高强度聚焦超声联合肝动脉化疗栓塞治疗中晚期原发性肝癌105例分析

目的　探讨高强度聚焦超声 (HIFU)联合肝动脉化疗栓塞 (TACE)治疗中、晚期原发性肝癌 (简称中、晚期肝癌 )的临床效果。方法　从 5年来收治的中、晚期肝癌患者中 ,无机抽样选择 10 5例 ,按治疗方法不同分两组 ;其中 HIFU联合 TACE治疗 5 5例 ,为联合组 ;单纯 TACE治疗 5 0例 ,为 TACE组 ;TACE采用 5 - FU Gemcitabine灌注 ,并注射碘油栓塞。分析治疗后 3个月 ,AFP的变化和病灶的局部改变 ;计算患者平均荷瘤生存期和 1年、 3年、 5年生存率 ,将两组结果进行比较。结果　在病灶局部 ,两组均出现不同程度坏死 ;联合组的 AFP下降幅度及转阴率、平均荷瘤生存期 ,结果优于 TACE组 ;1年、 3年、 5年生存率 ,联合组为 81.2 %、 4 7.3%、 2 5 .5 % ,高于 TACE组的 75 %、 30 %、 10 % ;两组结果经统计学处理 ,差异有显著性 (P<0 .0 5～ P<0 .0 1)。结论　对中晚期肝癌 ,HIFU联合 TACE,更有利于杀灭肿瘤 ,降低 AFP,提高患者的中、长期生存率 ,改善患者预后     

聚乙烯醇颗粒在原发性肝癌经导管肝动脉化疗栓塞术中的应用

目的 探讨聚乙烯醇颗粒(PVA)在原发性肝癌经导管肝动脉化疗栓塞术(TACE)中的应用价值.方法 对20例肝癌患者行TACE术,术中先使用碘化油化疗药物混合乳剂栓塞肿瘤血管,再用PVA颗粒超选择性插管栓塞肿瘤供血动脉.观察患者术后1个月、3个月、6个月、1年时肿瘤缩小程度、治疗有效率及甲胎蛋白(AFP)水平变化;术后1周及1个月时血清天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)及总胆红素(TBILI)水平,记录疾病进展时间及生存期.结果 术后1个月、3个月、6个月、1年肿瘤直径均较术前明显缩小(P＜0.05),其治疗有效率(完全缓解+部分缓解)分别为80.00%、90.00%、95.00%、95.00%,AFP水平较术前明显下降(P＜0.05).术后1周AST、ALT、TBILI均较术前明显升高(P＜0.05),但1个月时AST、ALT、TBILI均恢复为术前水平.随访时间12～32(19.8±7.0)个月,疾病进展时间为(17.0±6.8)个月,总生存时间为(19.3±7.0)个月.结论 PVA颗粒作为永久性栓塞材料,在肝癌TACE中栓塞效果明显,但术中需超选择性插管到肿瘤供血动脉内进行栓塞治疗.     

多次TACE联合TIPS治疗肝癌合并肝硬化上消化道出血的临床效果

目的 评价多次经肝动脉化疗栓塞术(TACE)联合经颈内静脉肝内门-体分流术(TIPS)治疗肝癌合并肝硬化上消化道出血的安全性及有效性.方法 回顾性分析2015年1月—2020年1月30例行多次TACE联合TIPS治疗肝癌合并肝硬化上消化道出血的临床资料.观察TACE治疗前后肝功能变化及并发症发生情况,同时观察其治疗效果...     

肝动脉化疗栓塞联合高强度聚焦超声、CIK细胞治疗原发性肝癌的疗效分析

目的超声观察肝动脉化疗栓塞（TACE）序贯高强度聚焦超声（HIFU）及TACE序贯HIFU联合CIK细胞疗法治疗原发性肝细胞癌的临床疗效。方法106例原发性肝细胞癌患者分为TACE序贯HIFU后联合CIK细胞治疗组（综合组,26例）,TACE序贯HIFU治疗组（联合组,40例）,单纯HIFU组40例。于治疗前后超声检测各组肿瘤的大小、血供,有无肝内转移;检查血清甲胎蛋白（AFP）、CD3^＋、CD8^＋、CD56^＋、AgNORS,观察患者的生存质量。结果综合组治疗后,肿瘤血供、肿瘤体积变化、有无肝内转移、AFP下降水平、生存质量等临床疗效指标,以及CD3^＋、CD8^＋、CD56^＋、AgNORS等免疫指标均明显优于联合组和单纯HIFU组（P〈0．05）。结论TACE序贯HIFU后联合CIK综合疗法治疗原发性肝细胞癌有较好的临床疗效,优于TACE序贯HIFU治疗,提高了患者的生存质量。     

