本文選題：肝細(xì)胞癌 + 射頻消融��； 參考：《中國人民解放軍醫(yī)學(xué)院》2016年博士論文

【摘要】：目的：(1)探討原發(fā)性肝細(xì)胞癌(Hepatocellular carcinoma, HCC)血流灌注程度對射頻消融(Radiofrequency ablation, RFA)臺療參數(shù)、溫度熱場及消融范圍的影響,并探討其影響機(jī)制。(2)研究患者肝組織硬度測值(LSM)對HCC射頻消融近期療效的影響。(3)分析HCC射頻消融后局部腫瘤進(jìn)展的危險(xiǎn)因素,為進(jìn)一步優(yōu)化治療策略提供相關(guān)依據(jù)。材料與方法：第一部分：2013年9月-2015年12月在302醫(yī)院行超聲引導(dǎo)RFA治的62例HCC患者共66個(gè)病灶,所有病灶均經(jīng)超聲引導(dǎo)組織穿刺活檢病理學(xué)或兩種以上增強(qiáng)影像學(xué)明確診斷。入組標(biāo)準(zhǔn)為：(1)腫瘤≤5cm或數(shù)目3≤個(gè),最大直徑≤3cm;(2)無血管、膽管栓塞及肝外轉(zhuǎn)移;(3)肝功能Child-Pugh A或B級;(4)患者拒絕手術(shù)治療或無手術(shù)切除適應(yīng)證;(5)血漿凝血酶原時(shí)間≤25秒,凝血酶原活動度≥40%,血小板計(jì)數(shù)≥50×109/L;(6)患者自愿受試,簽署知情同意書。對HCC病灶行超聲造影(CEUS)并進(jìn)行定量分析,根據(jù)曲線下面積(AUC)值,將病灶分為低血流灌注組和高血流灌注組。行RFA時(shí),相關(guān)治療參數(shù)包括輸出功率、組織阻抗和治療時(shí)間進(jìn)行記錄,治療同時(shí)在消融電極針旁開0.5cm(T1)及1.0cm(T2)處行實(shí)時(shí)溫度監(jiān)測,所有病灶完成射頻消融能量25KJ后,即刻行超聲造影CEUS檢查,測量消融區(qū)長軸徑(LAD)、短軸徑(SAD)及消融區(qū)體積(Volume)。研究HCC血流灌注程度與RFA治療參數(shù)和消融范圍之間的關(guān)系;研究HCC血流灌注程度對RFA溫度熱場的影響。第二部分：2013年9月-2015年10月行超聲引導(dǎo)RFA治療的106例患者共114病灶,所有病灶均經(jīng)超聲引導(dǎo)組織穿刺活檢病理學(xué)或兩種以上增強(qiáng)影像學(xué)明確診斷。采用FibroScan檢測儀對患者行肝組織硬度測量(LSM),以17.5kPa作為臨界值,將患者分為高LSM組和低LSM組,研究分析兩組病灶在技術(shù)有效率(TER)、局部腫瘤進(jìn)展(LTP)率等方面的差異。第三部分：2012年9月～2015年10月在302行超聲引導(dǎo)RFA治療的99例HCC患者107個(gè)病灶,所有病灶均經(jīng)超聲引導(dǎo)組織穿刺活檢病理學(xué)或兩種以上增強(qiáng)影像學(xué)明確診斷。所有患者均有完整的CEUS血流灌注參數(shù)、肝組織硬度測值LSM等檢查,平均隨訪時(shí)間10.6個(gè)月。采用單因素分析和Cox比例風(fēng)險(xiǎn)多因素分析方法,研究HCC患者RFA治療后局部腫瘤進(jìn)展的危險(xiǎn)因素,繪制生存曲線。結(jié)果：1、(1)HCC血流灌注程度與RFA平均輸出功率、作用時(shí)間呈線性正相關(guān),與組織阻抗呈線性負(fù)相關(guān);(2)低血流灌注組HCC內(nèi)部測溫點(diǎn)T1、T2均高于高血流灌注組,兩組差異有統(tǒng)計(jì)意義;(3)HCC血流灌注程度與RFA治療能量為25KJ的消融區(qū)長軸徑LAD、短軸徑SAD和消融體積Volume均呈線性負(fù)相關(guān),關(guān)系分別為y=-0.18×10-3x+3.2711(r=-0.662,p=0.00)、y=-0.21×10-3x+2.9988(r=-0.765, p=0.00)和y=-0.0031x+15.892(r=-0.761,p=0.00)、2、高LSM組與低LSM組HCC技術(shù)有效率分別為94.4%和95.3%,兩組間無統(tǒng)計(jì)學(xué)差異：高LSM組和低LSM組HCC局部腫瘤進(jìn)展率分別為16.9%和7.0%,兩組差異有統(tǒng)計(jì)學(xué)意義;高LSM組和低LSM組患者肝內(nèi)復(fù)發(fā)率分別為28.4%和10.3%,兩組差異有統(tǒng)計(jì)學(xué)意義。3、(1)單因素分析,HCC射頻消融后發(fā)生LTP的影響因素有腫瘤大小、鄰近較大血管、治療前行TACE、患者肝功能Child-Pugh分級、腫瘤血流灌注程度、患者肝病類型和肝組織硬度。(2)Cox比例風(fēng)險(xiǎn)多因素分析顯示：腫瘤大小、是否鄰近較大血管、血流灌注程度和肝組織硬度是HCC射頻消融治療后LTP獨(dú)立危險(xiǎn)因素,其風(fēng)險(xiǎn)比(HR)分別為1.12、1.38、1.59和1.77：HCC射頻消融前行TACE是LTP的保護(hù)因素,風(fēng)險(xiǎn)比為0.52。結(jié)論：1、HCC血流灌注對RFA治療具有“熱沉效應(yīng)”;2、肝組織硬度測量LSM是HCC消融后發(fā)生局部腫瘤進(jìn)展和肝內(nèi)復(fù)發(fā)的影響因素;3、腫瘤大小、是否鄰近較大血管、血流灌注程度和肝組織硬度是HCC射頻消融后LTP的獨(dú)立影響因素,有助于采取策略,提高RFA療效,而RFA前行TACE可有效降低LTP發(fā)生率。
