肝动脉化疗栓塞术联合CT引导下射频消融治疗大肝癌的疗效和安全性

 目的 评价肝动脉化疗栓塞术(transcatheter arterial chemoembolization, TACE)联合CT引导下经皮穿刺射频消融治疗大肝癌的疗效及安全性。方法 回顾性分析52例经穿刺病理或影像学诊断的大肝癌患者临床资料,患者均先行1次TACE术,术后2周复查增强CT,对碘油沉积欠缺的区域在CT导向下进行射频消融治疗,术后复查甲胎蛋白(AFP)、增强MRI或CT评价肿瘤体积缩小及坏死情况,随访时间为12个月。结果 52例 (56个病灶)手术均获得成功。TACE术前病灶最大径为(12.7±2.7)cm,射频术后1个月病灶最大径为(6.1±1.9)cm,肿瘤大小较术前均有不同程度缩小(t=14.416,P<0.05)。TACE术前AFP值为(4156±689)ng/ml,射频术后1个月为(256±178)ng/ml,AFP值明显下降(t=39.485,P<0.05)。其中完全消融(CR)26例,大部分消融(PR)21例,稳定(SD)4例,进展(PD)1例,总体有效率为90.4%,12个月生存率为92.3%。结论 TACE联合CT导向下射频消融治疗大肝癌是一种安全、有效、微创的治疗方法。     

The Value of Radiofrequency Ablation in the Special Sites of the Liver Cancer by Combining Ultrasound Guided with CT Monitoring

目的 探讨超声引导联合CT监视在特殊部位肝癌射频治疗中的应用价值.方法 采用超声引导联合CT监视经皮射频治疗45例(75个病灶)特殊部位肝癌患者.统计消融术中、术后的并发症情况.1个月后复查CT、MRI资料,观察病灶的消融情况.结果 消融术中无严重并发症,15例(33.3％)术后出现一过性发热;16例(35.6％)出现腹痛;3例顽固性咯呃逆;6例(13.3％)出现恶心.射频治疗后1个月随访显示,邻近膈肌13个病灶,其中病灶完全消融12个(92.31％);邻近胆囊8个病灶,完全消融6个(75％);邻近肠管5个病灶,完全消融5个(100％);邻近大血管9个病灶,其中病灶完全消融8个(88.89％),邻近胆管14个,其中病灶完全消融13个(92.86％).45例患者仅1例靠近胆囊患者出现肝内肿瘤新生,无一例出现肝外转移.结论 超声引导联合CT监视射频治疗特殊部位肝癌疗效满意,并发症发生率低,值得临床推广.     

肝动脉化疗栓塞联合CT引导射频消融序贯治疗中小肝癌的临床应用

目的探讨肝动脉化疗栓塞(TACE)联合CT引导射频消融(RFA)序贯治疗原发性中小肝癌的临床应用。方法对59例肝细胞性中小肝癌患者实施TACE联合CT引导RFA序贯治疗。结果 59例患者初次治疗,共80枚病灶,行TACE和RFA序贯治疗技术成功率100%。术后随访6～24个月,21例患者有病灶残余,再次行RFA或序贯治疗,3例再次联合放射性125I粒子植入治疗后,病灶控制良好。并发症有胆汁瘤合并胆道感染1例、门静脉分支血栓1例。结论 TACE联合CT引导RFA序贯治疗中小肝癌是一种微创、有效的方法,同时注意手术操作细节,对提高手术成功率,降低手术并发症有重要意义。     

TACE联合RFA治疗膈下肝脏恶性肿瘤22例

目的 评价TACE联合RFA治疗膈下肝脏恶性肿瘤的安全性和疗效.方法 22例膈下肝脏恶性肿瘤患者共有26个病灶,单例病灶数目≤3个,直径≤5 cm.所有患者先行1～2次TACE术,术后3～5周行CT引导下RFA治疗,RFA术后4～8周复查MRI评价疗效.所有患者随访12 ～ 30个月,观察并发症和疗效.结果 22例患者26个病灶RFA术中未出现任何严重并发症,术后MRI复查22个(84.6％)病灶达到完全消融,4个(15.4％)病灶经2次RFA后达到完全消融.结论 TACE术可使肝脏恶性肿瘤病灶缩小,轮廓更加清晰,联合RFA治疗膈下肝脏恶性肿瘤更加安全、精确、有效.     

