射频消融治疗方案对肝大肿瘤的临床应用价值

目的　研究建立超声引导对射频消融治疗直径 >3 .5cm肝肿瘤的方案 ,评价对大肿瘤的消融灭活效果。方法　根据治疗范围至少达肿瘤周边 0 .5～ 1.0cm的原则 ,采用 5 .0cm消融灶设计不同大小肿瘤重叠消融的方案。按照数学模型计算建立的治疗方案包括覆盖肿瘤所需的最少消融灶数目、定位模式及实施程序。设立易于把握的实际布针方法。临床应用对象为根据计算方案治疗的原发性肝癌患者71例及肝转移癌患者 42例 ,计 113例 12 4个肿瘤 ,大小为 3 .6～ 7.0cm ,平均 ( 4 .75± 0 .92 )cm。结果12 4个肿瘤共穿刺消融 5 5 4个球灶。治疗后 1个月CT检查显示肿瘤完全灭活率达 87.9% ( 10 9/12 4灶 ) ;随访 3～ 2 7个月 ,局部复发率为 2 4.2 % ( 3 0 /12 4灶 ) ,预测平均无复发生存时间为 17.3个月。 2 5例因肿瘤复发共进行了 3 8次再次治疗 ,其中 17例再治疗 1次 ,8例再次治疗 2～ 3次。并发症 7例 ( 6.2 % ) ,仅 1例复发癌再治疗 1周后肠穿孔需外科手术治疗。结论　超声引导射频消融治疗方案的制定对治疗较大肝肿瘤提供了依据 ,并可指导临床实际应用。治疗结果显示该方法可显著提高肝大肿瘤消融灭活率 ,减少复发 ,证实是一项有效可行的治疗方案。     

运用Cool-tip射频电极肝脏复合消融的实验研究

目的 了解在使用Cool-tip射频电极下肝组织的复合消融特点,为临床制定肝癌消融方案提供参考.方法 分别采用裸露端3cm的单束和裸露端2.5cm集束Cool-tip射频电极对离体新鲜猪肝行多针多点复合射频消融,能量输出0～200W,单次消融时间12min,观察不同针距及布针数所造成的组织凝固范围和形态.结果 单束电极复合消融针距2cm,而集束电极针距3cm,所获得的凝固区重叠好,横向2针2点和不同深度1针2点消融所获得的凝固范围(深径×横径×前后径)分别约为4.0cm×4.5cm×3.0cm、5.8cm×3.5cm×3.0cm;4.7cm×6.5em×4.5cm、6.5cm×4.5cm×4.3cm.集束电极3针3点,呈等边三角形布针,针距3cm,获得凝固范围约为4.8cm×6.4cm×6.8cm.集束电极4针4点,呈菱形布针,针距3cm,所获得的组织凝固范围约为5.0cm× 6.6cm×8.2cm.同针距呈正方形布针,所获得的组织凝固范围约为5.2cm×6.5cm×6.8cm.结论 设计合理的复合消融方案既可以提高消融效率、避免过度消融,又可以获得足够的凝固重叠范围.集束电极复合消融可使射频消融适应症扩大到6cm肿瘤.     

超声引导冷循环射频消融治疗肾癌的研究

目的探讨超声引导(UG)冷循环射频消融(RFA)治疗肾癌的价值。方法对46例不能行手术切除的先天或后天性孤立肾及肾功能不全患者的46个肾肿瘤,在UG行肿瘤RFA治疗,其中左肾肿瘤22例,右肾肿瘤24例,肿瘤直径1.5～5.2cm,平均3.6cm。在UG将射频针穿刺至肿瘤底部行RFA治疗,根据肿瘤大小行多针多点、交叉重叠法RFA治疗。对CDFI显示肿瘤有供血动脉及血供丰富者的肿瘤,先选择高温模式封闭肿瘤供血动脉及肿瘤内血供丰富区,再行RFA,直至消融气化范围覆盖全部肿瘤为止,每点治疗时间为6～12min,治疗结束后选择高温模式封闭针道,防止出血或肿瘤沿针道种植。治疗后1、3、6、12个月行对比增强CT (CECT)复查,评估疗效,如发现肿瘤残留再行追加治疗。结果 46例肾肿瘤患者的46个肿瘤均顺利行RFA治疗,治疗后1～3个月CECT复查,肿瘤完全灭活为80.4%(37/46),肿瘤残留19.6%(9/46),对肿瘤残留者均行再次RFA治疗,治疗后9～24个月肿瘤局部进展7例17.4%(7/46),对肿瘤局部进展患者均行再次RFA治疗。结论超声引导RFA治疗肾癌,能实时监视进针方向,穿刺成功率达到100%,选择多针多点立体定位法RFA治疗,经CECT复查肿瘤完全灭活成功率80.4%,且操作方便,并发症少,为不适合手术切除的肾肿瘤患者提供了一种新的安全有效的治疗方法。     

