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。     

经皮肝穿刺射频消融术对肝癌的疗效观察

目的 观察经皮肝穿刺射频消融术对肝癌的热消融作用及其适应证。方法在局麻或硬膜外麻醉下及B超引导下,射频穿刺电极经皮穿刺入肝癌瘤体内,对其进行消融。结果60例患者的96个瘤体中,直径<3.5 cm的41个(42.7％)瘤体获得一次手术热消融。其中,38个完全缓解(CR),3个部分缓解(PR),有效率(CR+PR)100％。41个瘤体中,36个经CT或MRI随访6～24个月,未见复发。直径≥3.5 cm～12 cm的55个(57.3％)瘤体可分2,3次手术,术后1～3个月CT或MRI提示,瘤体CR 2个,PR 37个,CR+PR70％。结论经皮肝穿刺射频消融术治疗肝癌,对直径<3.5 em的瘤体疗效可靠,对直径≥3.5 cm的瘤体仍具有部分热消融的作用。     

经皮肝穿刺微波治疗肝癌

由总后卫生部委托第二军医大学东方肝胆外科医院主办的"全军微波临床应用新技术"学习班于2001年11月6～9日在上海召开,有来自包括北京军区总医院等全军16个医院的代表参加.陈夷教授重点介绍了微波经皮肝穿刺微创术治疗肝癌.临床应用52例患者共97个瘤体,近期疗效观察满意. 微波经皮肝穿刺微创术热凝固损毁肝癌方法,是近年进入临床的一种新技术.使用2450MHz的微波天线,在局麻或硬膜外麻醉下,B超引导直接经皮肝穿刺入肝癌瘤体内,对其进行热凝固,52例中原发性肝癌42例,继发性肝癌10例,其中属手术切除后复发或再发的44例.瘤体直径介于0.5cm～5cm之间,<3cm61个,>3cm36个.术中输出功率,温度高低控制根据瘤体大小而设定,一般每点选择功率40W,时间15～20分钟即可,每点的加热范围在1cm～4cm之间.术后给予止血、保肝、抗菌等促进术后康复治疗.所有病例术后经CT或MRI随访.术后6个月>3cm的36个肿瘤中27个完全热凝损毁(75%),9个大部分热凝损毁(25%);术前瘤体总数97个,术后瘤体总数82个,消失15个(占15.5%);术前瘤体平均3.1cm3,术后瘤体平均2.8cm3,平均减少0.3cm3(占9.67%). 作者认为只要术者操作准确,热凝范围能确切将肿瘤覆盖,其治疗效果肯定.该法治疗<3cm的肝癌是一种定位准确、高效、快速、操作灵活、副作用小、安全,无需开腹,无需输血,对正常肝组织低损伤、低成本,方便实用的微创手术.尤其对于手术后复发,病灶在肝实质内,小、多发、临近肝门大血管、胆管部位的肿瘤,手术切除有困难,肝功能条件差,年老体弱的患者,PEIT、TACE要多次治疗的患者,将是一种更合适的选择.余昌中     

经皮微波热凝固治疗肝癌的初步研究

超声引导经皮肝穿刺微波热凝固疗法 ( percutaneousmi crowavecoagulationtherapy ,PMCT )是近年应用于临床的新技术 ,2 0 0 1年 3月至 2 0 0 3年 2月我们应用该疗法治疗了 2 1例肝癌患者 ,共 2 3个瘤体 ,现报告如下。1　资料与方法1.1　临床资料男性患者 16例 ,女性 5例 ,年龄     

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。     

经皮微波热凝固治疗肝癌的疗效观察

目的:观察超声引导经皮肝穿刺微波热凝固治疗肝癌的疗效。方法:21 例肝癌患者经皮肝穿刺植入频率为2 450 MHz的单导或双导微波天线,在丙泊酚静脉麻醉下对肿瘤进行一次整体覆盖原位热凝固治疗。结果:对21 例患者的23 个瘤体进行28 次治疗,平均随访6.7 个月,16 例生存,4 例死亡,1 例失访,术后AFP正常或明显下降,10 个瘤径≤5.0 cm的瘤体一次整体凝固,13 个瘤径>5.0 cm的瘤体术后肿块内血流信号大部分消失,治疗前后肝功能无明显变化,16 例次术后2 d ~ 6 d中度发热,1 例出现胸腔积液。结论:超声引导经皮肝穿刺微波热凝固治疗肝癌近期疗效满意,是一种定位准确、操作简单、安全价廉、可重复的微创手术。     

