氩氦刀靶向冷冻治疗肝癌的初步研究

Preliminary study of targeted Ar-He (Argon-Helium) cryoablation in the treatment for liver cancer

目的 初步建立氩氦刀靶向冷冻治疗肝癌的技术和探讨其原理、安全性及近期疗效。方法 8例无法手术的原发和继发性肝癌,其中3例术前行肝动脉栓塞化疗,采用氩氦超导手术系统(简称氩氦刀),分别在CT、DSA定位或术中直视下对肿瘤病灶行冷冻治疗。结果 8例患者冷冻治疗后无手术死亡、出血、胆瘘、皮肽冻伤、感染、穿刺道种植转移等严重并发症。术后CT影像能观察到病灶冷冻治疗的有效范围,3例术前接受肝动脉栓塞化疗者术后1～6个月瘤体有进一步不同程度的缩小。3例原发性肝癌术前AFP值增高的患者术后均有下降。治疗后随访2～11个月,仅1例死于全身转移,其余均存活。结论 CT、DSA引导和术中直视氩氦刀冷冻治疗肝癌技术可靠,创伤小,安全性高,是治疗无手术机会肝癌的一种有效的新手段,其远期疗效和在肝癌综合治疗中的价值尚有待于进一步的前瞻性临床试验研究说明。

Objective To investigate the feasible technique of targetd Argon-Helium ( Ar-He) cryoablation for liver tumors and to evaluate its preliminary results and safety. Methods 8 patients with primary or metastatic liver tumors were eligible to undergo CT, DSA or intr-aoperatively guided Ar-He cryoablation for their liver tumor focus. And preoperative transcatheter arterial chcmoembolization was performed on 3 patients with primary hepatocellular carcinoma. Results After Ar-He cryoablation, there were no intraoperative or postoperative complications such as cracking of the lesion, bile fistula, bleeding, and so on. CT was used to evaluate the regional focus changes at 1 week, 1 month and then every 3 months, which could illustrate effective area of cryotherapy. Especially the size of liver tumor in these patients who underwent preoperative chemoembolization, had been decreasing during 1 - 11 months follow-up of all 8 patients, only 1 case died of multiple extensive metastases. Conclusion CT, DSA or intraoperatively guided Ar-He cryoabltion is an feasible, effective, microinvasive and safe option in the treatment for liver tumors. We recommend more prospective clinical trial about targeted Argon-Helium (Ar-He) cryoablation for liver tumors be carried out to determine its long-term effect and its role in multimodality treatment of primary hepatocellular car-