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。     

经皮射频热切除术治疗肝脏恶性肿瘤

经皮射频热切除术(percutaneous radiofrequency thermalablation)是国外近年来开展的一项有效而快速损毁肝脏恶性肿瘤的新技术[1-4].其机制是通过经皮影象技术,以热传导的方式导致肿瘤组织发生凝固性坏死[4].1999年我院引进国内第一台自动控制射频治疗仪,并对75例患者成功地进行了治疗.现将该技术及临床运用概况做一介绍.     

磁共振成像对肝恶性肿瘤射频治疗的疗效评价

目前微创治疗已广泛用于不能手术的原发或继发性肝癌,而经皮肝穿刺射频热凝(PRFA)治疗因多电极放射针群的作用范围大,一次性凝固坏死彻底而成为一种有效的肝癌局部治疗方法。其疗效需准确的影像学评价,B超的评价能力有限,动态增强CT常用于评价PRFA疗效,但磁共振(MR)具有高组织分辨率、多参数、多时相及动态增强等特点,除在对肝恶性肿瘤定性方面具有明显优势外,在评价PRFA疗效方面亦有优势,能更准确地区分PRFA后热凝坏死区与残存肿瘤组织。通过对肝恶性肿瘤PRFA治疗后进行MR随访研究,探讨MR评价PRFA疗效的作用及临床意义。     

微波刀治疗肝脏恶性肿瘤的临床观察

目的探讨微波刀在肝脏恶性肿瘤治疗中的临床应用价值。方法超声引导下微波刀治疗肝脏恶性肿瘤患者56例共73个病灶，治疗前后经增强CT／MRI检查明确诊断及评价疗效。结果73个病灶经一次微波刀治疗后完全坏死53个（72．6％），经12个月的随访，32个病灶发生局部复发（43．8％），平均复发时间为5．1（2．5～9．2）个月，不良反应为局部疼痛、发热、包膜下血肿、气胸。结论微波刀能有效地原位灭活肝肿瘤细胞．是有效的非手术治疗恶性肝肿瘤的方法之一，副作用较小，病人恢复较快。     

经皮射频消融治疗不同类型肝癌的疗效分析

肝癌的局部治疗近年发展迅速，其中经皮射频消融(PRFA)在肝癌治疗中得到广泛的应用。但PRFA治疗肝癌的疗效与肿瘤大小密切相关，本研究比较了不同大小肿瘤经PRFA的治疗效果，以期对临床治疗患者的选择有一定的指导作用。     

中晚期原发性肝癌患者的集束射频治疗

目的:了解在超声引导下集束射频(RF)治疗中晚期原发性肝癌的疗效。方法:对58例原发性肝癌(PHC)患者接受RF治疗前后肿瘤大小、AFP值、肿瘤血供以及超声情况进行调查。结果:58例PHC于治疗1周后超声检查提示72.2％的患者肿块缩小30％以上,1个月后复查缩小40％以上。所有病例肿块内的血供消失。AFP值下降者占66.5％。其中6例随访3年肿块缩小均在80％以上,AFP均维持在正常值。结论:RF治疗中晚期PHC的近期疗效优于其他治疗方法。     

CT引导经皮肝穿射频治疗肝癌

研究集束电极射频 (radiofrequency ,RF)治疗肝癌的方法及疗效。在CT引导下将中空金属钛多极穿刺针经皮直接穿刺置入瘤体 ,分点一次或多次对瘤体进行射频治疗 ,术中直视肿瘤射频治疗后的图像及CT值 ,术后观察患者的瘤体血供情况、肿瘤大小及AFP值的变化。瘤体直径 <5cm的肝癌 ,术后 1- 5个月大部分瘤体血供消失 ,瘤体缩小 ,瘤体直径 >5cm的肝癌 ,配合介入栓塞治疗 ,多数瘤体缩小。CT引导多弹头射频治疗肝癌定位准确 ,近期疗效安全有效     

