Clinical study of Percutaneous Interstitial Nd-YAG Laser Hyperthermia for the Treatment of Hepatocellular Carcinoma

经皮间质Nd-YAG激光热疗治疗肝癌的临床研究

• 批准号: 09670944
• 负责人: MORI Hiromu
• 金额: $ 1.79万
• 依托单位: OITA MEDICAL UNIVERSITY
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 1997
• 资助国家: 日本
• 起止时间: 1997 至 1999
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-09670944/
• 关键词: Nd-YAG LASER; HEPATOCELLULAR CARCINOMA

PURPOSE:To determine the efficacy of percutaneous interstitial Nd-YAG laser hyperthermia (ILHT) in the treatment of hepatocellular carcinoma (HCC).MATERIALS and METHODS:Fifteen patients with 26 lesions of HCC (10mm-30mm in diameter, mean 17 mm; maximum diameters of 13 lesions were smaller than 15 mm) were treated with ILHT. ILHT was executed using continuous delivery of 2 watts for 15-20 minutes in 6 patients (7 lesions), pulse-mode delivery of 5 watts ( 1OOms intervals) for 5 minutes in 10 patients (17 lesions), and continuous delivery of 5 watts for 4 minutes in 2 patients (2 lesions), respectively. The therapeutic response was assessed with dynamic CT on 7-14 days, 1 month, and 2-6 months' after the treatment.RESULTS:The average number of ILHT sessions was 2.1. With a mean follow-up of 1 month, complete tumor necrosis was observed in 18 lesion (69%), and incomplete necrosis was seen in 8 lesions (31%). During follow-up for 2-24 months (mean, 7.1 months), local recurrence within or around a successfully treated lesion was seen in 14 lesions (78%). For minor complications, warm feeling and tolerable pain during the procedure were identified in all patients. Localized perihepatic hematoma was seen in 5 patients, and temporarily worsening of liver function was also seen in all patients. For major complications, there were tumor dissemination to the skin (n=1) and perforation of the colon (n=1).CONCLUSION:The effect of the ILHT at 2-5 watts on HCC was insufficient in this study. This is probably due to a cooling effect produced by the vessels such as hepatic artery and portal vein, which might protect adjacent tumor from the hyperthermia. Therefore, modified methods such as using balloon occlusion of hepatic artery or portal vein would be required for ILHT treatment.

目的：探讨经皮间质Nd-YAG激光热疗（ILHT）治疗肝细胞癌（HCC）的疗效。 材料与方法：对15例患者进行ILHT治疗，共26个病灶（直径10mm-30mm，平均17mm；其中13个病灶最大直径小于15mm）。分别对 6 名患者（7 个病灶）采用 2 瓦特持续输送 15-20 分钟，对 10 名患者（17 个病灶）进行 5 瓦特（100ms 间隔）脉冲模式输送 5 分钟，以及对 2 名患者（2 个病灶）进行 5 瓦特连续输送 4 分钟进行 ILHT。治疗后7～14天、1个月、2～6个月采用动态CT评估疗效。结果：平均ILHT疗程2.1次。平均随访1个月，肿瘤完全坏死18个（69%），肿瘤不完全坏死8个（31%）。在2-24个月的随访期间（平均7.1个月），成功治疗的病灶内或周围出现局部复发，有14个病灶（78%）。对于轻微并发症，所有患者在手术过程中都有温暖的感觉和可忍受的疼痛。 5例患者出现局限性肝周血肿，所有患者均出现暂时性肝功能恶化。主要并发症为肿瘤扩散至皮肤 (n=1) 和结肠穿孔 (n=1)。结论：本研究中 2-5 瓦 ILHT 对 HCC 的效果不足。这可能是由于肝动脉和门静脉等血管产生的冷却作用，可以保护邻近的肿瘤免受高温影响。因此，ILHT 治疗需要改进的方法，例如使用肝动脉或门静脉球囊闭塞。