CDFI引导下经皮微波热凝固联合血管介入法治疗肝癌的综合应用

目的:探讨应用彩色多普勒超声显像(CDFI)引导经皮微波热凝固(PMCT)联合血管介入法治疗肝癌的可行性与治疗效果。方法:56例肝癌患者,应用PMCT治疗26例,30个结节;PMCT联合TACE30例,42个结节,先行肝动脉化疗栓塞(TACE),3d后行PMCT治疗,其中8例合并门静脉癌栓的病例,在TACE治疗2周后行经皮门静脉化疗(PVC)。结果:肿瘤<5cm的肝癌结节53个,PMCT与联合治疗组均获较好疗效。肿瘤≥5.0cm的19个结节中,联合治疗组在肿瘤缩小、血流信号消失、生存期方面均优于PMCT组。结论:PMCT联合TACE治疗肝癌具有协同作用,是中晚期肝癌有效的综合治疗方法。     

经皮肝穿刺射频热凝对复发性肝癌的治疗意义

目的 探讨对于无再次手术指征的复发性肝癌行B超引导经皮肝穿刺射频热凝(PRFA)治疗的意义。方法 1999年10月～2001年7月经病理证实为原发性肝癌，术后影像学和血清肿瘤标记物证实为肝癌复发的47患者进行B超引导PRFA治疗。复发瘤灶为单发者24例、多发者23例，其中复发灶为单发且小于3．5cm者12例。定期随访，复查AFP、肝功能和B超，1个月后复查MRI或CT了解肿瘤坏死情况，以后每3个月复查。Kaplan—Meier法计算累积生存率。结果 复发灶为单发者1、2、3年的生存率分别为65.2％、37．5％、37．5％，复发灶为单发且小于3.5cm者1、2、3年的生存率分别为83.3％、51．4％、51．4％。复发灶为多发者1、2年的生存率为41．7％、19．5％。结论 B超引导经皮肝穿刺射频热凝是肝癌综合治疗中一种重要手段，对于无再次手术指征的复发性肝癌可以根据复发瘤灶的大小、范围、复发时间，决定单独或结合TACE给予B超引导经皮肝穿刺射频热凝(PRFA)治疗，可以更加有效地控制复发、提高生存率。     

超声引导经皮微波消融治疗肝癌的个体化方案及疗效

目的:探讨超声引导经皮穿刺微波凝固治疗(PMCT)对邻近膈肌、肠管、胆囊和肝表面等难治部位肝癌的个体化治疗方案疗效。方法:采用超声引导经皮穿刺微波凝固(PMCT)治疗750例肝癌患者,共902个病灶,其中,176个病灶邻近肠管,383个病灶邻近膈肌,163个病灶邻近胆囊,180个病灶邻近肝表面。肿瘤最大径平均(4.0±2.2)cm(1.5-6.8)cm。对不同部位肿瘤建立相应的个体化方案指导治疗,1个月后行增强CT判断肿瘤早期灭活率并定期随访。结果:肿瘤早期总灭活率为90.3%;邻近肠管、膈肌、胆囊和肝表面的肿瘤早期灭活率分别为90.3%、89.5%、91.7%和93.1%,局部复发率分别为9.1%、9.9%、8.1%和7.0%。1、2、3年的生存率分别为81.9%、60.8%、50.6%。750例共1150人次,较严重并发症占3.7%。包括腹腔出血8例,邻近脏器(膈肌、肠管)损伤6人,针道种植9例,肝包膜下血肿15例,肝脓肿5例。共计43人次。结论:对PMCT易灼伤邻近肝外结构的难治性肝癌,本研究采用个体化方案策略指导治疗,获得较好的肿瘤灭活率并降低并发症,本方案拓展了肝癌PMCT治疗适用范围,有助于提高PMCT在肝癌综合治疗中的作用。     