CT引导下经皮射频毁损治疗肺肿瘤近期疗效观察

为观察CT引导下经皮射频毁损治疗肺肿瘤的近期疗效，并探讨其治疗机理、优点及适应症，应用RT－2000型射频治疗仪、Leven多弹头射频电极，于CT引导下经皮穿刺毁损，对30例肺肿瘤患者进行50次治疗；分别观察其毁损范围、肺功能及并发症情况。结果显示，原发性肺癌直径＜5cm者，1次治疗完全毁损率为50％，2次治疗完全毁损率为18.75%，总毁损率为68.75%；肿瘤直径5－10cm者，1次完全毁损率为14.29%，2次完全毁损率为42.86%，总毁损率为57.14%；其余11例经2次治疗肿瘤组织部分或大部分毁损。并发症发生率为16.67%。表明经皮射频毁损治疗肺肿瘤是一种安全有效的治疗方法；大部分患者治疗后肿瘤组织可安全毁损，少部分患者治疗后肿瘤组织明显减小。     

射频消融治疗肝癌的近期疗效观察

目的探讨射频消融治疗肝癌的近期疗效及安全性。方法回顾性分析我科射频治疗的27例肝癌患者的资料。结果27例肝癌患者经射频消融治疗,一月后考核疗效发现达到显效者10例,有效13例(总有效率为85%)。其中肿瘤直径小于3cm的小肝癌4例,治疗后肿瘤均消失;肿瘤直径在3cm～5cm之间者9例,术后达到显效者4例(其中1例通过2次治疗后肿瘤消失),有效5例(有效率100%);在肿瘤直径5cm～10cm的患者中达到显效的1例,有效6例(有效率87.5%,7/8),无效1例;肿瘤直径大于10cm的患者中,达到显效的1例,有效2例(有效率为50%,3/6),无效3例。结论射频消融治疗肝脏肿瘤是一种疗效可靠、安全性较高的微创治疗技术,值得进一步推广应用。     

肝癌射频治疗后影像学检查的临床作用

2000年3月-2003年3月，我们对35例肝癌患者行射频治疗后进行彩色多普勒（CDU）、螺旋CT及肝动脉造影检查，以判断肿瘤射频治疗效果。现报告如下。 资料与方法：35例肝癌患者中，男27例，女8例；年龄38～69岁。均经活检诊断为肝细胞癌。肿瘤直径1．0～10.5cm，平均6．34cm。共56个结节，其中位于Ⅰ段2个，Ⅱ段4个，Ⅳ段5个、Ⅴ段9个．Ⅵ段12个、Ⅵ段15个、Ⅶ段9个。均经1～3次多电极射频治疗（50～90W）。射频治疗前均行CDU及螺旋CT检查，观察肿瘤大小、数目、部位及其与周边重要组织结构的关系，门静脉和下腔静脉内有无癌栓等；术后观察肿瘤中心及周边血流情况，原肿瘤区域情况。肝动脉造影观察治疗前后肝内肿瘤血供情况。     

EFFICACY OF LAPAROSCOPIC RADIOFREQUENCY ABLATION FOR HEPATOCELLULAR CARCINOMA COMPARED TO PERCUTANEOUS RADIOFREQUENCY ABLATION WITH ARTIFICIAL ASCITES

Aim: Hepatocellular carcinoma (HCC) nodules close to the liver surface exhibit high recurrence compared to those in distal parts of the liver. Moreover, when nodules remain adjacent to the gastrointestinal tract or gallbladder, severe complications such as perforation of those organs may occur due to invasive therapy. Percutaneous radiofrequency ablation (PRFA) with artificial ascites or laparoscopic radiofrequency ablation (LRFA) are used to treat these patients to avoid complications. The purpose of the present study was to assess the efficacy and safety of these two methods. Methods: Subjects comprised 74 patients (48 men, 26 women; mean age, 68.5 ± 8.0 years; range, 46–89 years) with 86 HCC nodules. PRFA with artificial ascites was carried out for 37 patients (44 nodules) and LRFA was used for 37 patients (42 nodules). Clinical profiles were compared between groups. Results: No significant differences in clinical profiles were found between patients treated by PRFA or LRFA. Mean number of treatments was significantly lower for LRFA (1.0 ± 0.0) than for PRFA (2.1 ± 1.0, P < 0.001). Mean number of PRFA treatments was 2.2 ± 1.0 in patients with HCC nodules >2 cm in diameter, whereas all tumors were completely ablated with only one session of LRFA. The safety margin was significantly wider for LRFA than for PRFA. Conclusion: LRFA is a better treatment option for ablation of HCC nodules >2.0 cm in diameter.     

