经皮穿刺氩氦刀治疗肝癌

Percutaneous cryoablation of heptic cancer

目的评估氩氦刀对肝癌的治疗作用。方法38例肝癌患者共接受51次经皮穿刺氩氦刀治疗(分别采用B超引导26次,CT引导25次),手术病灶64个。结果①冷冻1min后即可有冰球形成,B超可见冰球的前缘呈弧形强回声带,后方伴有“干净”的声影,其后弧形光带逐渐增宽。CT可见密度明显变低、边界清楚的冰球影。两把以上的超导刀同时操作时,可见冰球的融合图像。②B超可见瘤灶治疗后1周内瘤体增大,内部回声不均,少部分瘤灶可见内部及周边血流信号减少,瘤灶中央出现液化区;CT显示手术后肿瘤密度变低,有的呈空洞样改变。术后肿瘤病理可见明确的凝固性坏死灶形成。③无一例患者发生出血、胆管瘘等并发症。术后中位生存时间为12个月,平均生存(9.8±1.3)个月。结论B超为氩氦刀提供了术前、术后的肿块观测和术中治疗过程的实时监测,CT可用于术前制定治疗计划、术后判断疗效。超声引导氩氦刀的治疗过程实时、快捷,经济方便,对侵犯血管、胆管的肿瘤有更好的检测价值。CT引导准确可靠,并能准确地判断疗效,但费时、费力,需根据病灶部位的不同灵活选用引导方法。

Objective To evaluate the therapeutic effect of helium-argon cryosurgical ablation of heptic cancer.Methods The medical records of 38 patients with hepatic cancers undergoing 51 percutaneous ablative procedures for 64 lesions guided by CT and B-ultrosound in a single institution were retrospectively reviewed.Results An iceball with front sharp arc shadow appeared one minute after the ablation,and was accompanied by 'clean'echogenic shadow with broadening of arc.As the freeze course was prolonged,the iceball reached its biggest diameter in 5-6 minutes.The iceball with low density and clear edges could be found in CT scanning.Two iceballs could fuse together when two probes were used.Tumors were enlarged with decreased blood flow signals and irregular echoes within 1 week after cryotherapy under B ultrasonography.Tumors showed decreased density and cavities in CT scanning within 1 month after the cryoablation.Necrotic coagulation could be found in tumor biopsy.No severe complications occured,such as hemorrhage and biliary fistula.The median survival time of the patients was 1 year and mean survival time was 9.8±1.3 months.Conclusions Cryosurgical ablation with helium-argon knife for primary or metastatic hepatic tumors provides a minimally invasive treatment of heptic cancers.The combination of cryosurgery and resection extends the cohort of patients with surgically treatable diseases.