Lencioni R, Cioni D, Donati F, Bartolozzi C
Division of Diagnostic and Interventional Radiology, Department of Oncology, University of Pisa, Via Roma 67, Pisa I-56125, Italy.
Hepatogastroenterology. 2001 Jan-Feb;48(37):8-14.
Many interventional techniques aimed at achieving nonsurgical ablation of hepatocellular carcinoma have been developed and clinically tested over the last decade. Percutaneous image-guided therapies such as ethanol injection and radiofrequency thermal ablation provide an effective means for treating hepatocellular carcinoma lesions smaller than 3 cm, but do not ensure successful ablation of larger tumors. In view of the limitations of available interventional therapies, there is currently a focus on a multimodality strategy for the treatment of large hepatocellular carcinomas. Combination of transcatheter arterial chemoembolization and ethanol injection overcomes the weakness of each of the two procedures, enhancing local therapeutic effect and long-term survival. More recently, a new technique for single-session ablation of large hepatocellular carcinoma lesions has been devised by combining transcatheter hepatic arterial balloon occlusion/embolization and radiofrequency treatment. This combined approach substantially increases the thermal necrosis volume that can be created with respect to the conventional radiofrequency technique, as a result of the reduction of heat loss caused by convection. In a pilot multicentric clinical trial performed in 62 patients, successful ablation of hepatocellular carcinoma lesions ranging 3.5-8.5 cm in diameter was achieved in 82% of cases in the absence of major complications. This new technique seems to have the potential to replace other interventional methods for the treatment of large hepatocellular carcinoma.
在过去十年中，已经开发并对许多旨在实现肝细胞癌非手术消融的介入技术进行了临床测试。诸如乙醇注射和射频热消融等经皮图像引导疗法为治疗小于3厘米的肝细胞癌病变提供了一种有效手段，但不能确保较大肿瘤的成功消融。鉴于现有介入疗法的局限性，目前重点关注大肝细胞癌的多模态治疗策略。经导管动脉化疗栓塞术与乙醇注射相结合克服了这两种手术各自的弱点，提高了局部治疗效果和长期生存率。最近，通过结合经导管肝动脉球囊闭塞/栓塞术和射频治疗，设计出了一种单疗程消融大肝细胞癌病变的新技术。由于对流引起的热损失减少，这种联合方法相对于传统射频技术大大增加了可产生的热坏死体积。在一项针对62例患者的多中心临床试验中，82%的病例成功消融了直径在3.5至8.5厘米之间的肝细胞癌病变，且无重大并发症。这项新技术似乎有潜力取代其他介入方法来治疗大肝细胞癌。