Efficacy of selective transarterial chemoembolization in inducing tumor necrosis in small (<5 cm) hepatocellular carcinomas

Transarterial chemoembolization (TACE) is commonly used as a bridge therapy for patients awaiting liver transplantation (LT) and for downstaging patients initially not meeting the Milan criteria. The primary aim of this study was to analyze whether a difference exists between selective/superselective and lobar TACE in determining tumor necrosis by a pathological analysis of the whole lesion at the time of LT. The secondary aim was to investigate the relationship between the tumor size and the capacity of TACE to induce necrosis. Data were extracted from a prospective database of 67 consecutive patients who underwent LT for hepatocellular carcinoma and cirrhosis from 2003 to 2009 and were treated exclusively with TACE as a bridging (n = 53) or downstaging therapy (n = 14). We identified 122 nodules; 53.3% were treated with selective/superselective TACE. The mean histological necrosis level was 64.7%; complete tumor necrosis was obtained in 42.6% of the nodules. In comparison with lobar TACE, selective/superselective TACE led to significantly higher mean levels of necrosis (75.1% versus 52.8%, P = 0.002) and a higher rate of complete necrosis (53.8% versus 29.8%, P = 0.013). A significant direct relationship was observed between the tumor diameter and the mean tumor necrosis level (59.6% for lesions < 2 cm, 68.4% for lesions of 2.1-3 cm, and 76.2% for lesions > 3 cm). Histological necrosis was maximal for tumors > 3 cm: 91.8% after selective/superselective TACE and 66.5% after lobar procedures. Independent predictors of complete tumor necrosis were selective/superselective TACE (P = 0.049) and the treatment of single nodules (P = 0.008). Repeat sessions were more frequently needed for nodules treated with lobar TACE (31.6% versus 59.3%, P = 0.049). CONCLUSION: Selective/superselective TACE was more successful than lobar procedures in achieving complete histological necrosis, and TACE was more effective in 3- to 5-cm tumors than in smaller ones.     

Radiofrequency ablation of hepatocellular carcinoma in cirrhotic patients

BACKGROUND/AIMS: Radiofrequency ablation is useful for local destruction of primary and secondary hepatic tumors. However there is little information about long-term outcome for patients with hepatocellular carcinoma and cirrhosis. The aims of this study included the analysis of efficacy in local control of tumors, patterns of recurrence and survival rate related to severity of cirrhosis and tumor features. METHODOLOGY: From January 1998 to January 2001 we ablated 65 hepatocellular carcinomas in 53 patients with cirrhosis. Cirrhosis was related to HCV, HBV and alcohol intake in 32, 4 and 17 patients, respectively. According to Child-Pugh classification 24 and 29 patients belong to A and B class, respectively. Patients in Child-Pugh C class were excluded from the study. The mean diameter of lesions was 4 cm (range: 1-7 cm). In all cases radiofrequency ablation was performed with the percutaneous approach under ultrasound guidance. Treatment efficacy was estimated with dual phase computed tomography and alpha-fetoprotein dosage. RESULTS: Complete necrosis rate after first treatment was 90.9, 74.4 and 36.4% in hepatocellular carcinoma smaller than 3 cm, between 3 and 5 cm and larger than 5 cm, respectively (p = 0.01). After multiple treatment complete necrosis was achieved in 100, 93 and 63.6% (p = 0.01). The mean number of treatments was 1.5 (range: 1-4) per patients. Four lesions of 58 (6.8%) developed local recurrence during a mean follow-up of 18 months. No local recurrence was observed in tumors smaller than 4 cm. New tumors were observed in 15 patients (28.3%). There were no treatment-related deaths and 11 patients (20.7%) suffered minor complications. The survival rate of patients after treatment was 87, 63 and 45% at 12, 24 and 36 months, respectively. Survival was significantly related to Child-Pugh class (p = 0.01). CONCLUSIONS: Radiofrequency ablation is a safe and effective treatment of hepatocellular carcinoma smaller than 5 cm with complete necrosis in most lesions. No local recurrences were observed in lesions smaller than 4 cm. After 3 years survival was 83% in Child-Pugh A cirrhotic patients and 31% in Child-Pugh B patients.     

