经皮微波热凝治疗原发性和转移性肝癌

目的 经皮微波肝穿刺热凝损毁肝癌是个新的治疗方法,使用该法观察其对肝癌的作用疗效和安全性。方法 100例患者在局麻或硬膜外麻醉下,接受了经皮微波肝穿刺热凝损毁肝癌治疗,其中原发性和复发性肝癌79例,转移性肝癌21例。肿瘤总数186个,被分成瘤体直径<3cm的A组和瘤体直径≥3 cm-<5cm的B组。在局部麻醉或硬膜外麻醉下,单针或双针阵列的微波天线在B超的引导下直接经皮肝穿刺插入瘤体中对其行热凝损毁。结果 100例患者的186个瘤体中,直径<3cm A组的肿块123个(66％)能1次手术热凝损毁,其中112个(91％)经CT或MRI检查,并随访6-12个月,提示瘤体热损毁后未见复发;直径≥3 cm-<5cm B组的肿块63个(33.87％),被分2次手术,术后6个月 CT或MRI检查提示,31个热凝损毁(49％),32个大部分热凝损毁(51％)。经皮微波热凝治疗(PMCT)的患者均未见明显的不良反应和其他严重并发症。结论 PMCT治疗肝癌,尤其对直径<3cm的瘤体疗效可靠,对直径≥3cm-<5cm的瘤体仍具有大部分或完全热损毁的作用。它是一种微创、有效、安全的治疗方法,对肝功能较差的患者也可使用。     

经皮微波热凝治疗肝癌的疗效观察

目的 经皮微波肝穿刺对肝癌进行热凝损毁,观察其对肝癌的作用疗效。方法 52例患者在局麻或硬膜外麻醉下,使用2450MHz微波微型穿刺天线,在B超引导下直接经皮穿刺进入肝癌瘤体内,对其进行热凝固。结果 52例患者的97个瘤体中,直径均＜3cm的肿块61个（62．9％）能1次手术热凝损毁,其中57个（93．4％）经CT或MRI检查,并随访6－12个月,提示瘤体热损毁后未见复发;3－5cm的肿块36个（37．1％）,分2次手术,术后6个月CT或MRI检查提示,27个热凝损毁（75．0％）,9个大部分热凝损毁（25．0％）。经皮微波热凝治疗（PMCT）的患者均未见明显的副作用和其他并发症。结论 PMCT治疗肝癌,尤其对直径＜3cm的瘤体疗效可靠,对＞3．5cm或＜5cm的瘤体仍具有大部分或完全热损毁的作用。     

直径小于3cm肝癌的经皮射频微创治疗

[目的]初步总结采用经皮射频消融治疗肿瘤直径小于3cm小肝癌的疗效和经验。[方法]射频消融治疗肿瘤直径小于或等于3cm的小肝癌共53例，其中首次诊断为原发性肝癌30例，肝癌术后复发16例，肝转移癌7例，全部采用超声引导下经皮穿刺，单纯射频消融治疗31例，射频消融联合瘤内无水酒精注射术治疗22例。[结果]全组未见严重并发症，常见的术后反应为穿刺点疼痛，腹胀，低热，甲胎蛋白治疗后转阴者12例，下降但未完全转阴者5例，术后第1年出现复发者2例，第2年出现复发者1例，死亡1例，1年生存率为98.1%。[结论]经皮射频消融对小肝癌的治疗具有微创，简单，快速和重复性好的特点，是一种新的具有根治可能的微创治疗手段。     

B超引导下注射无水乙醇治疗肝癌34例疗效分析

作者采用在B超引导下经皮肝穿刺瘤内注射无水乙醇治疗肝癌34例,共43个病灶。其中原发性肝癌31例,继发性肝癌3例。肿瘤直径<3.0cm 30个,3.0-5.Ocm8个,5.0cm以上5个,治疗有效率分别为100％、75％和40％。术后半年、1年、3年生存率分别为73.5％、47％和11.7％。说明经皮肝穿刺瘤内注射无水乙醇法对肝癌,特别是小肝癌有较高的治疗应用价值。     

