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

目的：探讨经皮组织间激光热疗(ILHT)治疗肝细胞癌的疗效。材料与方法：对15例26个病灶(直径10 mm~30 mm，平均17 mm，13个病灶最大径<15 mm)进行激光热疗。6例(7个病灶)采用2W连续照射15~20min，10例(17个病灶)采用5W脉冲照射5min(间隔100ms)，2例(2个病灶)采用5W连续照射4min。分别于治疗后7~14天、1个月、2~6个月进行动态CT检查。结果：ILHT平均治疗次数为2.1次。平均随访1个月，肿瘤完全坏死18个(69%)，不完全坏死8个(31%)。在2-24个月(平均7.1个月)的随访中，14个病灶(78%)在成功治疗的病灶内或周围出现局部复发。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以忍受的疼痛。5例患者出现局限性肝周血肿，所有患者肝功能均有一过性恶化。主要并发症有肿瘤向皮肤扩散1例，结肠穿孔1例。结论：2~5W的ILHT对肝癌的治疗作用不大。这可能是由于肝动脉和门静脉等血管产生的降温效应，可能保护邻近肿瘤免受热疗的影响。因此，ILHT的治疗需要改进的方法，如使用球囊阻断肝动脉或门静脉。

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.