氩氦刀冷冻消融治疗原发性肝癌的临床研究

[目的]探讨氩氦刀冷冻消融综合治疗中晚期肝癌的疗效。[方法]96例中晚期原发性肝癌分3组观察。第一组用氩氦刀冷冻消融联合TACE治疗37例；第二组单纯用氩氦刀冷冻消融32例：第三组单纯用TACE27例。氩氦刀冷冻消融采用B超／或CT引导经皮穿刺肝肿瘤，共计对97个病灶使用203把氩氦刀二次循环冷冻。[结果]氩氦刀冷冻术后有94.2％（65/69）的患者精神状态得到改善，腹部疼痛症状减轻，恢复快。氩氦刀超低温冷冻联合TACE的近期疗效和12、24个月的生存率明显优于另外两组，中位生存期延长（P＜0．05）。[结论]氩氦刀联合TACE是治疗肝癌有效的方法之一，可望提高肝癌患者生存期和改善生命质量，为丧失手术机会的晚期肝肿瘤患者开辟了一条新的治疗途径。     

肝动脉栓塞化疗联合氩氦刀冷冻消融治疗不能手术的中晚期肝癌的临床观察

目的观察肝动脉栓塞化疗联合氩氦刀冷冻消融治疗不能手术的中晚期肝癌的有效性和安全性。方法对35例原发性肝癌患者首先进行动脉栓塞化疗治疗,2～3周后进行氩氦刀冷冻消融治疗,氩氦刀冷冻消融治疗后1～2周再次进行动脉栓塞化疗,治疗结束后评价近期疗效,并随访生存情况。结果35例患者均可评价疗效,其中完全缓解7例,部分缓解21例,稳定4例,进展3例,临床有效率为80．00％（28／35）,疾病控制率为91．43％（32／35）。患者中位无进展生存（PFS）为8．9个月,中位总生存（OS）为16．3个月。结论肝动脉栓塞化疗联合氩氦刀冷冻消融治疗不能手术的原发性肝癌创伤小、恢复快、并发症少、疗效可靠。     

冷冻治疗320例肝癌的并发症分析及处理

目的探讨冷冻治疗作为不可切除的中晚期肝肿瘤局部消融疗法的安全性。方法 320例不能手术切除的肝癌患者在CT、B超下行氩氦刀经皮冷冻治疗,观察其并发症的发生,并采取相应的处理措施。结果肝癌冷冻治疗出现一般并发症程度较轻,对症处理即可恢复。严重并发症包括肝衰竭、肝破裂等,重在预防。结论氩氦刀冷冻治疗不可切除的实质性肝癌是一种简单、有效且相对安全的方法,但要注意预防并发症的发生。     

氩氦刀冷冻治疗原发性肝癌的初步临床研究

背景与目的：近年来氩氦刀冷冻治疗肝癌发展迅速,本研究旨在通过回顾性分析,评价氩氦刀冷冻治疗无法手术切除的原发性肝癌的临床疗效。方法：选择124例经氩氦刀冷冻治疗的原发性肝癌患者．根据巴塞罗那分期分成早期、中期及进展期肝癌组,以治疗后患者的临床表现、局部病灶CT变化、AFP下降情况、术后并发症的发生及平均生存时间作为评价指标。结果：氩氦刀冷冻治疗肝癌后患者的并发症少,82．6％的患者术后AFP降低,92．3％的肿瘤缩小或保持不变。截止至2008年4月．仍有14例患者生存．110例患者死亡。早期、中期及进展期肝癌组的中位生存时间分别为31．25个月、17．41个月、6．82个月。结论：对于无法切除的中晚期肝癌,氩氦刀治疗的并发症少．有一定的疗效。     