射频消融治疗肝肿瘤的临床应用价值

【目的】研究建立超声引导射频消融复发率较高的肝肿瘤 (>3.5cm)的治疗方案 ,评价临床应用效果。【方法】根据治疗范围至少达肿瘤周边 0 .5～ 1.0cm的原则 ,采用 5cm消融灶设计不同大小肿瘤重叠消融的方案。按照数学模型计算建立的治疗方案包括覆盖肿瘤所需的最少消融灶数目、定位模式及实施程序。设立易于把握的实际布针方法。临床应用对象为根据计算方案治疗的原发性肝癌患者 83例及肝转移癌患者 5 8例 ,计 14 1例 16 2个肿瘤 ,大小为 3.6～ 7.7(4 .79± 0 .96 )cm。【结果】16 2个肿瘤共穿刺消融 712个球灶。治疗后 1个月CT检查显示肿瘤完全灭活率达 90 .1% (14 6 /16 2灶 ) ,随访 3～ 38个月 ,局部复发率为 2 1.0 % (34/16 2灶 ) ,其中肝转移癌高于原发癌 (P <0 .0 5 ) ;2 6例因肿瘤复发共进行了 39次再次治疗 ,其中 18例再治疗 1次 ,8例再次治疗 2～ 3次。严重并发症为 4 .9% (7/14 1例 ) ,仅 1例复发癌再治疗 1周后肠穿孔需外科手术治疗。【结论】本计算方案的制定为超声引导射频消融治疗 3.5cm以上肝肿瘤提供了依据 ,并可指导临床实际应用。治疗结果显示该方案可显著提高肝肿瘤消融灭活率 ,减少复发 ,具有较高的临床应用。     

提高肝肿瘤射频消融疗效及并发症处理

目的探讨提高超声引导射频消融(RFA)治疗肝癌(HCC)和肝转移癌(MLC)疗效及并发症诊断、预防及处理的方法.方法对不能或不宜手术治疗的HCC 167例,MLC 112例,共计279例,597个癌灶,共进行456人次超声引导下RFA治疗.肿瘤最大长径1.0～10.8 cm,平均4.1cm.275例在门诊进行,4例在术中进行治疗.对直径大于3.5 cm的癌灶根据数学球体覆盖原理计算治疗方案及制定布针方式,以达到大肝癌原位灭活.结果治疗后1 d～1个月CT检查,279例中可见559个癌灶被灭活,有效灭活率达93.6%(559/597个灶);经1～49个月追访,局部复发率为8.2%(49/597个灶);1年、2年及3年生存率HCC为76.3%,57.2%,51.6%;MLC为70.0%,39.7%,20.3%(P＜0.05);最长达4年1个月.发生严重并发症占2.6%(12/456例次),分别为肝被膜撕裂伤出血3例,胆汁瘘2例,肝脓肿、胆管狭窄、胆囊炎、膈肌损伤、肠穿孔、针道转移、皮肤烫伤各1例.该文探讨了并发症的处理方法.结论超声引导RFA作为一种肝癌的微创局部治疗方法,具有疗效好、创伤小、患者生活质量高、可随肿瘤复发反复进行治疗等优点,重视规范的治疗方案及对并发症的正确处理,可有效提高治疗水平.     