腹腔镜引导定位肝脏肿瘤射频消融治疗的临床观察

目的:探讨腹腔镜直视引导定位下肝癌射频热凝消融治疗(radio-ferquency ablation, RFA)的可行性.方法:在腹腔镜直视引导定位下分别对10例原发性肝癌和多发转移性肝癌进行一次性射频消融治疗.结果:10例患者28个瘤体中直径＜5 cm的20个肿瘤均获得一次性热凝损毁,其中18个瘤体完全缓解CR 90.0%(18/20),2个瘤体部分缓解PR 10.0%(2/20),近期疗效CR+PR为100.0%(20/20),1例术后15个月肝、肺转移复发;8个直径5～9 cm的瘤体近期疗效为CR+PR 100.0%(8/8),CR 50.0%(4/8),PR 50.0%(4/8),1例术后6个月发生肝门部转移及阻塞性黄疸而病情进展死亡,1例术后14个月因肝脏、肺脏广泛转移死亡.术后2周复查AFP、CEA和CA19-9等肿瘤标志均有不同程度的下降或转阴.所有患者均很好地耐受了射频消融治疗,无严重并发症出现.9例患者术后分别行1～4次肝动脉化疗栓塞介入治疗(TACE).1年生存率为85.7%(6/7),2年生存率为50.0%(3/6). 结论:腹腔镜直视引导定位下肝癌射频消融治疗为不能手术的原发性肝癌及多发性肝转移癌提供了一种微创、安全、有效、方便的治疗方法,与TACE结合效果更佳.     

Intracranial tumors in adult population of the Varaždin County (Croatia) 1996–2004: a␣population-based retrospective incidence study

SummaryAim To estimate the incidence of intracranial tumors in the adult population of the Varaždin County, Croatia, for the 1996–2004 period.Methods Setting: Varaždin County General Hospital and four university hospitals in Zagreb, the capital of Croatia. Study period: January 1, 1996 to December 31, 2004. Incident patients: county residents admitted for newly diagnosed intracranial tumors according to the WHO diagnostic criteria. Demographic data were extracted from the 2001 Croatian census. Incidence rates (IRs) per 100,000 person-years (p-y) and annual IRs (per 100,000 persons) were determined and compared as incidence rate ratios (IRRs) with 95% CI.Results For primary intracranial tumors (PITs), IR was 12.1/100,000 p-y (95% CI: 10.3–14.2), comparable in men and women. The highest incidence was recorded for glioblastoma (IR 4.8, 3.7–6.2) and meningioma (IR 3.1, 2.2–4.2). The incidence of PIT was somewhat greater than that of metastatic tumors (IRR 1.58, 95% CI: 1.22–2.05, P<0.001). Metastatic tumors were more frequent in men than in women, especially metastatic lung tumors (IRR 6.08, 2.32–20.16, P<0.001). IRs of all PIT taken together, neuroepithelial tumors cumulatively, nonepithelial tumors cumulatively, glioblastoma and meningioma were higher in the population aged ≥40 vs. population aged ≤ 39 (all IRRs with 95% CI greater than 1, P<0.05 or < 0.001), comparable in men and women. Women were somewhat older than men at the time of diagnosis of PIT: median difference −6 years (95.1% CI: −10 to −1, P<0.05). Annual IRs for all these tumor categories showed increasing trends over the study period.Conclusion Overall, there was an increasing trend in the incidence of primary intracranial tumors in the Varaždin County. Data did not allow estimation for most of the specific tumor types.     

Dynamic MR Based Analysis of Tumor Movement in Upper and Mid Lobe Localized Lung Cancer

Background and purpose: Tumor motion is a very important factor in the radiotherapy of lung cancer. Uncertainty resulting from tumor movement must be considered in 3D therapy planning especially in case of IMRT or stereotactic therapy. The aim of our dynamic MR based study was to detect tumor movements in upper and mid lobe lung tumors. Patient and methods: Twenty-four patients with newly diagnosed stage II-IV lung cancer were enrolled into the study. According to tumor localization in the right S1–S3 segments 9, in the right S4–S6 segments 2, in the left S1–S3 segments 9 and in the left S4–S6 segments 4 lesions were detected. In normal treatment position individual dynamic MR examinations were performed in axial, sagittal and coronal planes (100 slices/30 sec). For tumor motion analysis E-RAD PAC's software was used. Results: Movements of the tumor under normal breathing conditions were registered in the three main directions. The mean antero-posterior deviation was 0,109 cm (range: 0,063 cm–0,204 cm), the mean medio-lateral deviation was 0,114 cm (range: 0,06 cm– 0,244 cm). The greatest deviation was measured in cranio–caudal direction (mean: 0,27 cm, range: 0,079 cm– 0,815 cm). The mean direction independent deviation was 0,18 cm (range: 0,09 cm– 0,48 cm). Conclusion: Dynamic MR is a sensitive and well tolerated method for tumor motion monitoring in high precision 3D therapy planning of lung cancer patients. Our results demonstrate that tumors located in the upper and mid lobes have moderate breath synchronous movements. The greatest deviation occur in cranio–caudal direction.     