HIFU、TACE治疗原发性肝癌对患者免疫功能影响的比较

目的比较高强度聚焦超声（HIFU）、肝动脉插管化疗栓塞（TACE）治疗原发性肝癌对患者免疫功能的影响,为HIFU治疗原发性肝癌提供依据。方法将60例肝癌患者半随机分成两组,HIFU治疗组和TACE组,各30例。检测两组患者治疗前后CD4＋T细胞、CD8＋T细胞以及CD;／CDs比值、NK细胞百分数和IgM、IgG、IgA含量。结果HIFU组治疗后CD4＋T细胞、CD4＋／CD8＋比值、NK细胞较治疗前明显升高,CD8＋T细胞较治疗前下降（P〈0．05）;HIFU组0．5年、1年、2年生存率分别为83．3％、63．5％、40％,较TACE组的66．7％、43．3％、26．7％高（P均〈0．05）。结论HIFU治疗原发性肝癌,为非侵入性的治疗方法,对患者免疫功能有改善作用,较TACE治疗能延长生存时问,提高生存率。     

Image-guided locoregional non-intravascular interventional treatments for hepatocellular carcinoma: Current status

Hepatocellular carcinoma (HCC) is one of the most deadly and frequent cancers worldwide, although great advancement in the treatment of this malignancy have been made within the past few decades. It continues to be a major health issue due to an increasing incidence and a poor prognosis. The majority of patients have their HCC diagnosed at an intermediate or advanced stage in theUSA or China. Curative therapy such as surgical resection or liver transplantation is not considered anoption of treatment at these stages.Transarterial chemoembolization (TACE), the most widely used locoregional therapeutic approach, used to be the mainstay of treatment for cases with unresectable cancer entities. However, for those patients with hypovascular tumors or impaired liver function reserve, TACE is a suboptimal treatment option. For example, embolization does not result in complete coverage of a hypovascular tumor, and may rather promotes postoperative tumor recurrence, or leave residual tumor, in these TACE-resistance patients. In addition, TACE carries a higher risk of hepatic decompensation in patients with poor liver function or reserve.Non-vascular interventional locoregional therapies for HCC include radiofrequency ablation (RFA), microwave ablation (MWA), high-intensity focused ultrasound (HIFU), laser-induced thermotherapy (LITT), cryosurgical ablation (CSA), irreversible Electroporation (IRE), percutaneous ethanol injection (PEI), and brachytherapy. Recent advancements in these techniques have significantly improved the treatment efficacy of HCC and expanded the population of patients who qualify for treatment. This review embraces the current status of imaging-guided locoregional non-intravascular interventional treatments for HCCs, with a primary focus on the clinical evaluation and assessment of the efficacy of combined therapies using these interventional techniques.     

经皮经肝选择性门静脉栓塞技术及其安全性评价

目的 探讨经皮经肝选择性门静脉栓塞术(SPVE)的技术要点和安全性.方法 对41例肝脏肿瘤患者(包括原发性肝癌13例,转移性肝癌28例)行SPVE,对其中32例同期行TACE术(SPVE+ TACE组),9例未行或未同期行TACE术(单纯SPVE组).术后回顾性分析SPVE的技术要点、并发症及临床安全性.结果 对41例均成功完成SPVE术,成功率100％;术后第3天患者ALT、AST、TB较术前升高,SPVE+TACE组升高更为明显,至术后第7天均明显下降.5例出现SPVE相关并发症,包括2例异位门静脉栓塞、1例暂时性肝功能衰竭、1例肝包膜下出血和1例肝内门静脉-静脉瘘.结论 SPVE作为肝脏外科手术和TACE术的重要辅助技术是可行的,但术后相关并发症应引起足够重视.     

