肝癌局部消融治疗规范的专家共识

局部消融治疗是借助影像技术的引导对肿瘤靶向定位,用物理或化学的方法杀死肿瘤组织;影像引导技术包括超声、CT和MRI;治疗途径有经皮、经腹腔镜手术和经开腹手术三种。局部消融治疗的特点一是直接作用于肿瘤,具有高效快速的优势;二是治疗范围局限于肿瘤及其周围组织,对机体影响小,     

肝癌局部消融治疗规范的专家共识

局部消融治疗是在影像技术的引导对肿瘤靶向定位,用物理或化学的方法杀死肿瘤组织;影像引导技术包括超声、CT和MRI;治疗途径有经皮、经腹腔镜手术和经开腹手术三种。局部消融治疗的特点：一是直接作用于肿瘤,具有高效快速的优势;二是治疗范围局限于肿瘤及其周围组织,对机体影响小,可以反复应用。     

肝癌局部消融治疗规范的专家共识

局部消融治疗是在影像技术的引导下对肿瘤靶向定位,用物理或化学的方法杀死肿瘤细胞;影像引导技术包括超声、CT和MRI;治疗途径有经皮、经腹腔镜手术和经开腹手术三种.局部消融治疗的特点:一是直接作用于肿瘤,具有高效快速的优势;二是治疗范围局限于肿瘤及其周围组织,对机体影响小,可以反复应用.局部消融治疗在过去20年左右发展迅速,已经成为继手术切除、介入治疗后的第三大肝癌治疗手段,而且由于其疗效确切,特别是在小肝癌的治疗方面,射频消融治疗的疗效与手术切除相近,因此,被认为是小肝癌的根治性治疗手段之一.     

肝癌经皮消融治疗

肝癌(包括原发性和转移性)在获得明确诊断时，多数已不适于手术切除。近年来，一些试图代替手术的经皮消融疗法应运而生(表1)。这些方法的共同特点是：微创；对小的肿瘤可根治，与手术切除相媲美；对大的或多发性肿瘤，可减少瘤负荷，为进一步综合治疗创造条件，达到改善生活质量和延长生存期的效果。     

肝癌的局部治疗

原发性肝癌(简称肝癌，HCC)的治疗已发展为包括以手术切除为主，辅以介入疗法、化疗、免疫疗法、局部物理疗法和中医疗法等的综合治疗。     

较大肝癌局部消融的关键问题

近年来,超声、CT、MRI 引导下射频消融（RFA）和微波消融（MCT）作为微创热消融技术迅速发展,已证实热消融治疗肝癌安全、廉价、有效,且极具前景。对于小肝癌（〈3 cm）的疗效确切[1],目前被临床列为一线治疗方法[2]。对大于3 cm 的肝癌进行消融,虽有较高的坏死率[3],但由于受消融热场区限制,存在完全灭活困难,局部复发率高的问题[4]。鉴于在临床实际工作中,小肝癌比例较少,而3 cm 以上较大肝癌最常见,因此提高较大肝癌局部消融的疗效成为改善肝癌患者预后的关键。如何能做到穿刺次数少,又完全灭活肿瘤、减少消融治疗后肝癌的局部复发已成为重要的研究热点。     

综合靶向消融治疗中晚期肝癌的临床研究

目的 探讨用氩氦刀冷冻 微波消融 化学消融等综合靶向消融治疗中晚期肝癌的疗效.方法 78例中晚期肝癌患者采用综合靶向消融治疗,先行肝动脉栓塞化疗,一周后行局部氩氦刀冷冻术、微波消融或化学消融术;56例单纯行动脉栓塞化疗.结果 治疗组1年生存率56.4%,对照组1年生存率36.9%;治疗组AFP平均值低于对照组,有显著性差异.结论 综合靶向消融治疗能提高中晚期肝癌患者的生存率,较单纯介入疗法治疗更为有效.     

Intrahepatic dissemination of hepatocellular carcinoma after local ablation therapy

Background/Purpose

We aimed to clarify the histological features of and risk factors for intrahepatic dissemination after local ablation therapy (LAT) for hepatocellular carcinoma (HCC).

Methods

Between April 1992 and December 2005, 192 HCC patients underwent hepatic resection at our department, among whom were 17 patients who had local recurrences after LAT. Eight of these 17 patients had intrahepatic dissemination. The clinical and histological characteristics of these 8 surgically treated patients with intrahepatic dissemination were investigated.

Results

Histologically, numerous intrahepatic metastases were observed, mainly in the same section as the treated tumor, together with main or sectional portal vein tumor thrombi. Before the ablation therapy, the average tumor diameter was 2.1 cm, and 62.5% of the tumors were adjacent to the main or sectional portal vein. In terms of therapeutic factors, 25% of the patients had a prior needle biopsy and 62.5% had insufficient safety margins.

