超声引导单击冷循环射频消融治疗肝癌的临床研究

目的探讨超声引导单击冷循环射频消融（cooling cycle radio frequency Ablation，RFA）治疗肝癌的疗效。方法对124例肝癌患者的146个肿瘤在超声引导下行多点扇形立体定位法经皮穿刺RFA治疗，在局部或硬膜外麻醉后，将射频电极穿刺肿瘤至肿瘤底部，根据肿瘤大小由深至浅进行消融治疗，每点治疗5～12min，当肿瘤完全被强回声覆盖超出正常肝组织0．5cm时停止治疗，封闭针道。治疗后15min行超声造影（CEUS），判断肿瘤是否完全灭活，如果造影显示灭活不完全，可重复以上治疗；治疗后1个月行增强CT（CECT）或CEUS评估治疗效果。结果本组治疗后1个月CECT复查146个肿瘤，肿瘤内无强化者为125例（85．62％），其中〈3cm者125例，-5cm者34例（85.00％），～6cm者34例（80．95％），-10cm者13例（81．25％）。CEUS复查126个肿瘤，肿瘤内无增强者106例（84．13％），其中〈3．0cm者31例（86．11％），-5cm者31例（85．29％），-6cm者35例（83．33％），-10cm者3例（78．57％）。CECT与CEUS比较，差异无显著性。结论超声引导单极冷循环RFA治疗肝癌疗效可靠，安全性高、适应范围广、创伤小、提高了较大肝癌灭活率。

Clinical Study on Cool-tip Ultrasound-guided Radiofrequency Ablation Treatment of Hepatic Carcinoma

Objective To investigate the role of treatment of hepatocellular carcinoma with cooling cycle ultrasound-guided radiofrequency ablation. Methods One hundred and forty-six liver neoplasm of 124 patients were treated with percutaneous RFA using multipoint sectors stereotactic under the ultrasonic-guidance. The RF electrode was punctured into the bottom of the tumor after the local or epidural anesthesia. The tumors were ablated from deep to shallow according to their size. Each point was treated for 5 - 12min. The treatment would be stopped when the tumor was completely covered by strong echo with 0.5cm beyond the border of normal liver parenchyma and the needle tract was closed then. Contrast-enhanced ultrasound（CEUS） was examined 15min after the treatment to determine whether the tumor was completely inactivated. If the CEUS imaging showed that inactivation was not complete,then the above treatment would be repeated once aga/n;The therapeutic effect was assessed using enhanced computed tomography（ CECT） or CEUS after one month. Results In this study, 146 tumors were reviewed by CECT and 126 tumors by CEUS one month after the treatment. In 146 tumors reviewed by CECT, 125 tumors had no enhancement（ 85.62% ） ,the size of 125 tumors 〈 3.0cm in diameter（91.67% ） ,34 tumors - 5cm（ 85.00%） ,34 tumors -6cm180. 95% ） , 13 tumors - 10cm （81.25% ）. In 126 tumors reviewed by CEUS, 106 tumors had no enhancement （84.13% ） , the size of 31 tumors 〈 3.0cm in diameter（ 86.11% ） ,31 tumors-5cm{85.29% ） ,35 tumors-6cm（83.33% ） ,3 tumors - 10cm（78.57% ）. There was no significant difference between CECT and CEUS. Conclusions Ultrasound-guided monopolar cooling cycle RFA treatment of liver cancer may be reliable and high security ,having wide serviceable range, minor trauma and a greater inactivation rate of liver cancer.