Rapid progression of hepatocellular carcinoma after Radiofrequency Ablation

AIM: To report the results of radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) in cirrhotic patients and to describe the treatment related complications (mainly the rapid intrahepatic neoplastic progression). METHODS: Eighty-seven consecutive cirrhotic patients with 104 HCC (mean diameter 3.9 cm, 1.3 SD) were submitted to RFA between January 1998 and June 2003. In all cases RFA was performed with percutaneous approach under ultrasound guidance using expandable electrode needles. Treatment efficacy (necrosis and recurrence) was estimated with dual phase computed tomography (CT) and alpha-fetoprotein (AFP) level. RESULTS: Complete necrosis rate after single or multiple treatment was 100%, 87.7% and 57.1% in HCC smaller than 3 cm, between 3 and 5 cm and larger than 5 cm respectively (P=0.02). Seventeen lesions of 88(19.3%) developed local recurrence after complete necrosis during a mean follow up of 19.2 mo. There were no treatment-related deaths in 130 procedures and major complications occurred in 8 patients (6.1 %). In 4 patients, although complete local necrosis was achieved, we observed rapid intrahepatic neoplastic progression after treatment. Risk factors for rapid neoplastic progression were high preoperative AFP values and location of the tumor near segmental portal branches. CONCLUSION: RFA is an effective treatment for hepatocellular carcinoma smaller than 5 cm with complete necrosis in more than 80% of lesions. Patients with elevated AFP levels and tumors located near the main portal branch are at risk for rapid neoplastic progression after RFA. Further studies are necessary to evaluate the incidence and pathogenesis of this underestimated complication.     

Ultrasonography guided percutaneous radiofrequency ablation for hepatic cavernous hemangioma

AIM: Hepatic cavernous hemangioma (HCH) is the most common benign tumor of the liver and its management is still controversial. Recent success in situ radiofrequency ablation of hepatic malignancies has led us to consider using bhis technique in patients wibh HCH. This study was to assess the efficacy, safety, and complications of percutaneous radiofrequency ablation (PRFA) under ultrasonography guidance in patients with HCH.METHODS: Twelve patients (four men and eight women,age ranged 33-56 years, mean age was 41.7 years) wiUa 15 hepatic cavernous hemangiomas （2.5 cm to 9.5 cm) were treated using b~e RF-2000 generator and 10-needle LeVeen electrode percutaneously guided by B-ultrasound. Lesions larger than 3 cm were treated by multiple overlapping ablations that encompass the entire lesion as well as a rim of normal liver tissue (approximately 0.5 cm).RESULTS: All the patients who received PRFA therapy had no severe pain, bleeding or bile leakage during and after the procedures. Nine to 34 months‘ follow-up (mean, 21 months) by ultrasound and/or spiral CT scan demonstrated that the ablated lesions in this group were shrunk remarkably,and the shrunken range was 38-79 % (mean, 67 % per 21 months). The contrast enhancement was disappeared within the tumor or at its periphery in all cases on spiral CT scans obtained 3 to 6 months after treatment.CONCLUSION: The results of this study suggest that PRFA therapy is a mini-invasive, simple, safe, and effective method for the treatment of selected patients with HCH.     

