挥重要作用,在此,我们报道成功运用射频消融治疗伴有门静脉癌栓的肝内胆管细胞癌一例,该患者共计存活26个月。     

原发性肝内周围型胆管细胞癌的CT诊断

目的：探讨肝内周围型胆管细胞的ＣＴ表现特征。方法：回顾本院１９９３年７月～１９９９年４月经病理证实的３５例肝内周围型胆管细胞癌的ＣＴ表现。结果：ＣＴ检查见３４例病灶呈低密度（９７．１％）,其中２５例（７１．４％）病灶内见囊性更低密度区;病灶均可强化,多为轻、中度强化（２８／３２,８０％）,可延时强化（５／６）;表现为“边缘分叶征”２１例（６０％）,“边缘凹陷征”７例（２０％）,“胆管包绕征”６例（     

外周型肝内胆管细胞癌CT表现

目的：探讨外周型肝内胆管细胞癌的CT表现及特征。方法：回顾性分析经手术及病理证实的33例IHPCC的CT表现。结果：33病例中29例CT平扫表现为低密度实质病灶．4例无明确肿块；肝内胆管扩张23例，扩张胆管合并肝内胆管结石15例。所在肝叶萎缩、肝包膜凹陷征25例，三期增强扫描：早期或动脉期明显强化1例；27例早期周边轻度强化，门脉期延迟期周边向中心明显强化呈片状、条状、分隔状；1例均无强化。结论：肝内胆管细胞癌的CT表现有一定的特征性。     

周围型肝内胆管细胞癌的CT表现

目的：探讨周围型肝内胆管细胞癌（IHPCC）的CT表现及其诊断价值。方法：收集21例经手术病理证实IHPCC的CT表现进行回顾性分析。结果：21例平扫表现为低密度病灶,多数边界不清,伴病灶周边胆管扩张15例,肝内胆管结石9例,胆总管结石2例;伴肝叶萎缩13例,病灶局部肝轮廓凹陷10例;增强扫描动脉期病灶周边环形、结节状强化19例,内部呈斑片状强化7例,线样强化5例、网格状强化4例,静脉期及延迟10~15min后扫描病灶有进一步强化、充填,呈现渐进性强化的特点。发现肝门周围和后腹膜区淋巴结肿大8例,无弥漫性肝硬化表现及门静脉癌栓形成征象。结论：IHPCC与其它肝肿瘤及非肿瘤性病变有着不同的病理和CT表现特征,螺旋CT动态多期增强扫描对IHPCC的诊断具有重要的临床应用价值。     

肝内胆管细胞癌1例

病例 男54岁。因上腹部间歇性闷痛3月余，伴乏力、纳差、尿黄、皮肤搔痒6天入院。     

原发性肝内周围型胆管细胞癌的CT表现

目的分析原发性肝内周围型胆管细胞癌(PIHPCC)的CT表现。方法回顾性分析1992—2005年经病理证实15例PIHPCC的CT平扫和强化表现。结果15例中肝左叶10例,右叶5例;单发12例,多发3例;病变直径3~12cm;圆形6例,分叶形9例,平扫低于肝实质,CT值8~29HU,7例见扩张胆管,1例钙化,2例结石;病变区轮廓膨突8例,萎陷7例。CT强化早期见周围不完全、内部条网状强化,延迟扫描强化显著。结论CT检查对PIHPCC诊断有重要作用。     

周围型肝内胆管细胞癌的CT诊断及鉴别

周围型肝内胆管细胞癌起源于肝内胆管的上皮细胞，是原发肝癌的少见类型。其影像、病理及临床表现均与肝细胞癌有所不同，为进一步提高周围型肝内胆管细胞癌的CT诊断及鉴别诊断水平，本文收集了近年来经手术病理证实的周围型肝内胆管细胞癌10例，着重分析其CT表现，找出CT特征，加深对此病的认识。     