CLINICAL STUDY ON IRRADIATION COMBINED WITH TRADITIONAL CHINESE MEDICINE IN THE TREATMENT OF LARGE PRIMARY LIVER CANCER

ＣＬＩＮＩＣＡＬＳＴＵＤＹＯＮＩＲＲＡＤＩＡＴＩＯＮＣＯＭＢＩＮＥＤＷＩＴＨＴＲＡＤＩＴＩＯＮＡＬＣＨＩＮＥＳＥＭＥＤＩＣＩＮＥＩＮＴＨＥＴＲＥＡＴＭＥＮＴＯＦＬＡＲＧＥＰＲＩＭＡＲＹＬＩＶＥＲＣＡＮＣＥＲＹｕＥｒｘｉｎ于尔辛ＬｉｕＬｕｍｉｎｇ刘鲁明...     

Percutaneous microwave coagulation therapy for patients with primary and metastatic hepatic tumors during interruption of hepatic blood flow

BACKGROUND: Although percutaneous microwave coagulation is relatively noninvasive therapy for patients with hepatic tumors, coagulation of tumors is sometimes incomplete and local recurrence occurs. The authors hypothesized that the cause of incomplete coagulation was a cooling effect in surrounding hepatic blood flow. To prove this hypothesis and to improve the efficacy of this therapy, they interrupted hepatic blood flow during the treatment and measured the amount of tumor tissue coagulated by microwave. METHODS: The authors first performed an animal experiment on pigs. After laparotomy, the liver of an anesthetized pig was coagulated by microwave with or without interruption of hepatic blood flow; the interruption was achieved by squeezing hepatic blood vessels. Next, the authors applied the microwave coagulation percutaneously to 25 human patients with primary or metastatic carcinoma in the liver with or without intraoperative temporary interruption of hepatic blood flow; the interruption was achieved by inflating balloon catheters inserted in the hepatic blood vessels through femoral vessels. RESULTS: The greatest dimension of area of normal liver tissue coagulated by microwave with blood flow interruption was significantly (P < 0.001) larger (18.8 +/- 1.0 mm, n = 4) than without it (9.8 +/- 1.7 mm, n = 4) in the experiment with pigs. In human hepatic tumors, the greatest dimension of the area coagulated by microwave with blood flow interruption was also significantly (P < 0.001) larger (41.1 +/- 9.3 mm, n = 14) than without it (26.9 +/- 8.5 mm, n = 11). The local recurrence rate of the tumor during a period of 6 months after the treatment was lower (P < 0.05) with blood flow interruption (7%) than without it (45%). CONCLUSIONS: Intraoperative interruption of hepatic blood flow increases the areas of primary and metastatic hepatic tumors coagulated by microwave. It is expected to increase the efficacy of percutaneous microwave coagulation therapy for patients with hepatic tumors.     

Combination therapy with transcatheter arterial chemoembolization and percutaneous microwave coagulation therapy for hepatocellular carcinoma

BACKGROUND: A small number of microwave electrode insertions and microwave irradiations were used to obtain complete tumor necrosis in hepatocellular carcinomas (HCC) measuring > 2.0 cm but 2.0 cm but /= 5 mm). Necroses of tumors and noncancerous margins surrounding the tumors were obtained using 4 microwave irradiations (1 session) in 14 patients, 5 microwave irradiations (2 sessions) in 2 patients, and 6 microwave irradiations (2 sessions) in 1 patient. The follow-up period was short (12-31 mos), and all patients remained alive. No local recurrences in the treated areas were detected. No fatal complications were observed. Pleural effusion was observed in 1 patient only. CONCLUSIONS: This combined therapy of PMCT applied within 1-2 days of TACE effectively treated HCCs measuring > 2.0 cm but 相似文献   

The efficacy and safety of percutaneous microwave coagulation by a new microwave delivery system in large hepatocellular carcinomas: Four case studies

Purpose: To demonstrate the efficacy and safety of percutaneous microwave coagulation treatment (PMCT) by a new microwave delivery system (Forsea Microwave?) in large hepatocellular carcinomas (HCC) (≥5 cm).