超声造影对确定肝癌射频消融范围及治疗策略的应用价值

目的探讨射频消融(RFA)治疗前超声造影(CEUS)对制定消融范围及治疗策略的应用价值,并与RFA前未应用CEUS的治疗组比较疗效。方法161例原发性肝癌符合经皮RFA入选条件患者进行超声引导RFA治疗。其中,77例RFA前采用SonoVue行CEUS检查(CEUS组),84例RFA前未行CEUS检查(非CEUS组)。两组病例的临床资料无明显差异。肿瘤平均直径CEUS组(3.6±1.2)cm,非CEUS组(3.5±1.1)cm。治疗后采用常规超声、增强CT及(或)超声造影等影像检查进行规律性随访,至少随访6个月CT判断肿瘤灭活程度。结果CEUS组77例105灶行RFA治疗,造影动脉期显示59灶(56.2%)肿瘤范围较造影前增大,其中42灶(71.2%)造影前肿瘤边界不清;49灶(46.7%)肿瘤形态较常规超声更不规则,其中39灶(79.6%)为造影前边界不清。造影组>3.5 cm肿瘤52灶,37灶(71.1%)在动脉期显示主荷瘤血管。10例CEUS新发现≤2.0 cm病灶16个,其中3例为肝硬化随访病例,均进行RFA治疗。两组平均治疗次数为1.2次和1.5次。RFA后随访6~36个月,CEUS组完全灭活率高于非CEUS组(95.4%对87.8%,P=0.042)。CEUS组生存期高于非CEUS组[(34.2±1.2)月对(30.2±1.6)月,P=0.028]。结论RFA前CEUS可清晰显示肿瘤浸润范围,灵敏发现卫星灶及其他区域微小病灶,确认荷瘤血管,为准确制定消融方案,施行治疗策略,整体覆盖灭活肿瘤提供了可靠的依据,从而有效地提高RFA对肝癌的治疗水平。     

平行双针法与单纯双针法两种布针模式对肝癌射频消融局部疗效的影响

  目的  比较采用平行双针法与单纯双针法两种布针模式行超声引导下射频消融术治疗肝癌的局部疗效。  方法  回顾性分析2014年1月至2018年12月于北京大学肿瘤医院行射频消融治疗的肝癌患者临床资料。根据射频消融布针模式分为平行双针组、单纯双针组。射频消融治疗后1个月,行增强CT或MRI检查测量消融范围(长径、宽径及厚径)并计算肿瘤灭活率。对患者随访,观察肿瘤局部进展情况。  结果  共281例(370个病灶)符合纳入及排除标准的患者入选本研究,经倾向评分匹配法校正后最终纳入分析111例(111个病灶),其中平行双针组37例(37个病灶),单纯双针组74例(74个病灶)。平行双针组消融厚径大于单纯双针组(均值差=0.39,95% CI:-0.63~-0.15, P=0.002),两组消融长径、宽径差异均无统计学意义(均值差=0.07,95% CI:-0.33~0.20,P=0.631;均值差=-0.03,95% CI:-0.20~0.24,P=0.844)。两组治疗后1个月肿瘤灭活率均为100%;中位随访时间6个月,平行双针组肿瘤局部进展率低于单纯双针组(2.70%比16.22%,P=0.037)。  结论  两种布针模式射频消融均具有较好的肿瘤灭活率,平行双针法可能更易形成较大的消融范围,以完全覆盖肿瘤组织,从而降低肿瘤局部进展率。     

超声引导经皮肝肿瘤射频消融布针策略

超声引导经皮肝肿瘤射频消融(RFA)是最有发展前途的微创技术之一。而肿瘤RFA治疗的关键是目标的定位布针。与不充足的能量蓄积和热对流导致的热量损失相比,不准确的布针可能是导致治疗不彻底的主要原因。本文旨在综述超声引导经皮肝肿瘤RFA的布针策略。     

超声引导扇形立体定位单极冷循环射频消融离体猪肝实验研究

目的 通过离体猪肝的实验研究为超声引导扇形立体定位单极冷循射频消融(RFA)治疗肝癌提供参考依据.方法 应用单极冷循环射频消融治疗仪,取新鲜离体猪肝20个,分成2组,每组10个,应用单点和多点2种方法 进行实验.单点每次消融时间分别设定为6、8、10、12 min;多点扇形立体定位按设计为1针2点、2针4点、3针6点、4针8点法,每次消融时间设定为6 min.电极间的间距为2 cm,发射功率分别设置为50、70、90、120 W,在超声引导下行穿刺新鲜猪肝进行射频消融.超声实时观察猪肝声像图变化.切开猪肝观察及测量凝固范围,计算消融凝固面积,并将两组消融的面积进行比较;同时行病理检查.结果 声像图显示强回声气化区域逐渐扩大,离体猪肝凝固性坏死面积随时间及功率的增加逐渐扩大,扩大到一定范围后不再扩大.切开猪肝观察,单点消融区域的形态呈椭球形;多点扇形立体定位离体猪肝消融区域的形态呈类圆形,消融范围明显大于单点消融.镜下:RFA治疗区周围1 cm肝细胞正常,作用区细胞脱落、松解、变性,大片坏死区,失去小叶结构.结论 多点扇形立体定位消融范围明显大于单点消融,能够达到预期的治疗目的,估计具有一定临床实用价值.     