肝癌氩氦刀冷冻和射频治疗的CT探讨

目的：分析氩氦刀冷冻和射频治疗肝脏恶性肿瘤的CT表现,探讨其与疗效的关系.方法：选择1999年11月～2002年10月用氩氦刀和射频治疗的肝癌共36例,其中原发性肝癌29例,转移性肝癌7例,分为氩氦刀组11例,射频治疗组25例.氩氦刀术后即刻CT扫描和两种方法术后1～2周开始复查CT.结果：氩氦刀冷冻治疗出现典型“冰球”CT表现者达70%以上,继续复查局部保持低密度、增强扫描无强化;射频治疗后近期复查近半数可见类圆形较低密度及周围环状更低密度区,无强化效应.结论：氩氦刀冷冻治疗出现大于原病灶区的典型“冰球”CT表现者,疗效较佳,原发性肝癌AFP下降率可达95%以上;射频治疗后出现类圆形较低密度区及周围大于原病灶的环状更低密度影,提示疗效好,其原发性肝癌AFP下降比例明显提高.以上两种疗法对直径小于5cm的肝癌均有较好的疗效,尤其对直径小于3cm的小肝癌疗效更佳.对原发性肝癌和转移性肝癌的疗效无明显差异.     

氩氦刀冷冻消融辅助治疗骨巨细胞瘤三例早期临床报道

目的 探讨氩氦刀冷冻消融技术在治疗骨巨细胞瘤中的应用价值.方法 3例骨巨细胞瘤患者行肿瘤刮除植骨、内固定术,术中氩氦刀冷冻消融辅助灭活瘤体及瘤腔.比较冷冻消融前后肿瘤的病理组织学变化,观察术后皮肤、神经、血管等软组织并发症,评价早期关节功能.结果 术后无软组织损伤并发症,随访4个月,关节功能良好,无软骨退变,骨修复正常.结论氩氦刀冷冻消融技术辅助治疗骨巨细胞瘤安全有效.     

肝动脉栓塞化疗联合氩氦刀冷冻消融治疗62例中晚期原发性肝癌分析

[目的]探讨肝动脉栓塞化疗联合美国氩氦刀冷冻消融对中晚期原发性肝癌的治疗效果。[方法]62例巨块型肝癌患者，随机分为对照组和治疗组。对照组：肝动脉栓塞化疗（TACE）30例：治疗组：TACE＋氩氦刀32例。观察两组治疗后完全坏死率、初次复发率、1年生存率、AFP转阴率及不良反应。[结果]对照组、治疗组完全坏死率分别为26．7％、65．6％，初次复发率为46．7％、12．5％，1年生存率为56．7％、84．4％，AFP转阴率为28．57％、59．1％，两组间完全坏死率、初次复发率、1年生存率、AFP转阴率的差异均有统计学意义。[结论]肝动脉栓塞化疗联合美国氩氦刀冷冻消融治疗中晚期原发性肝癌效果明显优于单纯肝动脉栓塞化疗治疗效果。     

B超引导氩氦刀冷冻治疗肿瘤的价值

目的探讨B超引导氩氦刀冷冻治疗肿瘤的价值.方法无法手术切除的原发性肝癌、腹后腔血管内皮肉瘤、左肺鳞状细胞癌及右甲状腺髓样癌患者各一例在B超引导下进行氩氦刀冷冻治疗.结果4例患者三个月后B超及CT复查瘤体均缩小1/3,临床症状明显好转.结论B超引导氩氦刀冷冻治疗,定位准确,安全可靠,效果明显,具有重要的价值及临床意义.     

B超引导氩氦民冷冻治疗肿瘤的价值

目的探讨B超引导氩氦刀冷冻治疗肿瘤的价值.方法无法手术切除的原发性肝癌、腹后腔血管内皮肉瘤、左肺鳞状细胞癌及右甲状腺髓样癌患者各一例在B超引导下进行氩氦刀冷冻治疗.结果4例患者三个月后B超及CT复查瘤体均缩小1/3,临床症状明显好转.结论B超引导氩氦刀冷冻治疗,定位准确,安全可靠,效果明显,具有重要的价值及临床意义.     

