Percutaneous local ablation therapy in small hepatocellular carcinoma.
Percutaneous local ablation therapy in small hepatocellular carcinoma.
复制标题
小肝细胞癌的经皮局部消融治疗。
DOI：
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发表时间：
2003
期刊：
影响因子：
--
通讯作者：
D. Lin
中科院分区：
文献类型：
--
作者：
Shi;D. Lin
在不同国家进行的定期筛查计划，应用超声检查和血清甲胎蛋白对慢性肝病患者进行筛查，已经发现了许多小肝细胞癌（HCC）。虽然手术切除通常是治疗性消融的首选，但切除后的长期生存率并不比局部消融好。目前的局部消融方式通常易于执行、安全且可重复的程序，并且包括经皮乙醇注射（PEI）、经皮乙酸注射（派）、射频消融（RFA）和微波凝固治疗（MCT）。PEI或派的作用机制是基于无水乙醇或乙酸对肿瘤细胞的脱水、细胞内蛋白质损伤和血栓缺血效应。同时，RFA或MCT的机制是基于组织与RF或微波电极发射到肿瘤中的电流或微波之间产生摩擦热。一旦目标区域的温度超过60摄氏度，热量就会导致凝固，随后细胞死亡。根据这些手术的既往比较研究，RFA可能上级于PEI、派或MCT，因为其消融体积更大、治疗次数更少且消融尺寸更可预测。RFA、PEI、派和MCT的靶肿瘤完全坏死率分别约为90-98%、80-95%、90-95%和94%。此外，这四种方式的生存率在1年时约为90%，3年时约为70%，5年时约为40-50%。初步结论，RFA是大多数小HCC的首选局部消融治疗。但是，在RFA不可用的情况下，PEI是一种有用的替代方案。
Periodic screening programs conducted in various countries, applying sonography and serum alfa-fetoprotein to patients with chronic liver disease, have identified numerous small hepatocellular carcinoma (HCC). Although surgical resection is generally preferred for curative ablation, the long-term survival rates following resection are no better than those following local ablation. Current local ablation modalities are typically easily performed, safe and repeatable procedures, and include percutaneous ethanol injection (PEI), percutaneous acetic acid injection (PAI), radiofrequency ablation (RFA) and microwave coagulation therapy (MCT). The mechanisms of PEI or PAI are based on the dehydration, intracellular protein damage, and thrombo-ischemic effects of absolute ethanol or acetic acid on the tumor cells. Meanwhile, the mechanisms of RFA or MCT are based on the generation of friction heat between the tissue and electric current or microwave emitted by an RF or microwave electrode into the tumor. The heat causes coagulation, followed by cellular death as soon as the temperature in the target area exceeds 60 degrees C. From previous comparative studies of these procedures, RFA may be superior to PEI, PAI or MCT owing to its larger ablation volume, fewer treatment sessions and more predictable ablation size. The rate of complete necrosis of the target tumors was approximately 90-98% by RFA, 80-95% by PEI, 90-95% by PAI and 94% by MCT. Moreover, the survival rates of these four modalities were approximately 90% at 1 year, 70% at 3 years, and 40-50% at 5 years. In tentative conclusion, RFA is the preferred local ablation therapy for most small HCC. However, PEI is a useful alternative where RFA is unavailable.
DOI：
10.1007/978-4-431-68177-9
发表时间：
1992-11
期刊：
Gann monograph on cancer research
影响因子：
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作者：
S. Arii;T. Tobe
通讯作者：
S. Arii;T. Tobe