本文選題：高強(qiáng)度聚焦超聲（HIFU）　切入點(diǎn)：癌　出處：《鄭州大學(xué)》2014年博士論文　論文類型：學(xué)位論文

【摘要】：第一部分高強(qiáng)度聚焦超聲（HIFU）治療肝癌的劑量學(xué)研究 目的 通過(guò)SCT評(píng)估HIFU消融肝癌的結(jié)果，在有效性與安全性的基礎(chǔ)上，總結(jié)HIFU消融肝癌的劑量學(xué)數(shù)據(jù)，建立劑量模型，以預(yù)測(cè)治療一定體積肝癌所需要的超聲劑量，為HIFU治療肝癌的治療計(jì)劃系統(tǒng)（TPS）的制定和優(yōu)化提供劑量學(xué)基礎(chǔ)。 方法 1.研究對(duì)象 2009年12月至2013年6月，鄭州大學(xué)第一附屬醫(yī)院肝膽胰外科收治的行HIFU治療的122例肝癌患者，其中男88例，女34例，年齡24~78歲，平均53.82±10.44歲。 納入標(biāo)準(zhǔn)：（1）原發(fā)性肝癌診斷依據(jù)衛(wèi)生部頒布的“原發(fā)性肝癌診療規(guī)范(2011年版)”肝癌診斷標(biāo)準(zhǔn)，包括慢性肝病背景（肝硬化或HBV/HCV感染）、影像學(xué)檢查（CT或/和MRI）、血清AFP水平；（2）HIFU治療之前未經(jīng)過(guò)其它治療；（3）無(wú)遠(yuǎn)處轉(zhuǎn)移，無(wú)下腔靜脈癌栓；（4）失去手術(shù)機(jī)會(huì)的晚期肝癌或不愿意接受手術(shù)治療的原發(fā)性肝癌患者；（5）無(wú)嚴(yán)重心、肺、腎等重要臟器疾病，能夠耐受全身麻醉；（6）了解HIFU治療過(guò)程及可能風(fēng)險(xiǎn)，愿意接受HIFU治療。 排除標(biāo)準(zhǔn)（1）轉(zhuǎn)移性肝癌；（2）彌漫型原發(fā)性肝癌；（3）嚴(yán)重心、腦血管疾�。ú环�(wěn)定性心絞痛、半年內(nèi)有心肌梗塞、心律失常需用藥物控制者、嚴(yán)重高血壓及心力衰竭、近期有大范圍的腦梗塞、腦出血者）；（4）未控制的糖尿病患者。 2.研究設(shè)備 重慶海扶技術(shù)有限公司生產(chǎn)的JC200型聚焦超聲腫瘤治療系統(tǒng)。該系統(tǒng)由 計(jì)算機(jī)系統(tǒng)控制的治療頭、定位監(jiān)視裝置、治療運(yùn)動(dòng)控制裝置、超聲功率源、治療床及脫氣水裝置等組成。治療參數(shù):治療探頭頻率0.96MHz，焦距134mm，治療焦域1.5～10mm，治療聲功率200～400W，掃描速度3mm/s，焦域聲強(qiáng)4000～15000W/cm2，層距5mm。 GE LightSpeed CT成像系統(tǒng)。120KV，Auto-mA（240~700mA）；進(jìn)床速度為39.37mm/r，螺距為0.984：1；層厚為5mm，轉(zhuǎn)速為0.8s/r。高壓注射器采用了美國(guó)瑞達(dá)雙筒注射器，造影劑采用非粒子型對(duì)比劑如歐乃派克（300mgI/mL），經(jīng)肘靜脈注射，造影劑用量為80~100mL，注射流速4.0mL/s。掃描時(shí)相：動(dòng)脈期延遲25~30s，門靜脈期延遲60~65s，延遲期延遲90~180s。 3.研究方法 3.1影像學(xué)評(píng)估 所有患者術(shù)前均行SCT和超聲檢查，以明確腫瘤的性質(zhì)、形態(tài)、部位、數(shù)目以及與周圍組織和臟器的毗鄰關(guān)系。 腫瘤體積計(jì)算方法：SCT或超聲測(cè)量靶腫瘤的三維徑線：長(zhǎng)徑（D1）、前后徑（D2）和橫徑（D3），根據(jù)橢圓體計(jì)算公式計(jì)算靶腫瘤的體積。