[Abstract]:Objective: (1) to investigate the effect of blood perfusion on Hepatocellular carcinoma (HCC) blood perfusion on the parameters of radiofrequency ablation (Radiofrequency ablation, RFA), temperature and thermal field and ablation range, and to explore the mechanism of its influence. (2) study the effect of LSM on the short-term efficacy of HCC radiofrequency ablation (3) analysis of H The risk factors of local tumor progression after CC radiofrequency ablation provide a basis for further optimization of the treatment strategy. Materials and methods: Part 1: 62 cases of HCC patients were treated by ultrasound guided RFA in No.302 Hospital in December September 2013, with 66 lesions, all the lesions were guided by ultrasound guided biopsy pathology or more than two kinds of increase. Strong imaging diagnosis. The standard of the group was: (1) the tumor was less than 5cm or 3 or less, the maximum diameter was less than 3cm; (2) no blood vessels, bile duct embolization and extrahepatic metastasis; (3) liver function Child-Pugh A or B grade; (4) patients refused surgical treatment or no surgical resection indication; (5) plasma prothrombin time less than 25 seconds, prothrombin activity of more than 40%, thrombocytopenia Number more than 50 x 109/L; (6) patients volunteered to sign informed consent. Ultrasound contrast (CEUS) and quantitative analysis were performed on HCC lesions. According to the area of the curve (AUC), the lesions were divided into low blood flow perfusion group and high blood flow perfusion group. When RFA, the related treatment parameters included output power, tissue impedance and time of treatment were recorded, treatment simultaneously. Real-time temperature monitoring was performed at 0.5cm (T1) and 1.0cm (T2) at the ablation electrode. After all the lesions completed the radiofrequency ablation energy 25KJ, the long axis diameter (LAD), the short axis diameter (SAD) and the ablation area volume (Volume) of the ablation area were measured immediately after the radiofrequency ablation of 25KJ, and the relationship between the degree of blood flow perfusion with RFA treatment parameters and the range of ablation was studied. The effect of HCC perfusion on the temperature and thermal field of RFA. Second part: 114 lesions were performed in 106 patients with ultrasound guided RFA therapy in September 2013 -2015. All lesions were diagnosed by ultrasound guided biopsy pathology or more than two enhanced imaging. The degree of liver tissue hardness was measured by FibroScan detector (L SM), using 17.5kPa as the critical value, the patients were divided into high LSM group and low LSM group. The difference between two groups of lesions in technical efficiency (TER) and local tumor progression (LTP) was analyzed. The third part: 107 lesions of 99 HCC patients with 302 lines of ultrasound guided RFA from September 2012 to October 2015, all lesions were guided by ultrasound guided tissue All patients had complete CEUS perfusion parameters, LSM test of liver tissue hardness, and average follow-up time of 10.6 months. The risk factors of local tumor progression