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中华医学超声杂志(电子版) ›› 2020, Vol. 17 ›› Issue (04) : 289 -295. doi: 10.3877/cma.j.issn.1672-6448.2020.04.001

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肝癌射频消融治疗的临床应用现状与进展
杨薇1,(), 梁梓南1   
  1. 1. 100142 北京大学肿瘤医院暨北京市肿瘤防治研究所超声科 恶性肿瘤发病机制及转化研究教育部重点实验室
  • 收稿日期:2019-12-27 出版日期:2020-04-01
  • 通信作者: 杨薇
  • 基金资助:
    国家自然科学基金(81773286,81971718)

Clinical application and progress of radiofrequency ablation of hepatocellular carcinoma

Wei Yang1(), Zinan Liang1   

  • Received:2019-12-27 Published:2020-04-01
  • Corresponding author: Wei Yang
引用本文:

杨薇, 梁梓南. 肝癌射频消融治疗的临床应用现状与进展[J]. 中华医学超声杂志(电子版), 2020, 17(04): 289-295.

Wei Yang, Zinan Liang. Clinical application and progress of radiofrequency ablation of hepatocellular carcinoma[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(04): 289-295.

图1 射频消融联合热敏脂质体阿霉素治疗不可切除3~7 cm肝癌的研究示意图[引自J (Engl), 2017, 130(22):2666-2673]
图2 膈顶肿瘤消融前在膈上膈下注水示意图。图a为少量水若通过肋膈角注入膈上胸腔也可获得较好效果;图b为后膈肿瘤也可选用21 G~22 G细长针,通过肝组织直接刺达肿瘤上方肝外注水分离肝膈
图3 肠管附近肝肿瘤消融示意图。图a为将多针尖电极垂直于肠壁插入肿瘤中,并将针尖扩大至3 cm;图b为将射频消融电极针从3 cm扩展到4~5 cm以消融肠管附近的肿瘤区域时,RFA电极略微缩回以将肿瘤拉离肠管;图c为如果将多针尖RFA电极平行于肠壁插入肿瘤中,则扩展针尖时肠壁损伤的风险较高;图d为对于单根电极,穿刺方向平行于相邻肠壁
图4 肠管与肝肿瘤之间注水分离示意图。在射频消融前和期间,在肿瘤和附近的肠管之间制造人工腹水,保护肠管,箭头所示提针方向
图5 胆囊旁肝肿瘤射频消融病例。图a对位于GB床旁肝肿瘤,进针途径为右肋间纵切面引导垂直GB体长轴方向进针;图b治疗前利用PTC细针(▲为针尖位置),刺入胆囊床同时注射0.9%氯化钠溶液40 ml;图c注水分离肿瘤与胆囊,造成胆囊周围局部组织水肿(↑),以减少胆囊壁损伤
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