計(jì)算公式：V=0.5233×D1×D2×D3 肝癌血供評(píng)估：選擇肝癌最大截面為研究層面，根據(jù)CT多期掃描的動(dòng)脈期肝癌的強(qiáng)化面積占最大截面積的百分比將肝癌血供分為4級(jí)：（1）0級(jí)：腫瘤基本不強(qiáng)化或僅在腫瘤周邊有環(huán)形強(qiáng)化，強(qiáng)化面積＜25%；（2）Ⅰ級(jí)：腫瘤以不強(qiáng)化為主，其不強(qiáng)化的背景內(nèi)夾雜有強(qiáng)化區(qū)，25%"f強(qiáng)化面積50%；（3）Ⅱ級(jí)：腫瘤不均勻強(qiáng)化，其強(qiáng)化背景內(nèi)夾雜有低密度或等密度區(qū)，50%"f強(qiáng)化 面積90%；（4）Ⅲ級(jí)：腫瘤均勻強(qiáng)化，強(qiáng)化面積≥90%。通過(guò)SCT影像學(xué)測(cè)量腹壁厚度，肋間寬度，腫瘤距肝臟邊緣距離等參數(shù)。3.2HIFU消融治療 3.2.1治療前準(zhǔn)備①對(duì)于小肝癌或多發(fā)肝癌，術(shù)前進(jìn)行模擬定位，以便更好地制定治療計(jì)劃， 同時(shí)幫助病人消除治療的恐懼感，配合治療。 ②術(shù)前備皮、術(shù)區(qū)清洗、呼吸功能訓(xùn)練，并留置胃管尿管。 ③腫瘤靠近肝臟臟面并且為外生型者應(yīng)進(jìn)行嚴(yán)格的腸道準(zhǔn)備。④所有患者術(shù)前均不行肋骨切除術(shù)。 3.2.2手術(shù)過(guò)程所有患者均采用全身麻醉，局部皮膚行脫脂脫氣，對(duì)于靠近肝頂部的腫瘤，預(yù)計(jì)聲通道通過(guò)肺組織，需行“人工胸水”。根據(jù)腫瘤的部位，采用右側(cè)臥位或俯臥位（通常右半肝及左內(nèi)葉腫瘤采用右側(cè)臥位，左外葉腫瘤采用俯臥位）。在超聲實(shí)時(shí)監(jiān)控下確定腫瘤的部位、形態(tài)、數(shù)目、大小和與鄰近組織的關(guān)系。按5mm的層距將腫瘤分為多個(gè)不同的連續(xù)層面，由深到淺適形治療各個(gè)層面內(nèi)癌組織，直至完全覆蓋預(yù)定靶區(qū)。如遇肋骨阻擋，應(yīng)進(jìn)行呼吸控制，即在治療過(guò)程中暫停呼吸機(jī)，采用手動(dòng)擠壓呼吸球囊，使肺擴(kuò)張并保持1~2分鐘，從而使膈肌下移、肝臟下移，原先被肋骨阻擋的腫瘤組織下降至肋間隙。掃描方式采用點(diǎn)、線結(jié)合的方式，治療過(guò)程中通過(guò)實(shí)時(shí)監(jiān)控超聲影像圖，根據(jù)治療時(shí)靶區(qū)組織的灰階變化來(lái)評(píng)價(jià)HIFU的治療效果，靶區(qū)出現(xiàn)團(tuán)塊狀高回聲改變或整體灰度明顯增加是HIFU治療有效的確切證據(jù)。 3.2.3觀察指標(biāo) ①治療劑量參數(shù)：治療時(shí)間、輻照時(shí)間、治療功率；②安全性指標(biāo)：不良反應(yīng)。 3.3治療后影像學(xué)評(píng)估治療后1月內(nèi)行SCT復(fù)查，測(cè)量消融區(qū)體積（non-perfused volume，NPV）和腫瘤消融率。公式：體積消融率（non-perfused volume ratio，NPVR）=無(wú)灌注區(qū)體積/靶腫瘤體積×100％。體積消融率≥50%為臨床有效。 3.4治療后并發(fā)癥評(píng)價(jià) 統(tǒng)計(jì)并發(fā)癥發(fā)生情況，并發(fā)癥嚴(yán)重程度評(píng)價(jià)依據(jù)國(guó)際介入放射治療協(xié)會(huì)制定的SIR分類法。 3.5劑量學(xué)分析方法劑量用能效因子（energy effect factor, EEF）表示：EEF=η. Pt/V (J/mm3)η表示聚焦系數(shù)（=0.7），P為聲功率（W），t為照射時(shí)間，V為無(wú)灌注區(qū)體積（NPV）（mm3），EEF為消融單位體積腫瘤所需能量。 