MSCT联合肿瘤标志物对肝内肿块型胆管细胞癌的诊断价值

目的:探讨MSCT联合肿瘤标志物(包括CA19-9、CA125、CEA、AFP)对肝内肿块型胆管细胞癌(IMCC)的诊断及鉴别诊断价值.方法:回顾性分析74例肝占位患者(包括34例IMCC和40例非IMCC患者)的影像及临床资料.总结、分析34例IMCC的CT表现;比较CT单独诊断IMCC及CT联合肿瘤标志物(CA19-9、CA125、CEA阳性,AFP阴性)诊断IMCC的准确率;进行肿瘤大小、强化程度与肿瘤标志物的相关性分析.结果:IMCC CT表现为形态不规则,平扫肿瘤均呈低密度,28例肿瘤内有囊变坏死区,6例体积较小者病灶内密度均匀.CT增强扫描动脉期肿瘤呈环状、网格状轻度强化者16例.门脉期和静脉期33例呈渐进性延迟强化,门脉受侵4例,所在肝叶萎缩8例,邻近肝包膜凹陷15例,肝门、腹膜后淋巴结转移16例.CT单独诊断IMCC的准确率为66.2％(49/74),CT联合肿瘤标志物的诊断准确率为83.8％(62/74),两者差异有统计学意义(P=0.000).肿瘤大小、强化程度与肿瘤标志物的相关性无统计学意义(P＞0.05).结论:IMCC的典型CT表现为动脉期轻度边缘环状强化,门脉期、静脉期呈渐进性强化;CT联合肿瘤标志物可以有效提高IMCC的诊断准确率;肿瘤大小、强化程度与肿瘤标志物无相关性.     

肝动脉化疗栓塞联合CT引导热消融治疗肝内胆管癌

目的 探讨rACE联合CT引导热消融(射频/微波)治疗肝内胆管癌(ICC)的疗效及安全性.方法 回顾分析2009年9月至2013年7月用TACE序贯CT引导下RFA/MWA治疗病理诊断的ICC患者14例,18个病灶,病灶最大径(多个病灶取最大径之和)2.2～7.2 cm,平均(4.2±1.4) cm.TACE随访病灶的完全消融率、手术并发症、无瘤生存时间及总生存时间.结果 15个病灶实现了完全消融,肿瘤的完全消融率为83.3％(15/18),中度并发症的发生率为6.2％,无严重并发症及死亡患者.术后随访6-～44个月,平均(16.0±10.3)个月.至随访结束,死亡6例(42.9％,6/14).完全消融患者的中位无瘤生存时间为17个月,全组患者的中位生存时间为20个月,1、2、3年总体生存率分别为82.5％、41.3％及20.6％.结论 TACE联合CT引导热消融可作为ICC治疗的选择之一.     

Sonography-guided percutaneous microwave ablation of intrahepatic primary cholangiocarcinoma

Objective

To evaluate the efficacy and safety of sonography-guided percutaneous microwave ablation of intrahepatic primary cholangiocarcinoma.

Materials and methods

From May 2006 to March 2010, 15 patients (11 men, 4 women; mean age, 57.4 years) with 24 histologically proven intrahepatic primary cholangiocarcinoma lesions (mean tumor size, 3.2 ± 1.9 cm; range, 1.3-9.9 cm) were treated with microwave ablation.

Results

Thirty-eight sessions were performed for 24 nodules in 15 patients. The follow-up period was 4-31 months (mean, 12.8 ± 8.0 months). The ablation success rate, the technique effectiveness rate, and the local tumor progression rate were 91.7% (22/24), 87.5% (21/24), and 25% (6/24) respectively according to the results of follow-up. The cumulative overall 6, 12, 24 month survival rates were 78.8%, 60.0%, and 60.0%, respectively. Major complication occurred including liver abscess in two patients (13.3%) and needle seeding in one patient (6.7%). Both complications were cured satisfied with antibiotic treatment combined to catheter drainage for abscess and resection for needle seeding. The minor complications and side effects were experienced by most patients which subsided with supportive treatment.

Conclusion

Microwave ablation can be used as a safe and effective technique to treat intrahepatic primary cholangiocarcinoma.     

CT-guided radiofrequency ablation of a bronchogenic carcinoma

We report on the successful use of percutaneous CT-guided radiofrequency ablation (RFA) of a peripheral bronchogenic carcinoma in a 73-year-old patient. RFA was the favoured treatment option in this patient, who owing to comorbid factors was not a candidate for surgery. A 15 G LeVeen Needle Electrode (RadioTherapeutics, Sunnyvale, USA) with an array diameter of 3.0 cm was connected to a 200 Watt Generator (RF 3000, RadioTherapeutics, Sunnyvale, USA) and inserted into a 3.5 cm squamous cell carcinoma of the axillary subsegment of the right upper lobe. RFA resulted in complete tumour necrosis confirmed by histopathological examination. No complications such as a pneumothorax or bleeding occurred. Further clinical experience and prospective studies are necessary to determine the long-term efficacy of RFA in the treatment of lung tumours.     