经皮肝瘤内注入无水乙醇结合TACE治疗中晚期原发性肝癌的疗效观察

目的　评估B超引导下经皮肝穿刺注射无水乙醇结合肝动脉化疗栓塞术治疗中晚期原发性肝癌的时机选择与疗效。方法　对 52例中晚期原发性肝癌采用B超引导下经皮肝穿刺瘤内注射无水乙醇 (PEI) +肝动脉插管化疗栓塞术 (TACE)治疗并与同期 58例单纯肝动脉化疗栓塞术 (对照组 )比较。结果　治疗组的肿瘤缩小率、AFP下降、Karnofsky评分、0 .5年、1年累计生存率明显优于对照组。结论　PEI+TACE为中晚期原发性肝癌较好的一种综合治疗方法     

原发性肝癌术后复发246例再治疗的近期疗效

目的探讨不同治疗方法对复发性肝癌患者治疗效果的影响。方法回顾性分析我院246例复发性肝癌患者的临床资料,38例行再次切除术,其中复发性肝癌单纯根治性手术切除18例;复发．性肝癌手术切除联合综合治疗20例;经皮肝动脉插管栓塞化疗（TACE）62例;146例患者给予保守治疗。结果1、3,5年生存率手术切除组分别为76．3％、394％及25．8％;TACE治疗组分别为53．2％、19.6%及9．3％;保守治疗组分别为37．7％、8．0％及1．5％,手术切除组与TACE治疗组及保守治疗组的生存率差异有统计学意义（P均〈0．05）。结论复发性肝癌二次手术切除治疗仍为首选方法,手术切除联合综合治疗是目前复发性肝癌再治疗的理想治疗模式,对患者的无瘤生存率及生存率均有所提高,并降低肝内再次复发,延长患者生存时间。     

原发性肝癌五种介入治疗方法的疗效比较

目的：比较几种介入治疗大肝癌方法优劣。方法：采用Seldinger技术经股动脉穿刺插管到肝动脉并注入化疗药物和栓塞剂的方法(TACE)，合并B超引导下门静脉化疗栓塞(SPVE)或B超引导下肿瘤内无水酒精注入(PEI)或结合多频治疗；对具备手术条件的患行Ⅱ期外科手术切除的综合治疗。结果：TACE，TACE SPVE，TACE PEI，TACE及Ⅱ期手术切除，TACE结合射频治疗的肿瘤缩小率≥50％，分别为30．2％，44．9％，45．2％，58．4％；其1和2年生存率，分别为36．2％，57．9％，70．9％，94．7％，96．4％和22．9％，39．5％，41．9％，67．9％。(TACE结合射频治疗的2年生存率未随访)。结论：大肝癌的综合介入治疗优于单纯TACE治疗。     

小肝癌切除术后复发的监测及复发病灶再治疗的价值

本文对８２例手术切除的小肝癌进行了分析，探讨小肝癌术后复发的规律、监测方法和复发病灶再次治疗的价值。结果提示，本组术后１～５年累计复发率分别为３０．５％、４２．７％、４５．１％、５０．０％和５１．２％。其中，术后３年内为复发的高发期，术后３年内复发人数占总复发人数的８６．１％。首次手术采用根治性切除可以降低复发率。术后定期复查有利于发现亚临床复发病灶，为再次治疗提供有利条件。本组４３例复发病例中，再次肝切除１８例，行经皮肝动脉栓塞化疗术４例，Ｂ超引导下无水酒精注射１例。复发病灶的再治疗可明显提高术后生存率。其中，复发病灶的再切除是提高小肝癌术后生存率的最主要途径，可使术后生存率提高３０％左右。     

