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頁籤選單縮合
題名 | 肝臟腫瘤的冷凍治療=Cryoablation Therapy for Hepatic Neoplasm |
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作者 | 鄭隆賓; 陳敏夫; 江支銘; 王正儀; Jeng, Long-bin; Chen, Miin-fu; Jiang, Chi-ming; Wang, Jeng-yi; |
期刊 | 臺灣醫學 |
出版日期 | 19970700 |
卷期 | 1:4 1997.07[民86.07] |
頁次 | 頁440-446 |
分類號 | 416.246 |
語文 | chi |
關鍵詞 | 肝細胞癌; 肝轉移癌; 冷凍治療; Hepatocellular carcinoma; Colorectal liver secondary; Cryosurgery; |
中文摘要 | 肝臟腫瘤無法以傳統手術方法行肝切除時,可以冷凍療法進行。自1994年11月至 1996 年 9 月底為止, 林口長庚紀念醫院一共治療了 21 位肝臟腫瘤的病人,其中男性 14 位,女性 7 位, 年齡由 36 歲至 75 歲不等, 平均 53 歲。 腫瘤的病理以原發肝細胞癌 14 例最多,大腸癌轉移 6 例及膽管癌 1 例。腫瘤數目單顆 14 例,二顆 6 例,三顆者 1 例。 腫瘤大小最小為 3 公分,最大為 9 公分。使用冷凍療法的適應症,14 例肝癌中,10 例為嚴重肝硬化,2 例為橫跨左右兩葉的大腫瘤,1 例為位於尾狀葉, 另 1 例為身體狀況 太差,不適合傳統切除。 6 例轉移癌中有 4 例為二顆分在不同葉的病變,而其他兩側則位 於較深部。1 例膽管癌使用冷凍療法的理由為病變侵犯太廣泛。手術進行視病變大小及數目 決定使用幾支及何種大小的冷凍針。操作時,以術中超音波定位及監視冰球的變化,大部份 均使用兩個冷凍解凍的標準療程。無術後立即死亡例。併發症包括 1 例發生肝莢膜龜裂,2 例短暫性血小板減少,無肌蛋白尿引起的腎衰竭。全部病例的預後,肝癌 14 例中,1 例身 體情況太差者只存活 28 天,再發者 3 例,1 例仍存活,已達 18 個月,而 2 例死亡分別 存活 5 及 20 個月;無再發者 9 例,平均存活 11 個月。 膽管癌 1 例,發生肺轉癌,只 存活 5 個月。轉移癌 6 例,目前仍存活,平均為 8 個月。 由本院的 21 例經驗,顯示在 無法以傳統手術進行切除的肝腫瘤,以冷凍療法治療不失為另外的選擇。 |
英文摘要 | We present our experience using cryosurgery to treat hepatic neoplams. Twenty-one patients with liver malignancy underwent cryosurgery from November 1994 through September 1996. Fourteen were male and 7 were female. Their ages ranged from 36 to 75 years, with an average of 53 years. The pathology of the tumors included primary hepatocellular carcinoma (HCC) in 14 patients, colorectal liver metastasis in 6, and cholangiocarcinoma in 1. Among them, 1 patient had 3 nodules, 6 patients had 2, and the other 14 patients had only 1 nodule. The largest tumor was 9 cm in diameter. Of the 14 HCC patients, 10 underwent cryosurgery for severe liver cirrhosis with poor liver reserve, 2 for centrally located large tumor, 1 for tumor located at the caudate lobe, and 1 because of poor general condition. Of the six patients with colorectal liver meteastasis; 4 underwent cryosurgery for bilobar lesions, and 2 for deep seated lesions. One patient underwent cryosurgery for extensive cholangiocarcinoma lesion. The CMS Accuprobe system (Cryomedical Science, Rockvill, MD), was used to deliver the liquid nitrogen through cryoprobes to the lesions, under echoguidance. Most patients received 2 freeze-thaw cycles. There were no immediate postoperative deaths. The HCC patient with poor general condition died of sepsis 28 days postoperatively. The patient with cholangiocarcinoma developed lung metastasis, and died 5 months postoperatively. During the 2 years follow up period, 3 HCC patients developed recurrence, two of them died, with 5 and 20 months survival, respectively. Among the 9 HCC patients without recurrence, the average survival was 11 months. All patients with colorectal liver metastasis were still alive at the last follow up (average, 8 months). We conclude that cryosurgery is a good alternative to treat the hepatic lesions that are difficult to resect with traditional hepatectomy. |
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