开放式磁共振导航下经皮穿刺肝癌的冷冻消融治疗

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冷冻消融治疗的可行性、疗效和安全性。方法：采用新奥博为0．3-T开放式MRI系统对20例病人中的22个肝肿瘤进行冷冻消融治疗。冷冻探针通过实时监视被置于消融病灶中，冷冻消融术采取氩氦刀（Cryo—Hit），对临床体征、症状、实验室检验和影像学结果进行评估，并术后随访。结果：在MRI引导下经皮穿刺冷冻探针均成功置于病灶内，共对20例病人22个肝肿瘤进行了冷冻消融治疗（共24次治疗），手术期间MRI显示冰球扩展并包裹整个肿瘤，包裹肿瘤的冰球在MRI图像中呈现边缘清晰的信号暗区。使用一个冷冻探针形成最大的冰球为5．0cm×2．5cm×2．5cm、使用4个冷冻探针形成的冰球最大为7．6cm×5．5cm×5．0cm。冷冻消融治疗有血清肝酶水平临床上的改变，没有引起严重的并发症。术后随访1—6月，肿瘤经影像检查体积缩小者5例，增大3例，无变化12例。手术切除肿瘤1例，病情进展死亡2例，死于消化道出血。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。MRI能够在手术期间引导冷冻消融治疗，以及用于评估冷冻消融治疗的效果。

The open -configuration magnetic resonance guidance and cryoablation for liver cancer through percutaneous puncture injection

Objective： To study the cryoablation of liver cancer by using a percutaneous puncture injection and intraprocedural open -configuration Magnetic Resonance Imaging（MR/） monitoring and to access the feasibility,efficacy and safety. Methods：Total 22 hepatic tumors in 20 patients were treated with cryoablation under the guidance of the 0.3T open - configuration MRI system. MR - compatible cryoprobe was guided into the target and eryoablation was performed using a Cryo - Hit system. To observe the clinical signs, symptoms, laboratory examination and radiographic results. Meanwhile, we executed the postoperative follow - up. Results ： All cryoprobes were guided into tumors successfully and twenty - four cryoablations were performed for 22 tumors in 20 patients. Intraprocedural MRI enabled clear visualization of iceballs and all iceballs encapsulated tumors perfectly in operative period. The most large iceball was 5.0cm ×2.5cm ×2.5cm with one cryoprobe while the largest iceball was 7.6cm ×5.5cm ×5.0cm with four cryoprobes. There were changes in serum hepatic enzyme levels without any serious complications in eryoablation. After 1 - 6 months following - up, the volume reduction tumors were in 5 cases, the volume expansion tumors were in 3 cases and the volume unchanged tumors in 12 eases. The resection tumor was in 1 case and 2 patients died from tumor progression and gastrointestinal hemorrhage. Conclusion： MRI - guided percutaneous targeting intervention and monitoring cryoablation for liver cancer were feasible and safe. MRI was guided into cryoablation in operative period and evaluated effect of eryoablation.