TACE＋AHCS治疗原发性肝癌的临床研究

外科手术切除是治疗原发性肝癌的首选疗法,但是,患者确诊肿瘤时绝大多数失去手术根治的机会。微创治疗已成为肿瘤治疗中的重要组成部分。多年来肝动脉化疗栓塞（transcatheter arterial chemoembolization,TACE）是非手术治疗原发性肝癌的首选方法,取得了一定的疗效。但肿瘤完全坏死率较低。一种新型超低温介入冷冻消融治疗肿瘤的微创手术系统氩氦刀冷冻消融（argon—heliumcryosur-gerysystem,AHCS）,由于其独特的优点,目前已广泛用于原发性肝癌的治疗。TACE与AHCS联合治疗,可以优势互补,进一步提高疗效。     

氩氦刀冷冻消融治疗孤立性肺结节的临床观察

目的 探讨氩氦刀冷冻消融术在孤立性肺结节治疗中的应用价值和安全性。方法 回顾性分析2006年1月至2014年5月经CT诊断的34例孤立性肺结节患者的临床资料。患者均接受病灶穿刺活检及氩氦刀冷冻消融手术治疗。术后采用CT成像评价氩氦刀治疗的临床疗效。结果 所有患者CT均诊断为恶性病变。穿刺病理诊断为腺癌25例,鳞癌6例,结肠癌转移瘤3例。34 例患者均顺利完成氩氦刀冷冻消融术。术中CT显示冰球完全覆盖病灶30例,另4例冰球覆盖90％病灶。术后3个月复查CT显示,获CR 18例,PR 12例,NC 4例,有效率为88.2％。术后6个月复查CT显示,获CR 18例,PR 12例,NC 2例,PD 2例,有效率为88.2％。术后12个月复查CT显示,获CR 18例,PR 10例,NC 1例,PD 5例,有效率为82.3％。术后出现2例无症状性气胸,8例少量咯血,5例轻度胸痛,10例轻度胸闷,6例发热。术中及术后未出现胸腔积液、皮下气肿以及肺部感染的患者。术后2、5年生存率分别为61.7％和38.2％。结论 氩氦刀冷冻消融术是治疗无法外科手术切除的孤立性肺结节的安全、有效的方法。     

氩氦刀冷冻治疗上颌窦癌的临床疗效CSCD

目的探讨氩氦刀冷冻治疗上颌窦癌的疗效及其对免疫功能、IL-6、TNF-α、TNF-β、INF-γ的影响。方法收集2012年8月—2016年8月37例采用氩氦刀冷冻治疗的上颌窦癌患者作为观察组,选取同期35例采用传统手术+局部放射治疗的患者为对照组,记录与随访两组的近、远期疗效以及手术前后免疫功能与验证因子变化情况。结果观察组与对照组的治疗有效率分别为56.75%和60.00%。手术后两组CD8+降低,CD4+/CD8+升高(P<0.05)。术后不同时期患者血清IL-6、TNF-α、TNF-β、INF-γ含量均较术前下降(P<0.05)。结论氩氦刀靶向冷冻治疗上颌窦癌能改善患者的免疫功能及炎性反应,并发症少,远期疗效好。     

CT引导经皮氩氦刀靶向治疗肺癌的临床应用

目的探讨经皮经肺氩氦刀治疗肺癌的临床疗效、CT影像学变化及不良反应。方法62例肺癌患者在CT定位后,经皮穿刺置入行氩氦刀进行治疗。结果经氩氦刀治疗后3个月,胸部CT复查显示52个肿瘤病灶明显缩小(70.2%)。CT显示肿瘤冷冻后呈低密度坏死区,3个月冷冻区实变,12个月冷冻区阴影几乎消失。术后并发症包括气胸、咳嗽、咯血和发热。结论氩氦刀冷冻治疗肺癌创伤小,效果较好,无严重并发症,是治疗肺癌的一种新的有效治疗方法。     