Rapid progression of hepatocellular carcinoma after transcatheter arterial chemoembolization and percutaneous radiofrequency ablation in the primary tumour region

We report one patient who showed rapid progression of hepatocellular carcinoma (HCC) after undergoing transcatheter arterial chemoembolization (TACE) and percutaneous radiofrequency ablation (PRFA) for a small HCC measuring 2.5 cm in diameter. Enhanced magnetic resonance imaging (MRI) following treatment showed complete tumour necrosis and did not reveal the presence of a tumour around the treated area. Furthermore, the serum alpha-fetoprotein (AFP) level decreased at the completion of therapy. However, the HCC advanced in a very short time. Numerous tumours around the treated area were observed on enhanced computed tomography (CT) 50 days after PRFA. It is strongly suspected that the tumour was disseminated through the portal system because of the presence pattern of tumours. We believe this to be the first case illustrating a hepatic cancer that progressed rapidly following TACE and PRFA.     

Analysis of clinical effect of high-intensity focused ultrasound on liver cancer

AIM: To evaluate the clinical effect of high-intensity focused ultrasound (HIFU) in the treatment of patients with liver cancer. METHODS: HIFU treatment was performed in 100 patients with liver cancer under general anesthesia and by a targeted ultrasound. Evaluation of efficacy was made on the basis of clinical symptoms, liver function tests, AFP, MRI or CT before and after the treatment. RESULTS: After HIFU treatment, clinical symptoms were relieved in 86.6%(71/82) of patients. The ascites disappeared in 6 patients. ALT (95+/-44) U/L and AST (114+/-58) U/L before HIFU treatment were reduced to normal in 83.3%(30/36) and 72.9%(35/48) patients, respectively, after the treatment. AFP was lowered by more than 50% in 65.3%(32/49) patients. After HIFU treatment, MRI or CT findings indicated coagulation necrosis and blood supply reduction or disappearance of tumor in the target region. CONCLUSION: HIFU can efficiently treat the patients with liver cancer. It will offer a significant noninvasive therapy for local treatment of liver tumor.     

Analysis of clinical effect of high-intensity focused ultrasound on liver cancer

AIM:To evaluate the clinical effect of high-intensity focusedultrasound(HIFU)in the treatment of patients with livercancer.METHODS:HIFU treatment was performed in 100 patientswith liver cancer under general anesthesia and by atargeted ultrasound.Evaluation of efficacy was made onthe basis of clinical symptoms,liver function tests,AFP,MRI or CT before and after the treatment.RESULTS:After HIFU treatment,clinical symptoms wererelieved in 86.6%(71/82)of patients.The ascitesdisappeared in 6 patients.ALT(95±44)U/L and AST(114±58)U/L before HIFU treatment were reduced tonormal in 83.3%(30/36)and 72.9%(35/48)patients,respectively,after the treatment.AFP was lowered by morethan 50% in 65.3%(32/49)patients.After HIFU treatment,MRI or CT findings indicated coagulation necrosis and bloodsupply reduction or disappearance of tumor in the target region.CONCLUSION:HIFU can efficiently treat the patients withliver cancer.It will offer a significant noninvasive therapyfor local treatment of liver tumor.     

射频消融联合瘤体边缘无水乙醇注射治疗大血管旁肝癌的疗效分析

目的 探讨经皮穿刺射频消融联合瘤体边缘无水乙醇注射治疗大血管旁肝癌的效果.方法 将75例大血管旁肝癌患者分为治疗组和对照组,治疗组38例患者接受经皮穿刺射频消融+无水乙醇注射方法治疗,对照组37例患者接受经皮穿刺射频消融方法治疗.选择肿瘤坏死率、甲胎蛋白水平、局部复发率和中位生存期、累积生存率为评价指标,比较两种治疗方法的效果.组间比较采用t检验或x2检验,生存期、累积生存率采用生存分析法与log-rank检验.结果 治疗组和对照组的肿瘤完全坏死率分别为84.2%,54.1%(P<0.01).治疗后1、3、6,12个月治疗组和对照组患者的甲胎蛋白水平分别为(105.0±35.5)μg/L,(28.4±4.3)pg/L,(58.6±6.7)μg/L、(89.5±12.5)μg/L和(137.2±34.6)μg/L,(84.2±18.4)μg/L、(106.6±20.3)μg/L、(173.7±32.0)μg/L,治疗组明显低于对照组(P<0.05).治疗组和对照组在3、6、12、24个月的局部复发率分别为2.6%、7.9%、13.2%、31.6%和10.8%、21.6%、40.5%、62.1%(P<0.01).治疗组和对照组患者中位生存期分别为(28.0±2.8)个月、(19.0±3.6)个月,6、12、24、36个月的累积生存率分别为84.2%,78.9%、60.5%、31.6%和78.4%、67.6%、37.8%、8.1%.结论 瘤体边缘无水乙醇注射作为经皮穿刺射频消融的补充治疗,可以显著提高大血管旁肝癌的疗效,明显降低局部复发率,提高远期生存率.