TACE联合SPVE在肝癌二期切除术中的应用效果及对残余肝体积的影响

目的探讨肝动脉化疗栓塞术(TACE)联合选择性门静脉栓塞(SPVE)在肝癌二期切除术中的应用效果及对残留肝体积的影响。方法回顾性分析2017年7月1日至2018年12月31日于我院实施TACE后行肝癌二期切除手术患者(n=30,对照组)与实施TACE联合SPVE后行肝癌二期切除手术患者(n=30,观察组)的临床资料。比较两组的治疗效果。结果观察组左肝、右肝切除体积均小于对照组,术后残余左肝、右肝体积均大于对照组(P<0.05)。治疗后,两组的AST、ALT水平均较治疗前显著降低,且观察组低于对照组(P<0.05)。结论肝癌二期切除手术前实施TACE联合SPVE治疗,可最大限度保留肝体积,改善肝功能,对凝血功能损伤少,有利于提高患者存活率。     

高强度聚焦超声治疗放疗后残留肝癌的初步临床观察

目的 探讨高强度聚焦超声(HIFU)治疗放疗后残留肝癌的安全性和有效性.方法 HIFU治疗20例三维适形、立体定向放疗后25个肝癌残留病灶,比较HIFU治疗前、治疗后1周肝功能和血细胞变化,及治疗前、治疗后2周MRI、AFP变化,并行生存分析.结果 平均随访(12.6±8.0)个月,中位生存时间、1年生存率分别为22个月、87.5%.所有患者无皮肤烧伤.白蛋白、谷丙转氨酶、谷草转氨酶、总胆红素、直接胆红素、红细胞、白细胞、血小板HIFU治疗前与治疗后1周比较,差异无统计学意义(P=0.156、0.356、0.203、0.659、0.531、0.519、0.310、0.346).AFP(9例阳性)HIFU治疗前与治疗后2周比较,差异有统计学意义(P=0.030).MRI示16个病灶完整消融,6个消融体积≥80%.结论 HIFU可能是一种安全、有效治疗适形、立体定向放疗后残留肝癌的新方法.

Abstract：

Objective To investigate the safety and effect of high intensity focused ultrasound ablation(HIFU) on residual liver cancer in patients after radiotherapy. Methods Twenty liver cancer patients with twenty five residual tumors after three-dimensional conformal radiotherapy or stereotactic radiotherapy received HIFU ablation. Liver function and periphery blood cell counts were performed before HIFU and at 1 week after HIFU in all patients. Enhanced MRI and α-fetoprotein (AFP) level were performed before HIFU and at 2 weeks after HIFU to evaluate the effect of HIFU ablation. The survival of all patients was assessed by the Kaplan-Meier method. Results The mean follow-up time was (12.6 ± 8.0)months. The median survival time and 1-year survival rate were 22 months and 87.5% respectively. No skin burns were observed in all patients. As compared with before HIFU,there were no significant differences in the levels of albumin,alanine transarninase, aspartate transarninase, total bilirubin, direct bilirubin, blood red cell counts,blood white cell counts and blood platelet counts at 1 week after HIFU (paired t test, P =0. 156,0. 356,0. 203,0.659,0. 531,0. 519,0. 310,0. 346, respectively). Significant difference in AFP level of 9 patients with AFP＞20 μg/L was observed before HIFU and 2 weeks after HIFU (paired t test, P =0.030). Among 25 residual liver tumors,sixteen with complete ablation and six with ablation volume of ≥80% were observed by enhanced MRI at 2 weeks after HIFU. Conclusions HIFU may be a safe and effective new method to ablate residual liver cancer after three-dimensional conformal radiotherapy or stereotactic radiotherapy.     