B超引导下经皮氩氦刀治疗肝癌

目的：探讨经皮穿刺氩氦刀治疗肝癌的原理,方法及安全性。方法：15例肝癌患者,超声引导下穿刺,CRY Ocare-TM低温手术系统冷冻头插至瘤体远端冷冻。结果：15例病人冷冻治疗后无手术死亡,无肝破裂,出血,胆瘘,皮肤冻伤及穿刺道种植转移或感染等并发症,术后有1例出现气胸及反应性胸腔积液,术后低热有8例,术前AFP值增高的8例病人,术后AFP值均有下降,其中4例恢复正常。术后彩色多普勒B超显示肝癌内血供消失,术后1－5个月所有病人均进行了一次以上CT检查,见瘤体均有不同程度缩小,增强扫描亦未见强化灶。结论：B超引导下经皮穿刺氩氦刀治疗肝癌是一种合理,安全,有效,微创的新治疗方法。     

Cryoablation Combined with TACE for Treating Large Hepatocellular Carcinoma： Tumor Load and Cellular Immunity

OBJECTIVE To study the effectiveness on the tumor load and cellular immune function of percutaneous cryoablation （argon-helium cryoablative system, AHCS） combined with transarterial chemoembolization （TACE） for treating large hepatocellular carcinomas （HCCs） with diameters over 10 ca. METHODS A total of 48 HCC patients were treated with AHCS after TACE. Tumor sizes ranged from 10 to 14 cm. All cases were a hypervascular type. There were 38 Child A cases and 10 Child B cases. Forty were AFP positive and 8 negative. The patients were randomized with therapy group consisting of 26 cases and the control group 22 cases. The therapy group received AHCS 4 weeks following TACE treatment. Reexamination included pathology, tumor markers, T-lymphocyte subgroup levels and computed tomography or MRI. The necrosis rate of the tumor load was calculated by Cavalieri＇s theory. EORTC QLQ-C30 was used in quality of life evaluation. RESULTS The average tumor-load reduction rate （necrosis rate） was 8.07% after TACE, and 28.65% after AHCS. Coagulation necrosis was produced in the target area. The tumor markers deceased significantly after AHCS. Tumor-load reduction after AHCS was more significant than after TACE. Suppression of cellular immunity after TACE was significant. In contrast, CD3^＋, CD4^＋ and NK increased after AHCS and an abnormal T-lymphocyte distribution was corrected. Quality of life after AHCS increased according to the EORTC QLQ-C30 evaluation. No severe complications occurred. CONCLUSION Percutaneous AHCS cryoablation after TACE reduced the tumor load in the short term. At the same time, cellular immune function was increased after AHCS. TACE was critical in increasing the therapeutic efficacy of AHCS because of its embolisation of blood vessels preventing a Flow Effect. Reduction of the tumor load in the short term may conduce to increase cellular immunity. Percutaneous AHCS cryoablation combined with TACE can reduce the tumor load, improve cellular immunity and increase quality of life of HCC patients. This type of therapy deserves to be studied further research.     

氦氩冷冻治疗癌性疼痛的临床观察

目的探讨氩氦刀冷冻治疗癌性疼痛的疗效及安全性。方法 67例肿瘤患者在CT引导下行经皮穿刺氩氦刀冷冻治疗疼痛相关性瘤灶,观察术后患者疼痛缓解状况及瘤灶影像学改变。结果 67例患者在术后24小时、1周、1个月和3个月时疼痛缓解有效率分别为74.6%、86.6%、86.6%和73.1%,CT复查提示冷冻瘤灶呈坏死样改变,PET/CT提示病灶无活性或活性明显降低。全组术中、术后未出现严重并发症,主要不良反应包括寒战、血压波动、气胸或胸腔积液、术后发热、伤口渗血和周围神经损伤。结论氩氦刀冷冻治疗能有效缓解晚期肿瘤患者的癌性疼痛,改善生活质量,且安全性高,值得临床推广。     

A randomized trial of external beam radiotherapy versus cryoablation in patients with localized prostate cancer

BACKGROUND:

A recent randomized trial to compare external beam radiation therapy (EBRT) to cryoablation for localized disease showed cryoablation to be noninferior to external beam EBRT in disease progression and overall and disease‐specific survival. We report on the quality of life (QOL) outcomes for this trial.