超声引导射频消融对136例肝转移性肿瘤的应用价值

目的探讨超声引导射频消融治疗肝转移癌的疗效及临床应用价值.方法经皮射频消融(RFA)治疗肝转移癌136例347个病灶.原发灶来自消化道肿瘤99例,乳腺癌17例,肺癌12例,其他8例.病灶最大径1.4～7.7 cm.首次射频治疗前57例为单发病灶,≥3个病灶者42例.所有患者射频治疗后1个月均行增强CT检查判断病灶灭活状况,并随访患者生存期,随访时间为3～51个月.结果治疗后24 h或1个月增强CT检查,肿瘤灭活率为95.1%.经随访共有39个病灶(11.2%)在2～19个月局部复发增大.RFA治疗后局部灭活率及复发率与病灶大小有密切关系.55例(40.4%)在RFA后1～16个月内肝脏其他部位出现新生转移灶,初次RFA治疗时病灶越少肝内出现新生转移灶的比例越小,而与RFA治疗前病灶大小无关.本组病例平均生存期为(26.22±1.85)个月.1年生存率80.3%,2年生存率43.8%,3年生存率28.8%.RFA治疗后复发未再行治疗与复发后RFA治疗1～2次患者的生存期比较有统计学意义,而与复发后再次治疗3～4次者无明显差异.发生较严重并发症3例,经保守治疗后恢复.结论超声引导RFA治疗肝脏转移癌局部灭活率高,并发症较少,可有效延长生存期;对单发病灶疗效显著,对再发或复发病例可随肿瘤的复发转移多次治疗,显示了RFA治疗肝转移癌的良好应用前景.     

对比经皮微波消融与射频消融治疗肝癌疗效的Meta分析

目的 对比分析微波消融(MWA)与射频消融(RFA)治疗肝细胞肝癌(HCC)的疗效。方法 对相关电子文献数据库进行检索,筛选并确定2014年5月以前发表的符合纳入及排除标准的有关MWA与RFA治疗HCC疗效对比的随机对照试验(RCTs)、前瞻性及回顾性对比研究。采用固定效应模型或随机效应模型合并相对危险度以及95%可信区间。结果 共纳入8篇文献,总计766例患者。MWA组与RFA组的肿瘤完全消融率、主要并发症发生率、1年及3年总生存率、1年及3年无瘤生存率差异均无统计学意义(P均>0.05)。不同大小HCC亚组分析显示,对于≤5 cm的HCC,MWA组与RFA组肿瘤完全消融率、主要并发症发生率、总生存率及无瘤生存率差异均无统计学意义(P均>0.05)。结论 MWA对于HCC的疗效与RFA相当。随着相关技术的发展,改良后的MWA在今后应用前景可观。     

Microwave ablation for liver tumors

Surveillance programs and widespread use of medical imaging have increased the detection of hepatic tumors. When feasible, surgical resection is widely accepted as the curative treatment of choice, but surgical morbidity and mortality has spurred the development of minimally invasive ablative technologies over the last 2 decades. Microwave ablation has emerged as a promising thermal ablation modality with improving oncologic efficacy due to technical improvements and image guidance strategies. This article provides an overview of microwave application in liver tumors, and we discuss currently available equipment, clinical efficacy, and safety and provide comparisons with other commonly used therapies. This article also introduces advanced ablative techniques and combination therapies that may help achieve precise ablation and further enhance the efficacy of microwave ablation.     