3.6統(tǒng)計(jì)學(xué)分析采用SPSS17.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)分析。 結(jié)果 1．消融結(jié)果 122例病人，接受HIFU消融治療，治療時(shí)間平均2.76±1.34小時(shí)，，實(shí)際消融時(shí)間平均2301.98±1225.15秒，腫瘤的平均直徑57.67±32.73mm，腫瘤體積217.41±361.8cm3，平均腫瘤體積消融率為73.73%±22.37%。 2.并發(fā)癥和副反應(yīng) 術(shù)后常見(jiàn)并發(fā)癥為發(fā)熱、轉(zhuǎn)氨酶升高、治療區(qū)域疼痛、局部軟組織腫脹，治療區(qū)皮膚麻木，右側(cè)胸腔積液等。2例患者出現(xiàn)肋骨骨折，1例患者出現(xiàn)皮膚Ⅲ度燒傷。1例患者出現(xiàn)結(jié)腸穿孔。按照SIR分級(jí)系統(tǒng)分級(jí)，19.83%為SIR A級(jí)并發(fā)癥，79.59%為SIR B級(jí)并發(fā)癥，0.58%為SIR D級(jí)并發(fā)癥。 3.劑量學(xué)研究結(jié)果 腹壁厚度與EEF之間缺乏相關(guān)性，而腫瘤距肝臟邊緣的距離、肋間隙寬度、腫瘤直徑以及腫瘤血供分級(jí)均與EEF具有線性相關(guān)關(guān)系。結(jié)論 1. HIFU對(duì)肝癌是一種安全有效的治療方法。 2.能效因子（EEF）能夠直接反映HIFU治療肝癌量效關(guān)系，可作為HIFU治療肝癌劑量學(xué)研究的量化指標(biāo)。 3.肝癌距肝臟邊緣的距離、肋間隙寬度、腫瘤的直徑、血供分級(jí)與EEF具有 線性相關(guān)關(guān)系。 4.肝癌HIFU消融的預(yù)測(cè)回歸模型為：y=-56.096+21.029X1+1.165X2-0.502X3。注：X1=肝癌的血供分級(jí)+1（1,2,3,4）X2=肝癌距肝臟邊緣的距離（肝癌中心部位作為測(cè)量點(diǎn)mm）X3=肝癌直徑（平均直徑mm）。 第二部分高強(qiáng)度聚焦超聲與氬氦刀聯(lián)合治療富血供肝癌的臨床研究目的 1.通過(guò)比較高強(qiáng)度聚焦超聲（HIFU）與氬氦刀治療不同大小、不同血供豐富程度肝癌的療效差異，為臨床治療肝癌選擇合適的局部治療方案提供實(shí)驗(yàn)依據(jù)。 2.采用HIFU聯(lián)合氬氦刀的方法對(duì)于富血供大肝癌進(jìn)行消融，評(píng)價(jià)其療效，并與單獨(dú)HIFU組及氬氦刀治療組做對(duì)比，探討HIFU聯(lián)合氬氦刀治療富血供大肝癌的有效性及可行性。方法 1.選取2011年6月至2013年6月鄭州大學(xué)第一附屬醫(yī)院肝膽胰外科收治的原發(fā)性肝癌患者120例，其中男79例，女41例，患者年齡28-76歲，平均53.70±9.82歲。所有病例均經(jīng)螺旋CT或MRI結(jié)合AFP證實(shí)為原發(fā)性肝細(xì)胞癌，并且均為無(wú)法行外科手術(shù)切除或者患者本人拒絕接受手術(shù)治療。將患者隨機(jī)分為2組，分別接受HIFU治療及氬氦刀治療，每組各60例。將每組按腫瘤直徑分為3個(gè)亞組（小癌型：瘤體直徑3cm；結(jié)節(jié)型：3cm"f瘤體直徑5cm；塊狀型：5cm"f瘤體直徑10cm）；多發(fā)腫瘤按最大腫瘤直徑進(jìn)行分組。按腫瘤的血供豐富程度用術(shù)前增強(qiáng)SCT進(jìn)行評(píng)估同樣分為4個(gè)亞組，分組方法詳見(jiàn)第一部分摘要。所有患者均在治療后1月內(nèi)接受SCT影像學(xué)評(píng)估，計(jì)算肝癌的體積消融率。在各亞組層面比較HIFU和氬氦刀的的療效。 2.