不同影像方法对射频消融治疗肝癌疗效的评价

目的通过对射频消融治疗肝癌前后的B超、CT和MRI的比较,探讨不同影像方法对射频消融治疗肝癌疗效评价的意义。方法对100例肝癌患者进行了B超引导下经皮射频消融（PRFA）治疗。患者治疗前行B超、MRI或CT检查;治疗后1个月复查MRI或CT,每个月进行肿瘤标记物和B超检查。结果100例中,PRFA治疗前34例行CT检查;治疗后14例行CT复查,其中5例肿瘤区域呈现较原肿瘤更低的密度,动态增强无强化,9例肿瘤部分区域有强化。66例患者PRFA治疗前行MRI检查,T1加权像为低信号,T2加权像为相对高信号,动态增强扫描后动脉期强化,门脉期强化减弱。治疗后,全组有86例患者复查MRI,44例肿瘤T1加权像为等或高信号,T2,肌权像为等或低信号,动态增强无异常强化;42例肿瘤T1加权像呈不均匀等低混杂信号,T2,加权像部分呈相对高信号,动态增强有强化。结论增强CT扫描可以显示出残存肿瘤;MRI的T1、T2加权像及Gd-DPTA动态增强的信号变化,能够更好地反映肿瘤的坏死或残存状况,血清肿瘤标记物阳性者术后转阴并MRI（或CT）显示肿瘤呈完全凝固性坏死,可作为PRFA治疗肝癌的临床治愈标准。     

微波天线组合对不同大小肝癌热凝灭活的作用

[目的]探讨微波（2450MHz）天线多种组合方式经皮穿刺热凝方法及对肝癌的最佳灭活范围。[方法]200例患者299个肿瘤按大小分A、B、C、D4组，每组50例。A组：肿瘤直径≤2cm采用单支天线热凝方法。B组：2cm〈肿瘤直径3cm采用双天线组合方法。C组：3cm〈肿瘤直径≤4cm，采用三支天线组合方法。D组：4cm〈肿瘤直径≤5cm，采用四支天线组合方法。术后35±5d、2个月、4个月和6个月分别行MRI或CT增强扫描检查，随访近、远期肿瘤灭活效果。[结果]A组4次复查未见原位复发，热凝灭活率为100％；B组35±5d、2个月未见复发，4个月出现2例原位复发，热凝灭活率为96％（48／50）；C组首次复查1例复发，2个月后新增1例，4个月后再增2例，共4例出现原位残灶复发，热凝灭活率为92％（46／50）；D组为首次复查3例复发，2个月后新增6例，4个月后再增1例，6个月再增1病例，全组共11例出现原位残灶复发，热凝灭活率为78％（39／50）。[结论]微波经皮穿刺热凝方法对瘤径2cm≤肿瘤近、远期可达到100％灭活，疗效肯定。随着直径增大，灭活率有所降低，但基本满意。原位一次完全灭活有一定困难，术后复发率较高。     

Risk factors of survival after percutaneous radiofrequency ablation of hepatocellular carcinoma

AIMS: This study aimed to determine the risk factors of survival in patients with hepatocellular carcinoma (HCC) undergoing percutaneous radiofrequency ablation (PRFA). PATIENTS AND METHODS: Between August 1999 and May 2005, 281 patients (250 males and 31 females) who were 33-80 years old (mean 65.3 years) received PRFA only or PRFA in combination with percutaneous ethanol injection (PEI) in our center. Patients were treated with PRFA or PEI by a percutaneous approach with ultrasound (US) guidance and were evaluated at regular intervals to determine disease recurrence and survival. The survival curves were constructed by the Kaplan-Meier method and compared by the log-rank test. The relative significance of the variables in the risk factors of overall survival was assessed by multivariate Cox proportional hazards regression analysis. RESULTS: At the end of the study, 189 patients were alive, and 92 were dead. Median survival was 48.7 months. The overall 1-, 3-, and 5-year survival rates were 89%, 54%, and 43%, respectively. The overall 1-, 3-, and 5-year survival rates for small tumor (size < or = 3cm) were 97.8%, 65.7%, 58.6%, respectively, for medium tumor (size 3.1-5cm) 94.1%, 57.1%, 37.1%, respectively, and for large tumor (size >5cm) 62.8%, 40.3%, 0%, respectively. Survival of patients treated with PRFA was dependent on tumor size (p<0.001; risk ratio [RR] 9.6, 95% CI 5.2-17.8), number of tumors (p=0.003; RR 1.6, 95% CI 1.2-2.0), combination with PEI (p=0.01; RR 0.6, 95% CI 0.4-0.9), Child-Pugh class (p=0.002; RR 2.0, 95% CI 1.3-3.0) and safety margin (p=0.0026; RR 0.6, 95% CI 0.4-0.9). CONCLUSIONS: PRFA is an effective treatment for HCC. This study showed after PRFA, tumor size, number of tumors, combination with PEI, safety margin, and Child-Pugh class were independent risk factors of survival.     