Catheter ablation for cardiac arrhythmias

The safety and efficacy of catheter ablation for treatment of most types of cardiac arrhythmias are well established. These arrhythmias and arrhythmia substrates include AVNRT, accessory pathways, focal atrial tachycardia, atrial flutter, idiopathic ventricular tachycardia, and bundle-branch re-entry. Catheter ablation is considered as an alternative to pharmacologic therapy in the treatment of these cardiac arrhythmias.     

Radiofrequency ablation for cancer-associated pain

Many treatment options are available for the management of cancer pain including drugs, local excision, radiation, brachytherapy, and nerve blocks. Percutaneous radiofrequency ablation has been used to treat painful neurologic and bone lesions and thus could potentially be used to treat cancer pain in other sites. Two superficial subcutaneous metastatic nodules were treated with percutaneous radiofrequency ablation. The patient received significant pain relief and improved quality of life.     

Caring for women undergoing cardiac ablation

Radiofrequency cardiac ablation (RFCA) has become the treatment of choice for many cardiac arrhythmias that have not responded to medication. Complications of cardiac ablation include bleeding, thrombosis, pericardial tamponade, and stroke. Many complications are procedure specific, and several complications can be avoided with appropriate nursing care. Quality patient outcomes begin with competent nursing care. Therefore it is vital for a patient undergoing a percutaneous cardiac ablation procedure to receive supportive care and pre- and post-interventional patient education. This article discusses the nursing care of women undergoing RFCA.     

Radiofrequency ablation for chronic pain control

With an increased knowledge of neural anatomy and technologic improvement, radiofrequency ablation (RFA) became an often-used technique for the pain control over an extended time period. Today, RFA is used safely for spinal pains of facet or discogenic origin, sympathetically maintained pain, and other pains of neural origin.     

Optimal approach for complete liver tumor ablation using radiofrequency ablation: a simulation study

Purpose: To investigate the effect of radiofrequency ablation (RFA) electrode trajectory on complete tumor ablation using computational simulation.

Material and methods: The RFA of a spherical tumor of 2.0?cm diameter along with 0.5?cm clinical safety margin was simulated using Finite Element Analysis software. A total of 86 points inside one-eighth of the tumor volume along the axial, sagittal and coronal planes were selected as the target sites for electrode-tip placement. The angle of the electrode insertion in both craniocaudal and orbital planes ranged from ?90° to +90° with 30° increment. The RFA electrode was simulated to pass through the target site at different angles in combination of both craniocaudal and orbital planes before being advanced to the edge of the tumor.

Results: Complete tumor ablation was observed whenever the electrode-tip penetrated through the epicenter of the tumor regardless of the angles of electrode insertion in both craniocaudal and orbital planes. Complete tumor ablation can also be achieved by placing the electrode-tip at several optimal sites and angles.

Conclusions: Identification of the tumor epicenter on the central slice of the axial images is essential to enhance the success rate of complete tumor ablation during RFA procedures.     

Safety of the open-irrigated ablation catheter for radiofrequency ablation: safety analysis from six clinical studies

Background: The open-irrigated catheter is used most frequently for atrial and ventricular radiofrequency ablation (RFA), and is often considered as the standard by which new ablation systems are compared. But few data have been published concerning its safety. This report provides a comprehensive safety analysis of the use of an open-irrigated catheter for RFA of atrial flutter, ventricular tachycardia, and atrial fibrillation in 1,275 patients in six rigorously monitored, prospective, multicenter studies. Methods: This analysis is of data from six studies conducted as part of both Food and Drug Administration-mandated investigational device exemption studies and postapproval studies. The six studies span a period of more than 10 years. All serious RFA complications and vascular access complications that occurred within seven days postprocedure were included. Results: The number of patients who experienced any acute serious RFA complication in these studies combined was 4.9% (63/1,275). The two earliest studies were conducted when the open-irrigated catheter was first introduced, and accounted for 55.6% of the complications. In the first atrial flutter ablation study, RFA complications decreased by 60% (15.4%-6.2%) after a proctoring program was initiated during the study. For all studies, vascular access complications ranged between from 0.5%-4.7%, and no stroke or transient ischemic attack was reported within 7 days postprocedure. No significant pulmonary vein stenosis was reported from the atrial fibrillation studies. Conclusion: A proctoring program, careful fluid management, and absence of char and coagulum contributed to the safe use of the open-irrigated RFA catheter. (PACE 2012; 35:1081-1089).