取2009年12月~2013年6月鄭州大學(xué)第一附屬醫(yī)院肝膽胰外科收治的富血供大肝癌20例（直徑5cm，腫瘤血供Ⅱ、Ⅲ級(jí)）行聯(lián)合HIFU及氬氦刀治療，其中12例先行HIFU治療，經(jīng)SCT或超聲復(fù)查后證實(shí)仍有殘留組織，2周后行氬氦刀治療。另有8例先行氬氦刀治療，經(jīng)SCT或超聲證實(shí)有殘余腫瘤組織后再行HIFU治療。該組患者男14例，女6例，年齡59.32±12.34歲，瘤徑5.0~10cm。對(duì)照組為同期單獨(dú)行HIFU治療的富血供大肝癌30例，及單獨(dú)行氬氦刀治療的富血供大肝癌30例。比較三組治療方式的有效性及安全性。 結(jié)果 1.HIFU和氬氦刀的整體療效比較，兩組消融率無(wú)明顯差異(P0.05)。按腫瘤直徑分成亞組，瘤體直徑3cm組以及3cm"f瘤體直徑5cm組有效率HIFU與氬氦刀治療無(wú)明顯差異(P0.05)，但瘤體直徑≥5cm組，氬氦刀效果優(yōu)于HIFU（P0.05）。根據(jù)血供豐富程度分成亞組，在乏血供組（0~Ⅰ級(jí)血供）HIFU與氬氦刀療效無(wú)顯著性差異（P0.05），但在富血供組（Ⅱ~Ⅲ級(jí)血供），氬氦刀療效優(yōu)于HIFU（P0.05）。 2.并發(fā)癥方面，HIFU組無(wú)嚴(yán)重并發(fā)癥，多數(shù)并發(fā)癥經(jīng)對(duì)癥處理后好轉(zhuǎn)或觀察即可。氬氦刀治療組有1例出現(xiàn)冷休克，并最終腎功能衰竭。 3.三組比較，在腫瘤體積消融率方面，聯(lián)合組(75%)優(yōu)于HIFU組(30%)(P0.05),但和氬氦刀組(56.67%)比較，差異無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）；在癥狀改善方面，三組無(wú)統(tǒng)計(jì)學(xué)差異(聯(lián)合組58%，HIFU組50%，氬氦刀組48%，P0.05)；在AFP下降方面，聯(lián)合組(76.47%)優(yōu)于HIFU組(43.48%)及氬氦刀組(44.00%)(P0.05)。聯(lián)合治療組未出現(xiàn)嚴(yán)重并發(fā)癥。 結(jié)論 1. HIFU和氬氦刀對(duì)于直徑5cm的肝癌均為有效治療手段，對(duì)于富血供的大肝癌，HIFU及氬氦刀治療效果均下降，氬氦刀優(yōu)于HIFU。 2. HIFU和氬氦刀均是安全的治療手段，氬氦刀治療肝癌需注意并預(yù)防冷休克、腹腔出血等嚴(yán)重并發(fā)癥的發(fā)生。 3. HIFU聯(lián)合氬氦刀治療肝癌效果優(yōu)于單純HIFU治療或氬氦刀冷凍治療，HIFU聯(lián)合氬氦刀對(duì)于富血供大肝癌是一種有效、安全的治療方式。
[Abstract]:The dosimetry study of high intensity focused ultrasound (HIFU) in the treatment of liver cancer
objective
Through the SCT evaluation of HIFU ablation of hepatocellular carcinoma results in efficacy and safety, summarize the dosimetry data HIFU ablation of liver cancer, a model to predict the treatment dose, ultrasonic dose volume needed for liver cancer, treatment planning system HIFU for the treatment of hepatocellular carcinoma (TPS) to develop and provide basis for optimizing dosimetry.