高强度聚焦超声联合动脉栓塞治疗恶性实体肿瘤的初步视察

目的：高强度聚焦超声（HIFU）是治疗恶性实体肿瘤的新方法，本文主要探讨HIFU联合TACE治疗恶性肿瘤的近期临床疗效。方法：本文观察了19例HIFU联合TAE/TACE治疗恶性实体肿瘤，14例术中B超监测出现明显回声增强。根据患者术前后的临床症状、B超、肝功能检查、AFP、MRI等评价HIFU的临床疗效。结果：术后AFP呈不同程度下降，MRI示肿瘤体内血供减少，肿瘤有不同程度坏死，部分瘤体直径缩小。仅少数患者有轻度的局部烧伤，无一例严重并发症。结论：HIFU对实体肿瘤有确切疗效，TAE/TACE和HIFU在肿瘤治疗中有协同作用，新鲜碘油沉积可能在其中起较大作用。     

Fast and Selective Ablation of Liver Tumors by High-Intensity Focused Ultrasound Using a Toroidal Transducer Guided by Ultrasound Imaging: The Results of Animal Experiments

This study demonstrated that high-intensity focused ultrasound (HIFU) produced with an intra-operative toroidal-shaped transducer causes fast, selective liver tumor ablations in an animal model. The HIFU device is composed of 256 emitters working at 3 MHz. A 7.5 MHz ultrasound imaging probe centered on the HIFU transducer guided treatment. VX2 tumor segments (25 mg) were implanted into the right lateral liver lobes of 45 New Zealand rabbits. The animals were evenly divided into groups 1 (toroidal HIFU ablation), 2 (surgical resection) and 3 (untreated control). Therapeutic responses were evaluated with gross pathology and histology 11 d post-treatment. Toroidal transducer-produced HIFU ablation (average ablation rate 10.5 cc/min) allowed fast and homogeneous tumor treatment. Sonograms showed all ablations. VX2 tumors were completely coagulated and surrounded by safety margins without surrounding-organ secondary HIFU lesions. HIFU group tumor volumes at autopsy (39 mm³) were significantly lower than control group volumes (2610 mm³, p < 0.0001). HIFU group tumor metastasis (27%) was lower than resected (33%) and control (67%) group metastasis. Ultrasound imaging, gross pathology and histology results supported these outcomes. HIFU procedures had no complications. Rabbit liver tumor ablation using a toroidal HIFU transducer under ultrasound imaging guidance might therefore be an effective intra-operative treatment for localized liver metastases.     

分子吸附再循环系统治疗慢性肝功能衰竭疗效及安全性评价

目的评价分子吸附再循环系统（MARS）治疗慢性肝功能衰竭患者的临床疗效及安全性。方法回顾性分析32例60例次接受MARS治疗的慢性肝功能衰竭患者临床资料，检测患者行MARS治疗前后肝功能、肾功能、凝血指标、外周血象和电解质的变化，统计治疗过程中不良反应发生情况。结果单次MARS治疗8h能显著降低患者的血清总胆红素、直接胆红素、间接胆红素和总胆汁酸水平（P均＜0．05）；血清白蛋白、球蛋白、丙氨酸转氨酶、天冬氨酸转氨酶、外周血象水平均无明显变化（P均＞0．05）；凝血指标、肾功能亦无明显变化（P均2＞0．05）；电解质指标中，除二氧化碳结合力在MARS治疗后有显著下降外，其他指标均无明显变化。治疗前后患者的生命体征平稳，无显著不良反应发生。对32例患者随访1个月，有18例（56．3％，18／32例）患者仍然存活，14例（43．7％，14／32例）患者死亡。结论MARS治疗慢性肝功能衰竭具有很好的临床效果和安全性，可作为辅助治疗慢性肝功能衰竭的方法之一。     

高强度聚焦超声治疗子宫平滑肌瘤的病理变化及其超声随访研究

目的通过病理穿刺及超声随访探讨高强度聚焦超声（HIFU）治疗子宫肌瘤的有效性。方法62例经HIFU治疗的子宫肌瘤患者，术前、术后1周分别进行超声引导下穿刺活检，标本行光镜和电镜观察。并分别在术后1、3、6和12个月进行超声检查，计算瘤体均径并与治疗前均径比较。结果光镜和电镜显示HIFU治疗后子宫肌瘤组织明显的细胞坏死、核固缩浓染、核碎裂溶解以及细胞器的破坏；同时可见血管的破坏以及空泡的形成。超声随访显示治疗后1个月肌瘤出现缩小，治疗后3个月瘤体明显缩小，与治疗前相比有显著差异（P〈0．05）。结论病理检查和超声随访证实HIFU治疗子宫平滑肌瘤明确有效。     