Evaluation on Curative Effect of TACE Combined with Microwave Ablation For Hepatic Cellular Carcinoma with Moderate and Advanced Stage

目的 评价肝动脉化疗栓塞(TACE)联合经皮微波消融(microwave ablation)治疗中晚期肝癌的疗效及价值.资料与方法 68例中晚期肝癌患者,联合组37例先行TACE,再行微波消融治疗,对照组31例仅应用TACE治疗,全部病例于治疗前后行超声及动态增强CT或超声造影检查,观察患者肿瘤病灶大小变化及血流信号情况,同时检测治疗前后甲胎蛋白水平变化并随访患者生存率.结果 联合治疗组部分缓解(PR) 10例,稳定(SD) 18例,进展(PD)9例,对照组PR 5例,SD 14例,PD 12例;联合治疗组在肿瘤血流信号消失、生存期及甲胎蛋白水平变化方面均优于对照组,其6个月、12个月、24个月生存率分别为100％、94.6％、78.4％,明显高于对照组的90.3％、74.2％、54.8％;Kaplan-Meier生存分析显示,联合治疗组的生存时间较对照组延长,差异有统计学意义.结论 TACE联合微波消融治疗中晚期肝癌具有协同作用,疗效明显并可延长患者生存期,是一种有效的微创综合治疗方法.     

肝动脉化疗栓塞联合射频消融治疗肝癌疗效及预后分析

目的 探究肝癌患者采用肝动脉化疗栓塞(TACE)联合射频消融(RFA)治疗的临床疗效以及对患者预后的影响.方法 分析2016年7月-2019年7月接受TACE联合RFA治疗的肝癌患者52例的临床资料、治疗方法、治疗结果以及随访结果.结果 52例患者均接受TACE以及CT引导下的RFA治疗,治疗均顺利完成.术后随访12-36个月,平均(18.64±5.2)个月,术后1年患者的AFP明显低于术前,差异有统计学意义(P＜0.05);术后1年,患者的肿瘤体积低于术前,差异有统计学意义(P＜0.05);术后1年,肿瘤完全坏死率达到(56/64).患者的并发症发生率为3.85％(2/52).结论 TACE联合RFA治疗肝癌的疗效显著,能明显改善患者预后.     

聚焦超声消融联合TACE治疗10 cm以上大肝癌的临床效果分析

目的：初步评价聚焦超声消融（Focused ultrasound ablation,FUA）联合肝动脉化疗栓塞（Transcatheter arterial chemoembolization,TACE）治疗最大径10 cm以上大肝癌的临床效果及安全性。 方法：回顾性分析近5年在我院接受FUA联合TACE治疗的原发性肝癌患者19例（34个病灶）,肿瘤最大径10 cm以上,BCLC分期为B期8例,C期11例。术后通过增强MRI评价局部病灶消融效果,定期复查评价血清甲胎蛋白（AFP）下降效果,应用MRECIST标准评价治疗并发症,随访统计总生存率、中位生存时间(OS)、肿瘤进展时间(TTP)及局部复发时间(TTR)。 结果：（1）所有34个病灶治疗后均达到完全消融（CR）或部分消融（PR）,CR 2例（10.5%）,PR 17例（89.5%）;（2）17例血清AFP升高病例中,治疗后1月AFP均不同程度降低,降至正常2例,11例下降超过50%,4例下降低于50%;（3）患者总OS8～69个月,中位OS 16个月;TTR3～34个月,中位TTR 6个月;TTP2～34个月,中位TTP 5个月。1年、2年、3年的累积生存率分别为：63.2%、26.3%和15.8%;（4）主要并发症包括：发热、皮肤损伤、治疗术区区部疼痛、肝功能损伤、肋骨病理性骨折等,84.4%（38/45）为轻度,未出现治疗相关性死亡等严重并发症。 结论：FUA联合TACE治疗最大直径10 cm以上原发性肝癌,能使患者够获得较好的生存获益,安全性可控,值得深入探讨。     