Delayed-phase dynamic CT enhancement as a prognostic factor for mass-forming intrahepatic cholangiocarcinoma

PURPOSE: To retrospectively determine whether the degree of contrast material enhancement at delayed-phase dynamic computed tomography (CT) for intrahepatic cholangiocarcinoma (ICC) is related to the patient's prognosis after surgery. MATERIALS AND METHODS: Neither institutional review board approval nor informed consent was required for this retrospective evaluation. Thirty-two patients (22 men, 10 women; mean age, 60.8 years; range, 33-80 years) with mass-forming ICC underwent dynamic CT. Delayed CT images obtained 4-6 minutes after the injection of contrast material were evaluated by two radiologists. Patients were classified in consensus into one of two groups: Group 1 included those in whom more than two-thirds of the tumor showed enhancement on delayed-phase scans. Group 2 included those in whom less than two-thirds of the tumor showed enhancement on delayed-phase scans. The imaging findings were correlated with pathologic findings. Survival curves were drawn by using the Kaplan-Meier method, and the differences between the groups were compared with the log-rank test. Multivariate analysis was performed to clarify prognostic factors. RESULTS: There were 13 patients in group 1 and 19 in group 2. The degree of enhancement on the delayed-phase images showed statistically significant correlation with the amount of fibrous stroma (P < .001) and the frequency of perineural invasion (P < .01). The survival rate in group 1 was significantly lower than that in group 2 (P = .016). Multivariate analysis revealed that enhancement of more than two-thirds of the ICC was a significant and independent prognostic factor. CONCLUSION: The degree of enhancement on delayed-phase CT scans is a useful indicator for prediction of the prognosis of patients with mass-forming ICC.     

CT-guided radiofrequency ablation of an aldosterone-secreting primary adrenal tumor in a surgically unfit patient

Because of the speed and efficiency of laparoscopic adrenalectomy, alternative surgical procedures for adrenal adenomas are uncommon. The present report outlines the case of a young patient with an adrenal adenoma causing Conn syndrome who was a poor candidate for surgical treatment. Computed tomography (CT)-guided radiofrequency ablation of the adenoma was performed with a paraspinal approach and injection of dextrose 5% in water. After successful ablation of the 1.8-cm x 1.2-cm mass according to imaging criteria, the patient's symptoms largely resolved.     

肿块型肝内胆管细胞癌与肝脓肿的CT特征及鉴别诊断

目的：探讨肿块型肝内胆管细胞癌(ICC)和肝脓肿的 CT 表现及误诊原因分析,减少误诊率。方法回顾分析经临床手术、穿刺病理证实的肿块型 ICC 21例和肝脓肿20例影像资料,其中10例肿块型 ICC 术前影像误诊为肝脓肿,41例均行 CT 平扫和三期增强扫描。结果边缘强化环不规则、延迟不规则斑片状或片絮状强化、动脉血管穿行或环绕病灶、肝被膜凹陷征、合并肝内胆管软组织结节、肝内胆管扩张、肝门区和腹膜后淋巴结肿大、门静脉受侵狭窄或闭塞提示肿块型 ICC 可能性大。形态规则、环壁光滑完整、环壁周围环状水肿征、延迟分隔状或多环状强化、肿块缩小征、环内低密度类似液性提示肝脓肿可能性大。异常灌注肝脓肿出现几率高且明显。结论肿块型 ICC 与肝脓肿的影像特征有相似之处,又有各自的特征性表现,结合多个征象综合分析有利于正确诊断。     

CT-guided percutaneous radiofrequency ablation of spleen: a preliminary study

OBJECTIVE: The objective of our study was to evaluate the technical feasibility, safety, and changes of platelet counts of CT-guided percutaneous radiofrequency ablation of normal spleen in a porcine model. CONCLUSION: It is feasible and safe to perform CT-guided percutaneous radiofrequency ablation of the spleen in a pig. Although further study is still required in clinical applications, this method can be a minimally invasive and effective therapeutic technique in patients with hypersplenism.     

风险管理在CT引导下经皮肝癌射频消融术围术期护理的应用

 目的 通过提高护理人员的风险管理意识,降低CT引导下经皮肝癌射频消融(PRFA)治疗的风险.方法 通过对CT引导下PRFA风险的识别及评估,加强对风险事件的易发人群和易发环节的管理,提高护理人员对CT引导下PRFA的风险处理能力.结果 运用有效的护理风险管理方法,对149例CT引导下PRFA治疗的肝癌患者实施预防性护理措施,减少了术后并发症,杜绝了护理风险事件.结论 实施风险管理可以减少风险事件的发生,降低风险事件对患者和医院造成的危害,从而提高护理质量.