超声造影对肝动脉栓塞化疗与高强度聚焦超声联合治疗原发性肝癌的临床疗效评价

目的探讨超声造影对动脉栓塞化疗(TACE)与高强度聚焦超声(HIFU)联合治疗原发性肝癌的临床疗效评价。方法经TACE与HIFU联合治疗原发性肝癌(联合组)患者22例,经单纯TACE组54例,单纯HIFU治疗组41例。经TACE与HIFU联合治疗前及治疗后1周进行超声造影检查,观察肿瘤组织内部有无残留血供和遗漏病灶,并对经TACE治疗1~3次未完全灭活的病灶行HIFU补充治疗。结果 TACE组和HIFU组肿瘤灭活率均低于联合组,肿瘤残存率均高于联合组(P0.05);联合组6个月、1年、2年生存率分别为100%、90.9%、81.8%,高于TACE组和HIFU组(P0.05)。结论超声造影对TACE与HIFU联合治疗原发性肝癌的临床疗效能够做出准确判断,显示经TACE与HIFU联合治疗肝癌的疗效明显优于单纯TACE或HIFU治疗。     

High-intensity focused ultrasound ablation in hepatic and pancreatic cancer: complications

Purpose: To evaluate the complications of high-intensity focused ultrasound (HIFU) in patients with hepatic and pancreatic cancer. Materials and Methods: From January 2006 to December 2008, 133 sessions of HIFU treatment were performed in 114 consecutive patients with primary hepatic tumor (n = 57), hepatic metastasis (n = 22), and pancreatic cancer (n = 35) under general anesthesia. The extracorporeal, ultrasound-guided Model-JC system (HAIFU, Chongqing, China) was used. Artificial pleural effusion was created to obtain an adequate sonographic window for ablating hepatic dome masses in 53 patients. We reviewed medical records and imaging findings before, during, and after HIFU. Results: All patients had skin redness, edema, and pain in the treatment regions. All hepatic tumor patients had necrosis of the ribs along the main ultrasound beam path that did not require further treatment. Major complications included biliary obstruction, symptomatic pleural effusion, pneumothorax and fistula formation between an abdominal wall abscess and the ablated hepatic tumor. In 35 pancreatic cancer patients, major complications included third-degree burns and fistula formation between the tumor and duodenum. Delayed complications in hepatic tumor patients included a diaphragmatic rupture and rib fractures along the ultrasound pathway. Conclusion: The complications of HIFU develop mainly around the targeted lesions or along the ultrasound beam pathway. It is essential to have awareness of the possible complications related to HIFU and its imaging features for to avoiding serious complications.     

超声造影对高强度聚焦超声联合肝动脉栓塞化疗治疗肝癌的疗效评价

目的探讨超声造影(CEUS)评价高强度聚焦超声(HIFU)联合肝动脉栓塞化疗(TAE)治疗肝恶性肿瘤疗效的应用价值。方法 24例肝癌患者,其中原发性肝癌15例,转移癌9例,治疗病灶总计31个,TAE治疗后1周内行HIFU治疗,于治疗前和治疗后7～14 d行CEUS检查,并与同期彩色多普勒超声(CDFI)、增强MRI检查结果比较。结果 CEUS观察31个病灶治疗覆盖区,19个(61.3%)在各期均为无增强,提示肿瘤完全灭活,12个(38.7%)病灶边缘或中央局部动脉期高增强,门脉期或延迟期减退为低增强,提示为肿瘤残存。以最终诊断为金标准,CEUS诊断准确性90.3%,增强MRI为93.5%,彩色多普勒超声为48.4%。CEUS与增强MRI在评价肿瘤灭活方面的敏感性、特异性、准确性差异均无统计学意义(P>0.05),CEUS对肿瘤灭活诊断的准确性高于CDFI(P<0.05)。结论 CEUS可较准确地判断HIFU联合TAE治疗后肿瘤灭活程度,可为肝癌治疗近期疗效评价提供依据,有较高临床应用价值。     