Abstract：

Objective To explore the effects of percutaneous transhepatic radiofrequency ablation (PRFA) combined with tumor edge of percutaneous absolute ethanol injection (PEI) on liver cancer adjacent to major blood vessels. Methods Seventy five patients with liver cancer adjacent to major blood vessels were randomly divided into two groups: PRFA+PEI therapy group (38 cases) and PRFA control group (37 cases). Tumor necrosis rate, AFP levels, local recurrence rate, median for survival time and cum survival were used as the evaluation index to evaluate the efficacies of the two methods. Results Tumor necrosis rates of the therapy group and the control group were 84.2% and 54.1 % (P < 0.01), respectively; AFP levels of therapy group and control group at 1, 3,6 and 12 months after treatment were (105.0 ± 35.5) Mg/L, (28.4 ± 4.3)Mg/L, (58.6 ± 6.7) μg/L, (89.5 ± 12.5) μg/L and (137.2 ± 34.6) μg/L, (84.2 ± 18.4) μg/L, (106.6 ±20.3) Mg/L, (173.7 ± 32.0) Mg/L, respectively. The rates of therapy group was significantly lower than of control group. Local recurrence rates of the therapy group and control group were 2.6%, 7.9%, 13.2% and 31.6% vs 10.8%, 21.6%, 40.5% and 62.1% (P < 0.05) at 3,6,12 and 24 months after treatment, respectively.Median for survival time of the therapy group and control group were 28.0 ± 2.8 months and 19.0 ± 3.6months, respectively. Cum survival of the therapy group and control group were 84.2%, 78.9%, 60.5% and 31.6% vs 78.4%, 67.6%, 37.8% and 8.1% (P < 0.05) at 6,12,24 and 36 months after treatment, respectively.Conclusion PEI as a supplementary treatment of PRFA can effectively improve the treatment of liver cancer adjacent to major blood vessels and significantly reduce the local recurrence rate and improve long-term survival rates.     

Percutaneous microwave coagulation therapy for unresectable hepatocellular carcinoma

BACKGROUND/AIMS: Percutaneous microwave coagulation therapy (PMCT) has recently been introduced as a new treatment for hepatocellular carcinoma (HCC) in Japan. This study was performed to evaluate its efficacy and safety. METHODOLOGY: Thirteen patients with 17 nodules of unresectable HCC were subjected to PMCT under ultrasonic guidance. The tumors ranged from 1.2-4.4 cm in size. Assessment of the efficacy of PMCT was made by follow-up with dynamic computed tomography (CT). RESULTS: In the patients with small HCC (< or = 2.0 cm), 8 of 10 nodules (80%) showed complete remission after PMCT. In small nodules located on the liver surface, 3 out of 4 nodules (75%) showed complete remission. However, in the patients with larger HCC (> or = 2.1 cm), 5 out of 7 nodules developed local recurrence after PMCT. Regarding assessment of the necrotic area after PMCT, dynamic CT revealed enhancement that was possibly caused by congestion of the liver parenchyma surrounding the area of necrosis due to PMCT in the early phase of the treatment. Therefore, the necrotic area must be assessed carefully. Although a slight heat sensation and/or pain during microwave irradiation (a common effect of PMCT) occurred in all patients, there were no serious adverse effects. CONCLUSIONS: Complete remission of small HCC (< or = 2 cm in diameter) can be achieved with PMCT alone, but there seem to be limitations to its effectiveness with larger HCC (> or = 2.1 cm). There were no serious adverse effects from PMCT and the therapy can be safely carried out even in patients with poor liver function.