肝动脉化疗栓塞联合经皮微波消融治疗中晚期肝癌的疗效评价

目的评价肝动脉化疗栓塞(TACE)联合经皮微波消融(microwave ablation)治疗中晚期肝癌的疗效及价值。资料与方法 68例中晚期肝癌患者,联合组37例先行TACE,再行微波消融治疗,对照组31例仅应用TACE治疗,全部病例于治疗前后行超声及动态增强CT或超声造影检查,观察患者肿瘤病灶大小变化及血流信号情况,同时检测治疗前后甲胎蛋白水平变化并随访患者生存率。结果联合治疗组部分缓解(PR)10例,稳定(SD)18例,进展(PD)9例,对照组PR 5例,SD 14例,PD 12例;联合治疗组在肿瘤血流信号消失、生存期及甲胎蛋白水平变化方面均优于对照组,其6个月、12个月、24个月生存率分别为100%、94.6%、78.4%,明显高于对照组的90.3%、74.2%、54.8%;Kaplan-Meier生存分析显示,联合治疗组的生存时间较对照组延长,差异有统计学意义。结论 TACE联合微波消融治疗中晚期肝癌具有协同作用,疗效明显并可延长患者生存期,是一种有效的微创综合治疗方法。     

经皮射频消融治疗巨大肝癌

目的总结冷循环射频消融(RFA)治疗巨大肝癌的临床疗效和经验。方法采用CT引导下经皮穿刺冷循环RFA治疗巨大肝癌24例,每个病灶进行射频消融1～4次,其中22例患者结合1～6次TACE治疗,术后通过增强CT或MR评价疗效,所有病例随访12～37个月。结果10例病灶完全坏死,余14例病灶大部分坏死,1年生存率83%,中位生存时间20个月,13例患者现仍存活。结论CT引导下经皮穿刺冷循环RFA治疗巨大肝癌安全、有效。     

超声引导联合CT监视在特殊部位肝癌射频治疗中的应用价值

目的探讨超声引导联合CT监视在特殊部位肝癌射频治疗中的应用价值。方法采用超声引导联合CT监视经皮射频治疗45例(75个病灶)特殊部位肝癌患者。统计消融术中、术后的并发症情况。1个月后复查CT、MRI资料,观察病灶的消融情况。结果消融术中无严重并发症,15例(33.3%)术后出现一过性发热;16例(35.6%)出现腹痛;3例顽固性咯呃逆;6例(13.3%)出现恶心。射频治疗后1个月随访显示,邻近膈肌13个病灶,其中病灶完全消融12个(92.31%);邻近胆囊8个病灶,完全消融6个(75%);邻近肠管5个病灶,完全消融5个(100%);邻近大血管9个病灶,其中病灶完全消融8个(88.89%),邻近胆管14个,其中病灶完全消融13个(92.86%)。45例患者仅1例靠近胆囊患者出现肝内肿瘤新生,无一例出现肝外转移。结论超声引导联合CT监视射频治疗特殊部位肝癌疗效满意,并发症发生率低,值得临床推广。     

