Shafir M, Shapiro R, Sung M, Warner R, Sicular A, Klipfel A
Department of Surgery, Mount Sinai School of Medicine, New York, New York, USA.
Am J Surg. 1996 Jan;171(1):27-31. doi: 10.1016/s0002-9610(99)80068-3.
Unresectable malignant liver tumors, particularly metastases of gastrointestinal origin, are rapidly lethal in a vast majority of patients, regardless of treatment.
We evaluated 58 patients by laparoscopy and/or laparotomy. Thirty-nine were treated with cryoablation of liver tumors using a liquid-nitrogen cryoprobe delivering a tumoricidal temperature of -196 degrees C with intraoperative ultrasound monitoring. Histologic evaluation showed that 25 patients had colorectal metastases, 3 had gastric tumors, 4 hepatocellular carcinomas, 6 carcinoids, and 1 gastrinoma.
All patients who received complete cryoablation are alive with a mean follow-up of 14 months. Five whose treatment could not be completed died between 3 and 9 months postoperatively. Thirteen patients (28%) have recurrent disease and 20 (51%) have no evidence of disease. There were no operative mortalities. Postoperative transient elevation of liver function tests and thrombocytopenia were noted. All patients received postoperative chemotherapy.
Cryoablation is an active and safe treatment for advanced liver malignancies.
无法切除的恶性肝肿瘤，尤其是胃肠道来源的转移瘤，无论接受何种治疗，绝大多数患者都会迅速死亡。
我们通过腹腔镜检查和/或剖腹手术对58例患者进行了评估。39例患者采用液氮冷冻探头进行肝肿瘤冷冻消融治疗，术中超声监测，冷冻探头能将肿瘤温度降至-196℃。组织学评估显示，25例患者为结直肠癌转移，3例为胃肿瘤，4例为肝细胞癌，6例为类癌，1例为胃泌素瘤。
所有接受完全冷冻消融治疗的患者均存活，平均随访14个月。5例治疗未完成的患者在术后3至9个月死亡。13例患者（28%）出现疾病复发，20例患者（51%）无疾病证据。无手术死亡病例。术后观察到肝功能检查短暂升高和血小板减少。所有患者均接受了术后化疗。
冷冻消融是晚期肝恶性肿瘤的一种积极且安全的治疗方法。