射频消融与手术再切除治疗复发性肝癌的比较

目的:比较射频消融和手术再切除治疗原发性肝癌手术切除后复发癌患者的临床疗效.方法:分析比较2002年5月至2007年10月76例原发性肝癌手术切除后复发癌患者射频消融(n=45)和手术再切除(n=31)的临床疗效,引入COX比例风险模型初步分析探讨影响再复发和复发后患者生存期的可能因素.结果:消融组与再手术组比较,肿瘤完全清除率分别为88.9%和100%(P=0.147),1、2、3、5年复发率分别为45.2%、71.6%、80.1%、86.7%和39.6%、60.9%、77.6%、83.2%(P=0.711),1、2、3、5年复发后生存率分别为81.8%、60.1%、40.3%、24.2%和82.9%、64.7%、46.4%、34.8%(P=0.599).复发间期(复发癌距初次手术切除的时间)及复发癌结节个数是影响再手术切除和消融治疗后再复发的危险因素(P=0.035,P=0.005),复发癌结节个数及再复发时间是影响复发后患者生存期的危险因素(P=0.006,P=0.000).消融组并发症的发生率为13.3%,再手术组为29.0%(P=0.091).消融组患者无需输血而再手术组需输血的比率为35.5%(P=0.000).住院时间消融组为7.0天±0.8天,较之再手术组21.9天±1.6天明显缩短(P=0.000).结论:对于原发性肝癌切除术后复发癌患者射频消融术亦可以获得与手术再切除相当的长期生存率,而且具有微创、经济、重复性好的优势,适合于复发癌患者的治疗.     

经皮射频消融联合瘤内无水酒精注射与单纯射频消融治疗小肝癌的疗效比较

目的比较经皮射频消融联合瘤内无水酒精注射（RFA-PEI）与单纯射频消融（RFA）治疗单发小肝癌的疗效。方法随机应用RFA—PEI和RFA分别治疗小肝癌45例和41例,并按病灶大小分为A组（最大直径≤3．0cm）和B组（最大直径3．1～5．0cm）,以生存率和无局部复发率作为评价指标,比较两种疗法的疗效、结果RFA-PE组和RFA组的6,12,18,24个月生存率分别为88．9％、84．0％、80．6％、73．9％和87．6％、78．3%、73．7％、61.4％（P=0．6181）,无局部复发率分别为95．4％、95．4％、87．8％、73．7％和94．9％、72．7％、68.4％、57.0％（P=0．0393）,其中A组为95．7％、95．7％、79．1％、79．1％和923％、83．2％、81.3％、65．9％（P=0．3679）;B组为95．0％、95．0％、95．0％、72．6％和100．0％、583％、45．4％．45．4％（P=0．0440）结论RFA-PEI治疗肝癌安全有效,操作简单易行,可以提高RFA治疗的疗效, 特别是对于肿瘤直径为3-5cm的病灶,可以减少局部复发率,提高远期生存率。     

射频消融及125I粒子植入在预防肝癌切除术后局部复发的作用

目的探讨降低原发性肝癌切除术后局部复发的方法,提高肝癌患者的长期生存率。方法78例肿瘤靠近第一、第二肝门,估计切缘距肿瘤<1cm的肝癌患者,按就诊单双日分为单纯切除组和联合组。单纯切除组38例,仅行常规肝癌切除;联合组40例,在肝癌切除后,切缘行射频消融和~(125)I粒子植入。全部患者术后均定期随访。结果联合组术后1、3、5年肿瘤复发率分别为7.5%、30.0%和45.0%,术后1、3、5年生存率分别为92.5%、67.5%和30.0%,与单纯切除组比较,其中3、5年复发率差异有统计学意义((x~2=7.340,P<0.01;x~2=15.740,P<0.01);联合组的3、5年生存率较单纯切除组呈现明显升高的趋势。结论肝癌切除后切缘射频消融和~(125)I粒子植入能有效地降低术后局部复发率,提高治疗效果,且有可能延长肝癌患者的生存期。     

Long-term outcome of percutaneous radiofrequency ablation in recurrent hepatocellular carcinoma after liver transplantation

Purpose: To investigate the long-term outcome and prognostic factors of radiofrequency ablation (RFA) in recurrent hepatocellular carcinoma (HCC) after liver transplantation (LT).