经皮肝穿刺胆管腔内射频消融联合植入支架治疗肝门胆管癌伴恶性梗阻临床疗效研究

目的探讨经皮肝穿刺胆管腔内射频消融联合植入支架治疗肝门胆管癌伴恶性梗阻患者的临床应用价值。方法选取自2013年1月至2014年6月收治的肝门胆管癌伴恶性梗阻患者36例,行经皮肝穿刺胆管腔内射频消融联合植入支架进行治疗,观察患者术后并发症发生与肝功能变化情况。所有患者每月随访1次至术后1年,记录患者的存活率与支架通畅率。结果所有患者均手术成功,成功率为100.0%(36/36)。术后发生出血1例(2.7%),胆道感染4例(11.1%),腹泻5例(13.9%),呕吐6例(16.7%),疼痛10例(27.8%),对症治疗后均好转。术后1周,患者总胆红素、直接胆红素、谷氨酰转肽酶与碱性磷酸酶均明显低于术前,差异有统计学意义(P<0.05)。术后3、6、12个月的支架通畅率分别为91.7%(33/36)、69.4%(25/36)、38.9%(14/36);存活率分别为97.2%(35/36)、80.6%(29/36)、66.7%(24/36)。结论经皮肝穿刺胆管腔内射频消融联合植入支架治疗肝门胆管癌伴恶性梗阻安全有效,值得临床推广应用。     

肝动脉化疗栓塞联合同步DSA-CT引导下射频消融治疗大肝癌的临床研究

目的评估肝动脉化疗栓塞（TACE）联合同步DSA-CT引导下射频消融（RFA）治疗大肝癌（肿瘤最大直径≥5 cm）的安全性和疗效。 方法2010年1月～2012年3月21例原发性肝细胞癌患者接受同步联合治疗。术后定期进行影像学检查并复查甲胎蛋白,评估联合技术成功率、局部肿瘤治疗反应、无疾病复发时间、患者存活情况和技术相关并发症。 结果技术成功率100%,无重要并发症发生。介入术后1个月复查,病灶完全缓解19例（19/21,90.48%）、部分缓解2例（2/21,9.52%）。肿瘤坏死以凝固性坏死为主。在局部灭活肿瘤方面,单结节型完全坏死率（17/17,100%）高于多结节性病灶(2/4,50.00%;P=0.034）。随访2～28个月,19例完全缓解者平均无疾病复发时间为（11.8±6.0）个月。21例患者6、12、18个月生存率均为100%。 结论TACE联合同步DSA-CT引导下RFA治疗大肝癌安全、有效。局部肿瘤灭活方面,单结节型病灶优于多结节病灶。     

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.     

射频消融联合肝动脉化疗栓塞治疗肝转移癌

目的 评价射频消融术(RFA)联合肝动脉化疗栓塞术(TACE)对于肝转移癌的治疗效果.方法 搜集2005年3月至2010年10月36例肝转移癌患者的临床资料进行分析,其中男22例,女14例;年龄42～82岁,平均(63±12)岁;肿瘤最大径1.5～12.0 cm,平均(4.5±2.4) cm.其中单发转移灶29例,多发转移7例,共47个病灶.患者均为全身化疗失败或无法耐受,且无其他脏器转移证据者.术前CT扫描,对于富血供者先行TACE,术后3周内行RFA;对于乏血供者,先行RFA,术后3周内行TACE.对于多个病灶,采取分次逐一治疗.术后每个月行B超复查及肝功能、血象、肿瘤标记物检查,每3个月行腹部CT增强扫描1次.对于随访过程中肿瘤的局部残存及复发,在可能的前提下仍行RFA+TACE治疗.根据治疗后的影像表现分为病灶完全消融组和病灶部分消融组2个亚组,完全消融组不再进行任何治疗,定期随访观察;部分消融组如无法行进一步RFA治疗,则根据患者情况定期行TACE治疗.随访终点事件为患者死亡.对所有患者的整体生存期及两个亚组的生存期采用SPSS 18.0统计分析软件,Kaplan-Meier方法进行统计分析.结果 RFA全部采用经皮途径在局部麻醉结合静脉基础麻醉下完成,无严重并发症发生.16例患者经过1次或多次联合治疗后达到局部病灶完全消除(病灶完全消融组);20例患者病灶部分消除(病灶部分消融组).随访时间10～40个月,平均(25±10)个月.死亡23例,至今存活13例.中位生存期27个月(95%可信区间:24～32个月).至观察终点1、2、3年生存率分别为91.7%(33/36例)、55.5%(20/36例)、36.1%(13/36例).病灶完全消融组和部分消融组的3年生存率分别为75.0%(12/16例)和5.0%(1/20例),差异有统计学意义(P<0.01).结论 RFA+TACE可以有效控制肝转移癌患者肝内病变的进展,延长患者生存期.争取病灶的完全消融是提高疗效的关键.