Method
1. research objects
From December 2009 to June 2013, 122 cases of liver cancer treated by HIFU were enrolled in the First Affiliated Hospital of Zhengzhou University, including 88 males and 34 females, aged 24~78 years, with an average age of 53.82 + 10.44 years.
Inclusion criteria: (1) primary liver cancer diagnosis according to the Ministry of health promulgated the "standard of diagnosis and treatment of primary liver cancer (2011 Edition)" liver cancer diagnostic criteria, including the background of chronic liver disease (cirrhosis or HBV/HCV infection), imaging (CT or MRI), the serum level of AFP (2) HIFU before treatment; without other treatment; (3) no distant metastasis, no tumor thrombus in the inferior vena cava; (4) unresectable liver cancer or are not willing to accept the surgical treatment of primary liver cancer patients; (5) no serious heart, lung disease, kidney and other organs, able to withstand general anesthesia; (6) understand the HIFU treatment process and the possible risk, willing to accept HIFU treatment.
Exclusion criteria (1) metastatic hepatocellular carcinoma; (2) diffuse hepatocellular carcinoma; (3) serious heart cerebrovascular disease (unstable angina, 6 months after myocardial infarction, arrhythmia with drug control, severe hypertension and heart failure, the recent massive cerebral infarction, cerebral hemorrhage); (4) diabetic patients without control.
2. research equipment
The JC200 focused ultrasound tumor treatment system produced by Chongqing Haifu Technology Co., Ltd.
The treatment head of a computer control system, positioning monitoring device, control device for motor, ultrasonic power source, composition and water treatment bed degassing device. The treatment parameters: the treatment probe frequency 0.96MHz, focal length of 134mm, treatment of focal region of 1.5 ~ 10mm, 200 ~ 400W for sound power, scanning speed 3mm/s, focal intensity 4000 ~ 15000W/cm2, from the 5mm. layer
GE LightSpeed CT.120KV imaging system, Auto-mA (240~700mA); bed velocity is 39.37mm/r, pitch 0.984:1; layer thickness is 5mm, the speed of 0.8s/r. high pressure syringe Rita double syringe, contrast agent using particle contrast agent (300mgI/ mL), such as Omnipaque through elbow vein injection, contrast agent dosage 80~100mL injection velocity 4.0mL/s. scan time of arterial phase delay 25~30s, portal venous phase delay 60~65s delay time delay 90~180s.
3. research methods
3.1 imaging evaluation
All patients were examined by SCT and ultrasound before operation to determine the nature, morphology, location, number, and adjacent relationship with the surrounding tissues and organs.
The volume of tumor was calculated by SCT or ultrasound to measure the three-dimensional diameter of target tumor: long diameter (D1), anteroposterior diameter (D2) and transverse diameter (D3). The volume of target tumor was calculated according to the calculation formula of ellipsoid. The formula is: V=0.5233 * D1 * D2 * D3.
The evaluation for the liver blood: choose the maximum section of liver cancer as the research level, to strengthen the area according to the CT scan of the arterial liver percentage of the maximum cross-sectional area of the blood supply of liver cancer is divided into 4 levels: (1) 0: tumor basic no enhancement or only in the periphery of tumors with ring enhancement, enhanced area is less than 25%; (2) level I: to strengthen the tumor, its inclusion in the background of the reinforcement strengthening area, 25% "f enhancement area of 50%; (3) II: tumor inhomogeneous enhancement, the enhancement of background with low density or density, 50% f reinforcement
Area of 90%; (4) class III: tumor enhancement and enhancement area is larger than 90%. by SCT imaging measurement of abdominal wall thickness, rib width, distance from the edge of liver tumor ablation parameters such as.3.2HIFU
Pre - 3.2.1 preparation (1) for small or multiple hepatocellular carcinoma (HCC) or multiple hepatocellular carcinoma (HCC) before operation, in order to make the treatment plan better.
At the same time, help the patients to eliminate the fear of treatment, combined with treatment.
The preoperative skin preparation, preoperative cleaning, respiratory function training and indwelling gastric tube catheter.
(3) the tumor is close to the liver and should be prepared for the exogenic type. (4) all patients do not have ribs before operation.