Methods: From 2004 to 2014, 15 patients with 23 hepatic recurrent HCCs after LT underwent ultrasound-guided percutaneous RFA. There were 14 males and 1 female aged 54.3?±?9.5?years old (37–78?years old). The average tumour size was 3.3?±?1.2?cm (1.7–6.0?cm). Seven patients had a single HCC and eight had 2–4 HCCs. Regular follow-up after RFA was performed to assess local response rates and long-term survival rates. Survival results were generated using Kaplan–Meier estimates, and a multivariate analysis was performed using the Cox regression model.

Results: The technical success rate was 95.7% (22/23 tumours). The minor complication rate was 7.7% (2/26 sessions), and there were no major complications. The follow-up period was 27.4?±?18.9?months (12–116?months). The local progression rate and intrahepatic new lesion rate were 13.0% (3/23 tumours) and 53.3% (8/15 patients), respectively. Extrahepatic metastasis was found in four patients (26.7%). The 1-, 3- and 5-year estimated overall survival rates were 71.8%, 35.9% and 26.9%, respectively. Additionally, the multivariate analysis revealed that serum α-fetoprotein (AFP) before RFA, tumour number and extrahepatic metastasis were significantly related to overall survival after RFA.

Conclusion: Ultrasound-guided percutaneous RFA of recurrent HCC after LT had a high technical success rate and local control. However, RFA cannot decrease the frequency of new tumours or extrahepatic metastasis. The AFP level and tumour number before RFA should be considered to predict the outcome.     

胸腺肽α1对肝细胞癌患者热消融术后免疫功能及预后的影响

目的:探讨胸腺肽α1对原发性肝癌患者热消融术后免疫功能及预后的影响。方法:回顾性收集2010年至2012年在河南中医药大学第一附属医院的BCLC-A期原发性肝癌患者热消融术后共80例,按热消融术后是否使用胸腺肽α1分为观察组及对照组（各40例）,比较两组患者的免疫功能及远期治疗效果。结果:与对照组相比,观察组消融1年后仍存在较高的CD4+/CD8+比值（1.34±0.36 vs 0.64±0.26,P＜0.01)。观察组1年生存率、3年生存率及5年生存率分别为97.5%、90.0%及75.0%,对照组1年生存率、3年生存率及5年生存率分别为97.5%、80.0%及57.5%,二者的5年生存率比较差异有统计学意义（P=0.09）。观察组1年无瘤生存率、3年无瘤生存率及5年无瘤生存率分别为97.5%、72.5%及47.5%,对照组1年无瘤生存率、3年无瘤生存率及5年无瘤生存率分别为95.0%、52.5%及27.5%,二者的5年无瘤生存率比较差异有统计学意义（P=0.06）。结论:胸腺肽α1能改善原发性肝癌热消融后患者的CD4+/CD8+比值,提高患者的无瘤生存率及总生存率。     

A case-control study comparing percutaneous radiofrequency ablation alone or combined with transcatheter arterial chemoembolization for hepatocellular carcinoma

Aims

To assess whether combining percutaneous radiofrequency ablation (PRFA) with transcatheter arterial chemoembolization (TACE) was better than PRFA alone for hepatocellular carcinoma (HCC).

Materials and methods

One hundered twenty patients (with a solitary HCC ≤ 7.0 cm in diameter or multiple HCC (≤3), each ≤3.0 cm in diameter) treated with PRFA combined with TACE were compared with 120 well-matched controls selected from a pool of 652 patients who received PRFA alone during the study period.

