CT导向肝脏肿瘤射频消融病灶定位的研究

The Study of Radiofrequency Ablation under Computer Tomography

目的 探讨CT导向肝脏肿瘤射频消融的技术和方法.方法 2011年1月~2013年5月,选择67例肝脏肿瘤患者共75个肿瘤,直径2.1~6 cm,其中〈3.5 cm 64个,〉3.5 cm 11个.把CT定位图像导入肿瘤精确放射治疗计划系统内,将直径〉3.5 cm的11个肿瘤共划分成52个直径〈3.5 cm的肿瘤,共按照116个直径〈3.5 cm的小肿瘤,在CT导向下,利用研制的肿瘤穿刺辅助器械进行定位和穿刺,利用肿瘤精确放射治疗计划系统对穿刺效果和消融灶进行验证评估,采用RITA多极射频肿瘤消融仪对每个小肿瘤进行射频消融.结果 116个小肿瘤在空间内的平均穿刺误差2.9 mm（1~5 mm）,肝内75个肿瘤全部被消融灶包含,消融过程中和消融后无严重并发症发生.术后4~6周复查增强CT,75个肿瘤及其消融灶边缘均无强化.术后3个月肝脏CT增强扫描,75个肿瘤所在区域为低密度,动脉期未见强化.均为完全消融.结论 借助CT导向和肿瘤穿刺辅助器械对肝脏肿瘤进行穿刺和射频消融,穿刺准确,消融彻底安全.

Objective To investigate the method and skill of CT guided radiofrequency ablation （RFA）. Method The clinical data of 67 patients with 75 hepatic tumor from January 2011 to May 2013 were analyzed. The diameters of the tumors were within 2.1 - 6.0 cm, with 64 tumors being smaller than 3.5 cm and 11 tumors larger than 3.5 cm. Import all CT images into the accurate radiation therapy system, and 11 tumors with a diameter of more than 3.5 cm were divided into 52 smaller tumors. The final result was 116 tumors smaller than 3.5 cm. We used medical device such as puncture needle to locate all the 116 tumors and evaluated the likely effect of our therapy with accurate radiation therapy system. After this, multielectrode RFA was used to melt the tumor. Results The average puncture error was 2.9 mm （ 1.0 - 5.0 mm）. All 75 tumors were fully exposed to radiation and no serious complications were noted during the procedure. About 4 - 6 weeks after the radiation therapy, CT scan showed no enhancement layer around the target tumors. Three months after the surgery, CT scan showed complete ablation in all of the 75 hepatic lesions. Conclusion CT guided RFA is safe and effective for hepatic cancer.