The 3.2.2 procedure in all patients under general anesthesia, local skin degreasing for near the top of the degassing, liver tumor, lung tissue through the acoustic channel is expected, the need for "artificial hydrothorax." according to the location of the tumor, the right lateral decubitus or prone position (usually the right liver and left lobe tumor in the right lateral decubitus, left lateral lobe tumor with prone position). To determine the location of the tumor, ultrasound in real-time monitoring the number, shape, size and relationship with surrounding tissues. According to the 5mm layer from the tumor will be divided into a number of different continuous level, from deep to shallow conformal treatment of cancer organizations in various levels, until completely covering a predetermined the target area. If the ribs should be blocked, breath control, suspended mechanical ventilation in the treatment process, using manual extrusion breathing balloon, the lung expansion and keep 1~2 minutes, so that the diaphragm moves down, liver depression, had previously been rib bone block of tumor tissue under To the rib clearance. Scan mode using point line combination, in the course of treatment by real-time monitoring of ultrasonic images, HIFU treatment evaluation according to the gray-scale changes of target tissue to the treatment effect, appeared in the target region mass shaped high echo change or overall gray increased significantly for HIFU evidence effectively.
3.2.3 observation index
(1) treatment dose parameters: treatment time, irradiation time, treatment power, and safety index: adverse reaction.
3.3 after treatment, imaging evaluation of January underwent SCT re examination after treatment, measurement of ablation zone volume (non-perfused volume, NPV) and the tumor ablation rate. The formula: Volume ablation rate (non-perfused volume ratio, NPVR) = non perfusion volume / target tumor volume x 100%. volume ablation rate greater than 50% is clinically effective.
Evaluation of complications after 3.4 treatment
The incidence of complications was statistically analyzed, and the severity of the complications was evaluated according to the SIR classification established by the International Association for interventional radiology treatment.
3.5 methods of dosimetric analysis using dose efficiency factor (energy effect factor EEF) said: EEF= Pt/V (J/mm3). ETA ETA said focusing factor (=0.7), P (W), sound power t irradiation time, V volume perfusion area (NPV) (mm3) EEF, the energy required for ablation the unit volume of the tumor.
3.6 statistical analysis was carried out by SPSS17.0 statistical software.
Result
1. result of ablation
122 patients were treated with HIFU ablation, the average time of treatment was 2.76 + 1.34 hours, the actual ablation time was 2301.98 + 1225.15 seconds, the average diameter of the tumor was 57.67 + 32.73mm, the tumor volume was 217.41 + 361.8cm3, and the average tumor volume ablation rate was 73.73% + 22.37%..
2. complications and side effects
The postoperative complications included fever, elevated transaminases, regional pain treatment, local soft tissue swelling, numbness of skin in the treatment area, right pleural effusion.2 patients with rib fractures, 1 cases of patients with skin burns.1 patients with colonic perforation. According to SIR classification system for SIR grade, 19.83% grade 79.59% complications. SIR B 0.58% SIR D for complications and complications.
3. research results of dosimetry
There was no correlation between the thickness of abdominal wall and EEF, but the distance from tumor to the liver edge, the width of rib space, the diameter of tumor and the classification of tumor blood supply all had a linear correlation with EEF.
1. HIFU is a safe and effective treatment for liver cancer.
The 2. energy efficiency factor (EEF) can directly reflect the dose effect relationship of HIFU in the treatment of liver cancer, and can be used as a quantitative indicator of dosimetry for the treatment of liver cancer by HIFU.
3. the distance from the liver to the edge of the liver, the width of the intercostal space, the diameter of the tumor, the classification of blood supply and the EEF
Linear correlation.
4., the predictive regression model of HIFU ablation for liver cancer is: y=-56.096+21.029X1+1.165X2-0.502X3. note: X1= blood supply grading +1 (1,2,3,4) X2=, liver cancer distance from the liver edge (the center of liver cancer as the measurement point mm), the diameter of X3= liver cancer (mean diameter mm).
Clinical study on the combination of second parts of high intensity focused ultrasound and argon helium knife in the treatment of liver cancer with rich blood supply
1., by comparing the therapeutic effects of high intensity focused ultrasound (HIFU) and argon helium knife on different sizes and blood supply levels, we can provide experimental evidence for selecting suitable local treatment for liver cancer.