METHODS:

From December 1997 through February 2003, 244 men with newly diagnosed localized prostate cancer were randomly assigned to cryoablation or EBRT (median dose 68 Gy). All patients received neoadjuvant antiandrogen therapy. Patients completed the EORTC QLQ C30 and the Prostate Cancer Index (PCI) before treatment and at 1.5, 3, 6, 12, 18, 24, and 36 months post‐treatment.

RESULTS:

Regardless of treatment arm, participants reported high levels of QOL with few exceptions. cryoablation was associated with more acute urinary dysfunction (mean PCI urinary function cryoablation = 69.4; mean EBRT = 90.7; P < .001), which resolved over time. No late arising QOL issues were observed. Both EBRT and cryoablation participants reported decreases in sexual function at 3 months with the cryoablation patients reporting poorer functioning (mean cryoablation = 7.2: mean EBRT = 32.9; P < .001). Mean sexual function score was 15 points lower at 3 years for the cryoablation group and 13% more of the cryoablation men said that sexuality was a moderate or big problem.

CONCLUSIONS:

In this randomized trial, no long‐term QOL advantage for either treatment was apparent with the exception of poorer sexual function reported by those treated with cryoablation. Men who wish to increase their odds of retaining sexual function might be counseled to choose EBRT over cryoablation. Cancer 2009. © 2009 American Cancer Society.     

经皮穿刺氩氦超导靶向治疗头面部肿瘤

目的观察氩氦超导靶向治疗头面部肿瘤的可行性和安全性.方法在B超或CT引导下,依据影像学资料所提示的进针方向、进针角度、进针深度,将氩氦刀插入瘤体内,启动氩氦超低温手术系统,进行治疗.结果 5例头面部肿瘤(包括腮腺瘤2例,颌下腺癌、上颌窦癌和眼睛黑色素瘤各1例)接受氩氦超导靶向治疗,肿瘤冷冻面积均在90%以上.术中较安全,无一例围手术期死亡.头面部肿瘤表浅部位有2周左右的红肿期.3例患者发生面神经麻痹(面神经附近冷冻),持续1个月后渐缓解.3个月后肿瘤均有不同程度的缩小.结论氩氦超导靶向治疗是一种安全、有效的治疗头面部肿瘤方法,特别适于侵犯大血管或术后复发的患者.     

Percutaneous cryoablation therapy under local anesthesia for unresectable metastatic liver tumors

Even though liver resection is the first choice against metastatic liver tumors, oncologists are often obliged to include other treatment modalities depending on metastatic tumor size, number of metastatic nodules, location of tumors, patient's general condition, and so on. Among others we selected cryoablation therapy against unresectable tumors and examined its usefulness clinically in 5 patients. Under local anesthesia, the cryoprobe, which was 3 mm in diameter, was introduced into the center of the tumor by use of an ultrasonographic guiding technique. In the middle of the freezing process, through ultrasonography we could clearly monitor the target tumor, which would change into an ice ball. It was noteworthy that not only the treated tumor but also untreated tumors were reduced in 2 cases. Because of extra-hepatic metastases, 3 patients died within 1 year after the therapy, while 2 patients are alive. This modality was easily repeatable and was minimally invasive with little toxic effect. In addition, it did not worsen quality of life (QOL). The above results indicate that cryoablation therapy could be a feasible modality against unresectable metastatic liver tumors.