磁共振导航经皮穿刺肝癌冷冻消融治疗27例

目的探讨在开放式磁共振（MRI）监视下采用经皮穿刺方法进行肝癌的冷冻消融治疗的可行性、疗效和安全性。方法2008年1～9月,对27例原发性肝癌在MRI引导下行经皮肝穿刺行氩氦刀治疗2个冷冻、解冻程序,MRI显示冰球扩展并包裹整个肿瘤。冷冻治疗后第10天联合肝动脉灌注化疗栓塞（TACE）5例。结果MRI引导下经皮穿刺冷冻治疗均成功,26例（96.3%）显示冰球扩展并包裹整个肿瘤,呈现边缘清晰的信号暗区,1例冰球不能包裹整个肿瘤。术后随访1～12个月,平均3.5月,甲胎蛋白（AFP）值下降至正常14例（51.9%）,AFP持续升高1例,先降复又升高12例。进行1次以上影像学复查肿瘤完全坏死或无明确存活病灶14例（51.9%）,肿瘤不完全坏死或有存活病灶13例（48.1%）。无严重并发症。结论MRI引导下经皮穿刺的肝脏肿瘤冷冻消融治疗是可行和安全的,疗效确切。

MRI-guided Percutaneous Cryoablation for Hepatic Carcinoma: Report of 27 Cases

Objective To study the feasibility, efficacy, and safety of MRI-guided percutaneous cryoablation for the treatment of hepatic carcinoma. Methods From January to September 2008, 27 cases of hepatic carcinoma were treated with MRI- guided percutaneous cryoablation with Cryo-Hit system via two cycles of freezing-thawing. During the procedure, MRI showed the expansion of ice globe wrapping the tumor. Ten days after the freezing treatment, TACE was carried out in 5 cases. Results MRI- guided percutaneous cryotherapy were completed successfully in all of the eases. In 26 patients （ 96. 3% ） , expanded ice globe wrapping the tumor was detected by MRI, showing a dark zone with clear margin. Only in one patient, the tumor was wrapped, The patients were followed up for 1 to 12 months （mean, 3.5 months） , during which the level of AFP decreased to a normal value in 14 eases （51.9%） , continued to inerease in 1 cases, and increased after an reduction in 12 eases （44.4%）. The patients received more than one times of re-examination by imaging, which showed completed necrotic tumor tissues or no confirmed living tumors in 14 cases （51.9%） ; and incomplete tumor necrosis or living tumor lesions in 13 （48. 1% ）. No severe complications occurred in this series. Conclusions MRI-guided percutaneous cryoablation is feasible, effecitve and safety for hepatic earcinoma.