2., we used HIFU combined with argon helium knife to evaluate the efficacy of ablation for hepatocellular carcinoma with large blood supply and evaluate its efficacy. Compared with group HIFU and argon helium knife therapy, we explored the feasibility and effectiveness of HIFU combined with argon helium knife in the treatment of large hepatocellular carcinoma with rich blood supply.
1. were selected and hepatobiliary surgery the First Affiliated Hospital of Zhengzhou University from June 2011 to June 2013, 120 cases of primary liver cancer patients, 79 were male, 41 were female, with average age of 28-76 years, 53.70 + 9.82 years. All cases were confirmed by spiral CT or MRI combined with AFP confirmed primary liver cell carcinoma, and as to surgical excision or patient refused to accept surgical treatment. The patients were randomly divided into 2 groups, were treated with HIFU and cryoablation therapy, 60 cases in each group. Each group according to the diameter of the tumor was divided into 3 subgroups (small cancer type: tumor diameter 3cm; node type: 3cm the diameter of tumor f 5cm; massive type: 5cm "f tumor diameter 10cm); multiple tumors were grouped according to the maximum diameter of the tumor. According to tumor blood supply by preoperative enhanced SCT assessment is also divided into 4 sub groups, in the first part the grouping method. All the patients were cured After January, the SCT imaging assessment was performed to calculate the volume ablation rate of liver cancer. The therapeutic effects of HIFU and argon helium were compared in each subgroup.
2. December 2009 ~2013 year in June of hepatobiliary surgery the First Affiliated Hospital of Zhengzhou University, the rich blood supply of large hepatocellular carcinoma in 20 cases (diameter 5cm, the blood supply of the tumor II, III) treated with HIFU and cryoablation, first HIFU treatment in 12 cases, by SCT or ultrasound examination confirmed that there is still residual tissue, 2 weeks after treatment of argon helium knife. Another 8 cases of the first treatment of argon helium knife by SCT or ultrasound confirmed residual tumor after HIFU treatment. The patients were male 14 cases, female 6 cases, age 59.32 + 12.34 years, tumor diameter 5.0~10cm. control group for the same period alone HIFU rich blood supply of large hepatocellular carcinoma in 30 cases, and a separate line of argon helium cryoablation of hypervascular large hepatocellular carcinoma in 30 cases. The efficacy and safety of treatment were compared between the three groups.
Result
Comparison of the overall effect of 1.HIFU and argon helium knife, two groups of ablation rate had no significant difference (P0.05). Divided into sub groups according to tumor diameter, tumor diameter had no significant difference between group 3cm and 3cm with HIFU and f efficiency of argon helium knife diameter of tumor in 5cm group (P0.05), but the diameter of tumor was more than 5cm group, argon helium knife is better than HIFU (P0.05). According to the blood supply into subgroups in hypovascular group (0~ grade of blood supply) there was no significant difference between the efficacy of HIFU and argon helium knife (P0.05), but in the rich blood supply (group II or III blood supply), argon helium knife the curative effect is better than that of HIFU (P0.05).
2., there were no serious complications in HIFU group. Most of the complications were improved or observed after symptomatic treatment. 1 cases suffered from cold shock and eventually renal failure in argon helium therapy group.
Comparison of 3. groups in three, the volume of tumor ablation rate, the combined group (75%) than that of HIFU group (30%) (P0.05), but the cryoablation group (56.67%), the difference was not statistically significant (P0.05); improvement in symptoms, no significant difference between three groups (group 58%, HIFU group 50% argon helium knife, group 48%, P0.05); the decline in AFP, the combined group (76.47%) than that of HIFU group (43.48%) and cryoablation group (44%) (P0.05). The combined treatment group had no serious complications.
conclusion
1. HIFU and argon helium knife are effective treatments for hepatocellular carcinoma with diameter of 5cm. For blood rich large hepatocellular carcinoma, the effect of HIFU and argon helium knife is decreased, and argon helium knife is better than HIFU..
2. HIFU and argon helium knife are all safe treatment methods. Argon helium knife should pay attention to the treatment of liver cancer and prevent severe complications such as cold shock and abdominal bleeding.
The effect of 3. HIFU combined with argon helium knife in the treatment of liver cancer is better than that of HIFU alone.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2014
【分類號(hào)】：R735.7

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