after RFA treatment in HCC patients were studied by means of single factor analysis and Cox proportional risk multivariate analysis. Draw the survival curve. Results: 1, (1) HCC blood flow perfusion degree and RFA average output power, action time is linear positive correlation, and the linear negative correlation with tissue impedance; (2) low blood flow perfusion group HCC temperature measurement point T1, T2 are higher than the high blood flow perfusion group, two groups of differences have unified significance; (3) HCC perfusion degree and RFA treatment energy for 25KJ elimination The long axis diameter LAD, the short axis diameter SAD and the ablation volume Volume have linear negative correlation, the relationship is y=-0.18 x 10-3x+3.2711 (r=-0.662, p=0.00), y=-0.21 * 10-3x+2.9988 (r=-0.765, p=0.00) and y=-0.0031x+15.892. The efficiency is 94.4% and 95.3% respectively. There is no statistical difference between the two groups, respectively: The progression rate of HCC local tumor in high LSM group and low LSM group was 16.9% and 7% respectively. The difference between the two groups was statistically significant. The recurrence rate of the liver in the high LSM group and the low LSM group was 28.4% and 10.3%, respectively, and the two groups were statistically significant.3, (1) the single factor analysis, the influence factors of LTP after HCC radiofrequency ablation were tumor size, adjacent to larger vessels, treatment TACE, patients with liver function Child-Pugh classification, tumor blood perfusion, liver disease type and liver tissue hardness. (2) multiple factor analysis of Cox ratio risk showed that tumor size, adjacent larger blood vessels, blood flow perfusion and liver tissue hardness were independent risk factors of LTP after HCC radiofrequency ablation, and the risk was 1.12, respectively, (HR). TACE is a protective factor for LTP before 1.38,1.59 and 1.77:HCC radiofrequency ablation, and the risk ratio is 0.52. conclusion: 1, HCC blood perfusion has "heat sink effect" for RFA treatment; 2, liver tissue hardness measurement LSM is the influencing factor of local tumor progression and intrahepatic recurrence after HCC ablation; 3, tumor size, adjacent to larger vessels and blood perfusion process Degree and liver tissue hardness are independent factors of LTP after radiofrequency ablation of HCC. It is helpful to adopt strategies to improve the efficacy of RFA, while TACE before RFA can effectively reduce the incidence of LTP.
【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R735.7;R445.1

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9 張海清;超聲造影評價(jià)肝纖維化血流灌注特征的初步研究[D];山西醫(yī)科大學(xué);2013年

10 周連吉;2型糖尿病患者足底肌肉血流灌注變化及其與腎病、視網(wǎng)膜病變關(guān)系[D];廣西醫(yī)科大學(xué);2013年

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