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

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26个HCC病变（直径10mm-30mm，平均17mm，最大直径小于15mm的13个病变）进行ILHT治疗。6例患者（7个病变）连续输送2瓦，持续15-20分钟；10例患者（17个病变）连续输送5瓦（间隔100 oms），持续5分钟；2例患者（2个病变）连续输送5瓦，持续4分钟。分别于治疗后7-14天、1个月和2-6个月采用动态CT评估治疗效果。结果：平均ILHT次数为2.1次。平均随访1个月，肿瘤完全坏死18例（69%），不完全坏死8例（31%）。随访2-24个月（平均7.1个月），14例（78%）病灶内或周围局部复发。对于轻微的并发症，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：在本研究中，2-5瓦的ILHT对HCC的治疗效果不足。这可能是由于肝动脉和门静脉等血管产生的冷却作用，可以保护邻近肿瘤免受高温的影响。因此，ILHT治疗需要改良方法，如球囊闭塞肝动脉或门静脉。

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.