改进经皮微波凝固治疗大肝癌技术的研究

目的：改进微波肝组织凝固技术，为该技术在治疗大肝癌的应用奠定基础。方法：对离体牛肝采用不同的条件进行微波辐射，测量单点及两点辐射的组织温度和凝固范围，借助计算机模拟技术设计多点辐射方案并通过体外肝实验验证。临床上，对９个和４个施行单点和两点辐射的肝癌结节测温，对１６个３－６ ｃｍ的肝癌结节按多点辐射方案进行治疗。结果： ６０ Ｗ × ３００ ｓ的微波辐射可形成横径 ３． ０ ｃｍ的凝固区。两点辐射的最佳距离为２．５ｃｍ。７针穿刺可形成横切面直径７．１ｃｍ的球形凝固区。 １６个经治结节仅２个坏死不完全。结论：适当延长单点辐射的时间及使用合适的多点穿刺方案可使微波凝固治疗的适应证扩大至６ ｃｍ的肿瘤。

Study on Improving the Techniques of Microwave Coagulation in Treatment of Patients with Large Liver Cancer

Objective：The aim of this study was to improve the technique of percutaneous microwave coagulation therapy( PMCT) in the treatment of the patients with large liver cancers. Methods： The changes of temperature and coagulation area were measured in single and double irradiation for ex vivo liver tissue. Multiple irradiation schemes were devised by the aid of computer assistant design technique and verified by ex vivo experiment. Thermal monitor was conducted for 9 liver cancer cases with single irradiation and 4 cases with double irradiation. Multiple irradiation was applied for 16 liver cancer nodules ranging from 3 to 6 cm. Results： With 60 W× 300 seconds, single irradiation could create a coagulation area of 3.0 cm in transverse diameter. The suitable distance of double irradiation was 2.5 cm. Seven insertions could produce a spherical coagulation area of 7.1 cm in diameter. Incomplete necrosis only occurred in 2 treated nodules. Conclusion： PMCT can completely ablate liver cancers about 6 cm by suitably prolonging the irradiation duration and using rational multiple insertion schemes.