Abstract：

Objective To investigate the efficacy and safety of radiofrequency ablation (RFA) combined with transarterial chemoembolization (TACE) for treating of hepatic metastasis. Methods From Mar. 2005 to Oct. 2010, 22 males and 14 females with hepatic metastasis were enrolled in this study. Mean age of the patients was 63±12 (42-82) years. Tumor size was (4.5±2.4) cm (min.1.5 cm, max. 12.0 cm). Totally 47 lesions were treated with single metastasis in 29 cases and multiple ones in 7 cases. All cases were failed to chemotherapy or could not stand for the side effect of chemotherapy. Contrast enhanced CT scan was given to all patients before RFA+TACE. For lesions with rich blood supply, TACE was given and then RFA. For those with poor blood supply, RFA was given first and then TACE. For multiple lesions, RFA+TACE was given one by one for each lesion. As for follow up, ultrasound and blood check was given monthly. Enhanced CT scan was given every 3 month. For residual lesions or recurrent lesions, RFA+TACE were given repeatedly. The whole patients was divided into two groups according to the image follow up including complete ablation group and partial ablation group. For complete ablation group, no further treatment was given. For partial ablation group, if it was not suitable for further RFA, repeated TACE was given there after. The end point of follow up was death event. Survival of the whole group and the two subgroups was analyzed statistically by Kaplan-Meier method. Results All RFA procedures was given under intravenous anesthesia and local anesthesia, no severe complication was noted. Lesions in 16 patients were completely ablated after single or multiple sections of RFA+TACE. Twenty patients were in the partially ablated group. Follow up time was 25±10 (10-40) months. Twenty-three patients died and 13 kept alive during the follow up time. The estimated median survival time was 27 month (95%CI: 24-32 months). Survival ration at 1, 2, 3 years for the whole group was 91.7%(33/36),55.5%(20/36),36.1%(13/36) for the whole group. The 3 years survival for complete and partial ablation group was 75.0%(12/16),5.0%(1/20),there was a significant difference between the two groups(P<0.01). Conclusion For patients with hepatic metastasis, RFA+TACE can effectively control the local lesion. Complete ablation is the key point for a better survival.     

TACE+RFA和TACE+MWA应用于早期原发性肝细胞癌的疗效差异

目的探讨肝动脉化疗栓塞联合射频消融术(TACE+RFA)和肝动脉化疗栓塞联合微波消融术(TACE+MWA)应用于早期原发性肝细胞癌(PHC)的疗效差异。方法选取我院接受TACE+RFA或TACE+MWA治疗的68例早期PHC患者资料,其中TACE+RFA组31例,TACE+MWA组37例。比较两组患者的病灶消融率、并发症发生率,并对患者的生存情况进行分析。结果TACE+RFA组和TACE+MWA组病灶完全反应(CR)率差异无统计学意义(P>0.05)。在肿瘤直径≤3cm患者中,TACE+RFA组和TACE+MWA组病灶CR率差异无统计学意义(P>0.05);而在肿瘤直径3~5cm患者中,TACE+MWA组病灶CR率高于TACE+RFA组,差异有统计学意义(P<0.05)。两组患者的并发症(发热、腹痛、恶心&呕吐及额外镇痛)发生率比较,差异无统计学意义(P>0.05)。随访6.0~45.7个月,中位随访时间26.6个月。全组患者1年、2年、3年累积生存率分别为92.3%、85.2%、47.9%。其中,TACE+RFA组患者的1年、2年、3年累积生存率分别为87.1%、80.1%、43.1%,TACE+MWA组为96.8%、89.6%、52.9%,两组生存率差异无统计学意义(Log rankχ^2=3.506,P=0.061)。在肿瘤直径≤3cm患者中,TACE+RFA组患者1年、2年、3年累积生存率分别为90.0%、90.0%、60.0%,TACE+MWA组为88.9%、74.1%、74.1%,两组生存率差异无统计学意义(Log rankχ^2=0.010,P=0.922)。在肿瘤直径3~5 cm患者中,TACE+RFA组患者1年、2年、3年累积生存率分别为85.7%、75.6%、36.3%,TACE+MWA组为100.0%、95.2%、50.8%,TACE+MWA组生存率高于TACE+RFA组(Log rankχ^2=4.485,P=0.034)。结论TACE+RFA和TACE+MWA应用于早期PHC均是安全、有效的。肿瘤直径≤3 cm时,两种疗法疗效相当,而肿瘤直径3~5cm时,TACE+MWA的病灶消融率和生存率优于TACE+RFA。     