Materials and methods: Four patients with 4 HCC lesions measuring ≥6 cm in the greatest dimension underwent PMCT by means of the Forsea Microwave? microwave delivery system. Final therapeutic efficacy was evaluated with dynamic computer tomography (CT) scans performed within one month after PMCT. During and after PMCT, patients’ complaints and any abnormal physical signs were recorded for safety assay. CT or ultrasound scan (US) performed immediately after the treatment was used to detect acute complications related to the treatment. Repeated dynamic CT scans were performed every three to four months thereafter to detect local disease recurrence and/or other recurrences.

Results: Three of these patients achieved a complete ablation of the cancer nodules (two patients with two treatment sessions and one patient with three treatment sessions). One of these patients obtained a complete ablation of the cancer nodule with two treatment sessions except the lesion of portal vein tumour thrombus (PVTT). No obvious symptomatic complication was observed except abdominal pain during and after the treatment in two of these patients. All the patients remained asymptomatic and no recurrent tumour was observed during their follow-up (1-19 months).

Conclusions: PMCT by the Forsea Microwave? microwave delivery system could offer a satisfactory therapeutic effect and is applicable to the treatment of large HCC.     

Targeted cancer chemotherapy with arterial microcapsule chemoembolization: review of 1013 patients

 To evaluate the feasibility of intraarterial infusion of microencapsulated anticancer drugs (chemoembolization), collective data on 1013 cancer patients were reviewed. Ethylcellulose microcapsules containing mitomycin C (median total dose 20 mg), cisplatin (60 mg) or peplomycin (40 mg) were given to tumor-feeding arteries by bolus infusion in 79% of the patients and by fractionated infusion in the others, as a palliative (71%) or preoperative measure (29%). The target sites were the liver (42%), kidney (24%), intrapelvic organs (18%), lung (4%), head and neck (3%), bone (1%) and others (9%), excluding the central nervous system and gastrointestinal tract. The incidence of overall adverse effects ranged from 0.2 to 54.9%, but grade 2–3 hematological, renal and hepatic toxicities, local pain, abdominal discomfort, cutaneous reaction, remote embolization and infection were < 10%. Nine patients (0.9%) in the early stages of trials suffered serious complications including treatment-related death in two with critical underlying diseases of the target organs. The remaining patients recovered from the adverse effects, except for grade 2 cutaneous reactions, within 2 months by routine palliative measures. A ≥ 50% tumor reduction was seen in 28% of 427 evaluable tumors (42% for < 25-cm² tumors and 20% for ≥ 25-cm² tumors) with a median treatment number of one. The response rate depended on both the tumor size and the treatment number (P< 0.05), but it was not affected by prior therapies. Mitomycin C microcapsules produced a higher response rate. Complete or partial remission of intractable pain and genitourinary gross hemorrhage was found in two-thirds of eligible patients. The results indicate that this treatment modality, though restricted by catheter technique, can be applied to various tumor lesions with an acceptable morbidity and prospective trials are justified to evaluate the potential role of such a targeted chemotherapy. Received: 30 December 1994/Accepted: 14 May 1995     

紧贴肝门大血管的肝癌切除术

Objective To study the surgical experience with resection of a hilar liver cancer close to major vessels and how to improve the therapeutic result. Methods From January 1990 to June 1997, 58 hilar liver tumors (segment I, IV, V, VIII) were resected. The tumors in these 58 patients were within a distance of 1 cm to major hepatic vessels (retrothepatic inferior vena cava, root of hepatic veins, and left or right trunk of portal vein). The diameter of the tumors was > 5 cm in 42 cases and < 5 cm in 16 cases, respectively. The size of the largest tumor was 20 cm × 18 cm × 18 cm. The surgical techniques are summarized, and the prevention and treatment of postoperative complications are discussed. Results All operations have been carried out successfully and had a regular follow-up until now with 1−, 3− and 5− year survival rate of 71%, 38% and 25%, respectively. Conclusion While hilar liver surgery is quite difficult and risky, the safety and therapeutic of surgery could be improved by observing a meticulous surgical technique, and by preventing and treating postoperative complications by multimodal measures.