TACE．PVE．HIFU序贯治疗原发性肝癌的疗效评价

目的 研究TACE.PVE．HIFU序贯治疗原发性肝癌临床疗效及方法。方法将我院60例原发性肝癌患者随机分为两组：治疗组30例：TACE．PVE．HIFU序贯治疗;对照组30例：给予经导管化疗栓塞术（TACE）。两组患者治疗后对其临床疗效进行评价分析,所有患者随访3年观察生存情况,并分析相关因素。结果60例原发性肝癌患者,治疗组总有效率为16例占53．3％,而对照组7例占23．3％,治疗组治疗后临床疗效明显要好于对照组。两组原发性肝癌患者治疗后,其治疗组3年生存率为14例占46．7％,而对照组8例占26．7％,治疗组生存率明显高与对照组。60例原发性肝癌不同肝功能Child分级患者治疗后：6个月生存率51例占85．O％、1年生存率43例占71．7％、2年生存率32例占53．3％、3年生存率22例占36．7％。肝功能ChildA生存率较高。结论TACE．PVE．HIFU序贯治疗在原发性肝癌应用互为补充,最终达到彻底杀灭癌细胞的目的。     

超声评价高强度聚焦超声治疗肝癌疗效的应用价值

目的评价高强度聚焦超声(HIFU)治疗肝癌的疗效及超声在疗效评价中的应用价值。方法HIFU治疗肝癌患者78例,通过术中实时超声监控及治疗前后彩色多普勒超声对比评价治疗效果。结果HIFU术中靶区声像图灰阶值增高(P<0.01)。HIFU术后肿瘤回声增强,体积缩小或不增大(P<0.01),血供一定程度减少或消失(P<0.05)。患者的生存期延长(P<0.01)。结论HIFU治疗肝癌局部疗效明确,是一种很有发展前景的无创治疗肝癌的方法。超声是HIFU术中监控及术后判断疗效的一种有效方法。     

HIFU联合HL-1损伤正常兔肝脏组织的体内实验研究

目的　探讨一种脂质体 (HIFU L iposomes- 1,HL - 1)增强兔肝高强度聚焦超声 (high intensity focused ultrasound,HIFU )能量沉积和灰阶超声实时监控的效果。方法　将兔随机分为 A,B两组 ,A组右肝为实验侧 (HL - 1侧 ) ,左肝为生理盐水侧 ,B组相反。输入生理盐水后以一定参数行 A组左肝或 B组右肝 HIFU损伤 ;然后输入 HL - 1以相同参数行对侧组织 HIFU损伤 ;记录 HIFU靶区 B超灰度值。实验后 2 4h解剖 ,测量凝固性坏死组织大小、计算能效因子 (energy efficiency factor,EEF)并行组织病理检查。结果　灰度增强出现率在 A、 B两组的 HL - 1侧均有所增加 ,但差异无显著性 (P>0 .0 5 ) ;A,B两组 HL - 1侧的 EEF均明显低于对照侧 (P<0 .0 1) ;损伤组织大体观及病理检查两组两侧均为典型的凝固性坏死。结论　 HL - 1联合 HIFU能导致靶区组织发生凝固性坏死 ,并有增强正常兔肝脏组织 HIFU能量沉积的作用 ,灰阶超声对靶区组织凝固性坏死的实时监控作用有待进一步研究。     

肝动脉置管栓塞在高强度聚焦超声(HIFU)治疗肝癌中的作用

目的 探讨肝动脉置管栓塞在高强度聚焦超声治疗肝癌中的作用。方法 利用高强度聚焦超声(HIFU)治疗44例肝癌患者。对12例HIFU治疗前需肋骨开窗的病人，在开窗的同时给予肝动脉置管栓塞，观察其在此方治疗中的利弊。结果 此法为肝癌HIFU治疗中需开窗的病人争取了时问，节约了费用，为进一步追加治疗提供了方便。结论 肝癌HIFU治疗中需开窗的病人在肋骨切除术中给予肝动脉置管栓塞是可行的。