實(shí)體腫瘤射頻消融研究相關(guān)進(jìn)展

1、實(shí)體腫瘤射頻消融研究相關(guān)進(jìn)展蘇格拉底格言如果藥物治不好病人就用手術(shù)治療如果手術(shù)治不好病人就用熱來(lái)治療如果熱也治不好，這病人就沒(méi)治了(Hippocrates 460-377 B.C. Translated by Overgaard 1985)Cautery treatment in the Middle Ages with the “ferrum candens”.Use of a ring-shaped hot iron to cauterize a tumorous lesion of the breast in the seventeenth century. Armamentarium

2、chirurgicum of Johann Schultes, Amsterdam 1672 (Paris, Bibliothque de Facult Mdecine)射頻組織滅活機(jī)理離子振蕩電阻產(chǎn)熱熱傳導(dǎo)射頻能量轉(zhuǎn)換及產(chǎn)熱RFA 電極演進(jìn)第一代電極: 滅活范圍 1.6 cm原始電極 Goldberg SN. Acda Radiol 1995; 2:399第二代電極: 滅活范圍 3-5 cm雙極電極 McGahan JP. Acad Radiol 1996; 3:418冷卻電極 Lorentzen T. Acda Radiol 1996; 3:556鹽水電極 Miao Y. J Surg R

3、es 1997; 73:19 傘狀電極 Rossi S. Am J Radiol 1998; 170:1015 RFA 電極演進(jìn)第三代電極（復(fù)合電極）: 滅活范圍 7 - 10 cm集束電極 Goldberg SN. Radiology 1998; 209:371冷卻-鹽水電極 Miao Y. Invest Radiol 2000; 35:438傘狀-鹽水電極 Miao Y. Eur Radiol 2000; 11:1841雙極-鹽水電極 Fernando B Radiol, 2003;229:447 第四代電極: 滅活范圍 10 cm ？商品化電極RITA Expandable Electr

4、odeRadionics Cool-tip RF System 冷循環(huán)中空電極工作原理冷卻水流出道冷卻水流入道-+ElectrodeRFA LesionGround PadLiverPerfusion PumpIn FlowOut FlowRF Generator 冷循環(huán)電極工作流程CoolingWater 鹽水增強(qiáng)電極集束2電極雙極鹽水增強(qiáng)電極腫瘤消融重疊治療腫瘤 3 cmRFA面臨的問(wèn)題缺少系統(tǒng)的臨床前研究組織消融范圍仍較小 治療過(guò)程監(jiān)控并發(fā)癥預(yù)防和處理優(yōu)化RF能量釋放增大組織消融范圍鹽水增強(qiáng)電極RFA（可輸注鹽水的中空電極）Miao Y, et al. J Surg Res, 1997;

5、 71:19鹽水增強(qiáng)電極工作流程-+ SalineElectrodeRFA LesionGround PadLiverPumpRF Generator 組織內(nèi)“液體”電極MRI平片電阻能量輸出組織消融范圍鹽水增強(qiáng)電極工作機(jī)理傘狀鹽水電極（可張開(kāi)的傘狀電極 + 鹽水輸注）Miao Y, et al. Eur Radiol, 2001; 11:1841電阻輸出功率組織消融范圍傘狀鹽水電極RFA冷卻鹽水電極（冷循環(huán)電極增加鹽水輸注功能）Miao Y, et al. Ivest Radiol, 2000; 35:438US patent (6,514,251 B1) Feb, 04.2003 冷卻鹽水

6、電極示意圖鹽水輸注通道冷卻水流入通道冷卻水流入通道冷卻鹽水電極工作流程-+ 5% SalineElectrodeRFA LesionGround PadLiverPerfusion PumpInfusion PumpIn FlowOut FlowRF GeneratorCoolingWater 電阻能量輸出電極組織界面溫度組織消融范圍冷卻鹽水電極體內(nèi)實(shí)驗(yàn)有血流灌注組織Pringels 肝門(mén)阻斷冷卻鹽水電極機(jī)理影像組織對(duì)應(yīng)研究（ VX2 腫瘤模型） Miao Y. Experimental research on radiofrequency tissue ablation as an alte

7、rnative in cancer therapy. Leuven university press. Leuven, Belgium,2000肝臟腫瘤 RFA 治療Miao Y,et al. Eur Radiol, 2000; 10:188肝VX2腫瘤RFA MRI表現(xiàn) 肝動(dòng)脈造影RFA病灶鏡下所見(jiàn) (H-E)動(dòng)脈造影活瘤已消融腫瘤“鬼影”現(xiàn)象 (H-E)活瘤已消融腫瘤HE vs.組化染色 H-E NADHOpen RFA of HCCPre 1M post Pre2W3M9MTAE+ RFA for HCCPre 1 W post CT Guided RFA for HCCLaparosc

8、opic RFACT of RFA Lesionpre 1M post 腎腫瘤 RFA 治療Miao Y, et al. Ann Surg Oncol,2001; 8:651MRI動(dòng)態(tài)觀察T1-wT2-wCE腎動(dòng)脈造影&大體標(biāo)本TAE RFA for Renal TumorHall WH, et al. AJR, 2000; 174:1592 顱內(nèi)腫瘤 RFA 治療Miao Y, et al. J Neur Oncol, 2002; 56:119 Pre-RFA1 h1 M3 M T1CET2大體標(biāo)本肺腫瘤 RFA 治療 Miao Y, et al. J Surg Res, 2001; 99:265肺動(dòng)脈造影MRI觀察T1CET2治療前治療后Microscorpy (H-E)肺腫瘤滅活MRI動(dòng)態(tài)觀察病理所見(jiàn)Dupuy DE, et al. AJR 2000; 174:57-59Stefanie S. Arch Surg. 1999;134:1064RFA of Breast CancerDupuy DE, et al. AJR, 2000; 175:1266 RFA of Spine Tu