TACE联合微波消融对比单独TACE治疗＞5cm原发性肝癌的倾向性匹配分析

目的 对比肝动脉化疗栓塞(TACE)联合微波消融(MWA)与单独TACE治疗＞5 cm原发性肝癌的临床疗效.方法 回顾性分析2014年6月至2015年12月,208例原发性肝癌患者的临床资料,其中TACE联合MWA组40例、TACE组168例,按1∶1进行配对后分析两种治疗方式的临床效果.首要观察指标是患者的生存期,次要观察指标是1个月的改良实体瘤反应(mRECIST标准)和AFP下降水平.结果 实际配对完成患者31对,配对后组间基线资料具有可比性.结果显示TACE联合MWA的0.5、1、1.5、2和2.5年生存率分别为96.8％、90.3％、86.8％、82.5％和70.7％,明显优于TACE组的77.4％、61.3％、53.6％、48.2％和24.1％(P=0.011).联合治疗组在1个月时有更好的肿瘤控制和AFP下降水平.两组均无严重并发症发生.结论 TACE联合MWA对于＞5 cm肝癌的治疗在患者生存和肿瘤控制方面要优于单独TACE治疗.     

Stereotactic Radiofrequency Ablation of Unresectable Intrahepatic Cholangiocarcinomas: A Retrospective Study

Purpose

To evaluate treatment effects, complications, and outcome of percutaneous stereotactic radiofrequency ablation (SRFA) of intrahepatic cholangiocarcinoma (ICC).

Patients and Methods

Eleven consecutive patients (nine men and two women) with a total of 36 inoperable ICCs (18 initial lesions, 16 lesions newly detected during follow-up, and two local recurrences) underwent SRFA between December 2004 and June 2010. Two different radiofrequency ablation (RFA) devices with internally cooled electrodes were used. Tumor diameters ranged from 0.5 to 10?cm (median 3.0?cm). A total of 23 SRFA sessions were performed. The efficacy of SRFA was evaluated by contrast-enhanced computed tomography or magnetic resonance imaging 1?month after treatment and then every 3?months.

Results

Primary technical effectiveness rate was 92%. Further follow-up every 3?months revealed three local recurrences (8%), two of which were successfully retreated, resulting in a secondary technical effectiveness rate of 98%. After a total of 23 RFA sessions, three major complications occurred (13%) that could be managed interventionally. Mean follow-up time was 35?months (range 12–81?months). One- and 3-year overall survival rates were 91 and 71%, respectively. The median overall survival was 60?months (according to the life table method). Eight (73%) of 11 patients were still alive at the end of follow-up.

Conclusion

SRFA is effective in the treatment of unresectable ICC even if the tumor is large and located close to major vessels. SRFA shows a survival benefit compared to other palliative treatment options and may also be considered as the first-line local treatment of ICCs in selected patients.