Results

The 1-, 2-, 3-, 5-year overall survival rates for the TACE-PRFA and PRFA groups were 93%, 83%, 75%, 50%, and 89%, 76%, 64%, 42%, respectively (p = .045). Subgroup analyses showed the survival for the TACE-PRFA group was better than the PRFA group for tumors >5.0 cm (p = .031) and for multiple tumors (p = .032), but not for tumors ≤5.0 cm (p = .319) and for solitary tumor (p = .128). The 1-, 2-, 3-, 5-year progression free survival (PFS) for the TACE-PRFA and PRFA groups was 90%, 76%, 63%, 42%, and 76%, 60%, 47%, 30%, respectively (p = .002). Child-pugh class, Diameter of tumor and hepatitis B surface antigen (HBsAg) were significant prognostic factors.

Conclusion

Patients treated with TACE-PRFA had better overall survivals than PRFA alone, but only in a subgroup of patients with tumor >5 cm or multiple tumors.     

老年肝癌患者的射频消融治疗

目的 比较射频消融治疗老年和非老年肝癌患者的临床疗效。方法回顾性分析比较2004年3月~2007年8月77例老年和非老年肝癌患者射频消融的治疗效果,年龄≥60岁者为老年组(n=31),＜60岁者为非老年组(n=46)。结果 老年组与非老年组比较,肿瘤完全清除率87.1％vs 82.6%(P=0.832),1~3年复发率分别为44.4％、59.8％、71.3％vs 56.4％、70.7％、78.1％(P=0.464)。1~3年生存率分别为89.6％、63.8％、35.9％vs 78.9％、46.6％、20.1％(P=0.114)。并发症的发生比率分别为29.0％vs 26.1％(P=0.776)。肿瘤个数、初治时是否复发及治疗后是否再复发是影响预后的危险因素,而年龄、肿瘤直径不是预后的影响因素。结论 对于老年肝癌患者PRFA治疗可以获得与非老年患者相当的长期生存率,而其微创、重复性好的优势更适合老年肝癌患者,尤其是复发癌患者。     

经皮射频消融术治疗外科切除术后复发性肝细胞癌疗效分析

背景与目的：大部分复发性的肝癌结节的直径小于3 cm,且射频消融(radiofrequency ablation,RFA)治疗直径小于3 cm的肿瘤结节,其疗效已受到广泛认可。探讨RFA对手术切除术后复发性肝细胞癌(hepatocellular carcinoma,HCC)的临床疗效与安全性。方法：回顾性分析61例手术切除后复发性HCC患者在经动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)结合RFA的治疗下的1、3、5年总生存(overall survival,OS)率和无进展生存(progression-free survival,PFS)率,并发症发生率,死亡率,完全消融率以及影响患者生存率的独立风险因子。结果：完全消融率为93.4%(57/61),不完全消融率6.6%(4/61)。1、3、5年生存率分别为96.3%、77.9%和77.9%。1、3、5年PFS率分别为48.6%、20.3%和13.5%。消融术后出现主要并发症的患者1例,为肝包膜下出血;无消融治疗相关的死亡患者;消融后住院时间为4~7 d,中位值为5 d。影响OS的独立风险因子为患者HBsAg阳性(P=0.044,HR=7.496,95%CI：1.057~53.152)。结论：RFA治疗手术切除术后复发的HCC安全、有效,能够有效提高切除术后复发性HCC患者的生存率,对改善HCC患者的预后具有重要意义。     

Percutaneous radiofrequency ablation (PRFA) for hepatocellular carcinoma]

Percutaneous local treatment for hepatocellular carcinoma is minimally invasive. Moreover, since local radical cure may be possible, the procedure has become widely performed. Percutaneous radiofrequency ablation (PRFA) was recently introduced in Japan. Excellent results are expected. PRFA was conducted on 244 tumor nodules found in 177 cases of hepatocellular carcinoma (a total of 349 procedures), and the usefulness was examined. 1. Tumor markers significantly decreased after PRFA and a favorable necrotic effect was obtained on CT images. 2. Mild post-operative inflammatory reaction and exacerbation of liver dysfunction was noted, but recovery was achieved in one week. There were no major complications. 3. The cumulative local recurrence in 1 year was 5.4%, which is lower than that with percutaneous microwave coagulation therapy. 4. PRFA is a safe and handy procedure for hepatocellular carcinoma, which promises the favorable effect of coagulation necrosis. PRFA will likely become a key method among local ablation therapies.