McCarty T M, Kuhn J A
Department of Surgery, Baylor University Medical Center, Dallas, Texas, USA.
Oncology (Williston Park). 1998 Jul;12(7):979-87; discussion 990, 993.
The curative management of primary and metastatic liver tumors has traditionally relied on surgical resection. Unfortunately, fewer than 10% of newly diagnosed patients have tumors that are considered to be surgically resectable. Limitations that often preclude a safe surgical resection include bilobar or centrally located tumors, insufficient hepatic reserve, cirrhosis, and/or associated comorbid medical conditions. For individuals with unresectable hepatic tumors, the treatment options are few, and the prognosis is uniformly poor. However, cryosurgery is a promising therapeutic alternative for these patients. This rapidly emerging technology allows for image-guided in situ tumor eradication using subzero temperatures, while selectively sparing most normal hepatic tissue. Tumor death occurs by direct cellular freezing and indirectly through vascular thrombosis and tissue anoxia. Accumulating data suggest that cryosurgery is a safe, effective treatment option for patients who would otherwise fair quite poorly, and that it may achieve long-term survival rates similar to those observed with formal surgical resection. This article summarizes the role cryosurgery may play in the management of patients with surgically unresectable primary and metastatic liver tumors.
原发性和转移性肝肿瘤的治疗管理传统上依赖于手术切除。不幸的是，新诊断的患者中不到10%的肿瘤被认为可进行手术切除。常常妨碍安全手术切除的限制因素包括双侧或位于中央的肿瘤、肝储备不足、肝硬化和/或相关的合并内科疾病。对于无法切除肝肿瘤的患者，治疗选择很少，预后普遍较差。然而，冷冻手术对于这些患者来说是一种有前景的治疗选择。这种迅速兴起的技术允许在图像引导下利用零下温度原位消除肿瘤，同时选择性地保留大部分正常肝组织。肿瘤死亡通过细胞直接冷冻以及间接通过血管血栓形成和组织缺氧而发生。越来越多的数据表明，冷冻手术对于那些原本预后很差的患者来说是一种安全、有效的治疗选择，并且它可能实现与正规手术切除相似的长期生存率。本文总结了冷冻手术在无法手术切除的原发性和转移性肝肿瘤患者管理中可能发挥的作用。