Conclusions

LAT for HCCs (even those less than 3 cm in diameter) adjacent less than 5 mm to the main or sectional portal vein possibly promotes intrahepatic dissemination.     

Tumor markers after radiofrequency ablation therapy for hepatocellular carcinoma

BACKGROUND/AIMS: The aim of this study was to evaluate the clinical value of measurement of the AFP-L3 fraction before and after radiofrequency ablation (RFA) therapy for HCC, compared with the measurement of total AFP and des-gamma-carboxy prothrombin (DCP). METHODOLOGY: One hundred and twenty-four patients with HCCs were evaluated for their complete response with a 5-mm-thick safety margin around the tumor. Three tumor markers (AFP, DCP, AFP-L3) were measured after RFA therapy, and their clinical significance was studied. RESULTS: Multivariate analysis revealed that of the three tumor makers only AFP-L3 showed significant differences in the survival and disease-free rates. CONCLUSIONS: AFP-L3 is the most reliable tumor marker for estimating overall survival and disease-free survival in patients with HCC effectively treated by RFA in contrast to AFP and DCP.     

Secondary hemocholecyst after radiofrequency ablation therapy for hepatocellular carcinoma

A 65-year-old Japanese man underwent radiofrequency ablation (RFA) therapy of a hepatocellular carcinoma. Hemobilia from the intrahepatic bile ducts adjacent to the tumor developed on the fifth day after the RFA therapy. Ultrasonograms and computed tomograms showed swelling of the gallbladder, which was filled with a clot, suggesting the diagnosis of hemocholecyst. The hemobilia resolved with conservative therapy, but a cholecystectomy was performed to manage postprandial abdominal pain. The resected gallbladder was filled with a clot, but injury or ulceration of the gallbladder was absent, suggesting that the hemocholecyst developed secondary to the hemobilia. Secondary hemocholecyst is a rare complication of RFA therapy. The number of cases of secondary hemocholecyst is likely to increase as hepatocentestic therapy becomes more common. Cholecystectomy is indicated for hemocholecyst because spontaneous liquefication and drainage of a clot in the gallbladder usually does not occur. Received: December 10, 2001 / Accepted: March 8, 2002 Reprint requests to: T. Yamamoto     

胆汁淤积性肝病诊断治疗专家共识

胆汁淤积性肝病是一组以胆汁淤积为主要表现的临床常见疾病,近年来,对该病的诊断治疗取得迅速进展。基于此,《中华实验和临床感染病杂志(电子版)》与《中国肝脏病杂志(电子版)》编辑部组织国内部分专家对相关资料进行     

Biliary-duodenal fistula following radiofrequency ablation therapy for hepatocellular carcinoma]

Hepatocellular carcinoma (HCC) is one of the most common malignant neoplasms occurring worldwide. Surgical resection currently provides the best chance of long-term tumor free survival, but the most HCCs are not candidates for surgical excision due to poor liver function or poor medical background. Numerous noninvasive alternatives to surgical resection have been introduced to treat liver cancers. Radiofrequency thermal ablation has begun to receive much attention as an effective and minimally invasive technique for the local control of HCC. The biliary system related complications after radiofrequency ablation has rarely been reported. We report a case of biliary-duodenal fistula with liver abscess after radiofrequency ablation for HCC. The case was treated by abscess drainage and antibiotics.     

Activation of dendritic cells by local ablation of hepatocellular carcinoma

BACKGROUND/AIMS: Local ablation methods are an effective treatment for hepatocellular carcinoma (HCC). The rate of recurrence or development of intra-hepatic metastases may be lowered by antitumoral immune responses. Since HCCs are in general only weakly immunogenic, cell injury induced by local tumor ablation (PEI/RFTA) may increase HCC immunogenicity and may release endogenous adjuvants that activate dendritic cells (DC). The aim of the study, therefore, was the analysis whether PEI or RFTA induced injury results in an adjuvant effect for immune responses to HCCs. METHODS: Eight HCC patients were treated with PEI or RFTA and serially analyzed for 4 weeks. Plasmocytoid (PDC) and myeloid dendritic cells (MDC) were analyzed directly ex vivo and in vitro using FACS and proliferation assays. RESULTS: HCC ablation induced a functional transient activation of MDC but not of PDC associated with increased serum levels of TNF-alpha and IL-1beta. CONCLUSIONS: These findings suggest that the combination of PEI or RFTA and active antigen specific immunotherapeutic approaches using DCs is a promising approach for the induction of sustained antitumoral immune responses aiming at the reduction of tumor recurrence and metastases in HCC patients.