| Liver cancer is one of the seriously malignant diseases that affect human health and life,with a high degree of malignancy,and extraordinarily rapid development and poor prognosis.In China,the morbidity and mortality were listed as the second and the third malignant disease respectively.Surgical resection of liver cancer is the standard treatment,however,the majority of liver cancer patients have different degrees of hepatitis,cirrhosis,limited liver reserves,and the surgical resection rate is low,about 20%～30%.At the same time,the liver is one of the most common malignant gastrointestinal metastasis,due to its multi-center regional growth or located in liver door area,only 10-15%of cases can be surgically removed. Therefore,surgical treatment is the best option for liver malignancies,but its narrow indications,it is difficult to meet clinical needs,and the majority of patients need to receive non-surgical treatment.In the past 10 years,being a representative of the local therapy,freezing of microwave ablation had been developed rapidly and become the third-largest HCC treatment,after surgical resection and interventional therapy.At the same time,with technology improvements and innovation,its treatment effect is getting improved continuously,especially in the treatment of small HCC.A number of studies have shown that its therapeutic effect is close to surgical resection,therefore subject to a wide range of attention,freezing of microwave ablation has become one of radical treatments,along with surgical excision,liver transplantation.Compared with surgical excision??l treatment has many advantages,such as small trauma,rapid recovery and simple operation can be carried out for out-patient.Currently,NCCN guideline has listed partial ablation treatment represented by freezing of microwave ablation,as a recommendation of standard treatment for non-suitable surgery liver cancer.In China,the minimally invasive ablation for the local treatment,intention on inactivation of tumor cells,the elimination of tumor burden,has widely aroused the concern in recent years.Local ablation therapy could provide an option for the patients who lose the opportunity of conventional surgical treatment of solid tumors. Among these,percutaneous argon-helium frozen,radio frequency and microwave ablation for the treatment of liver cancer have been widely used in clinical due to their minimally invasive targeted,fewer complications,fast recovery,simple operation,and has become a conventional treatment for liver cancer.Cryotherapy is a means of in situ tumor ablation.Compared with surgical excision,cryotherapy has more advantages.In 1970,Stucke and Hirte introduced cryotherapy of liver malignancies for the first time in German.In 1976,Ikeda found that hematogenously immune response appeared after frozen liver tumor.After that, cryotherapy of liver tumors was applied in many countries including China. Currently,cryotherapy has become an important treatment of liver cancer,which could not be treated with the surgical resection.Argon-helium Cryoablation makes use of the rapid dilation of the argon at the probe tip and reduces the temperature of the tissues that undergo pathological changes to -140℃and then rapidly thaws the ice ball and elevates the temperature at the probe tip by the helium.The ultra low temperature can lead to the formation of ice crystals in the cells and subsequently induce the cellular necrosis at low temperature.The formation of ice crystals in cells is the main reason of cell necrosis which constitutes the theoretical basis for the development of modern cryoablation techniques. Meanwhile,the rapid elevation of the temperature and the thermal thawing of the high pressure helium can cause the dilation of the ice crystals and the blowout of the ice ball,which finally lead to the further destruction and breakdown of the cell structures in the tumor tissues,and this is also an important element that leads to the cellular necrosis of the tumors.Argon-helium Cryoablation represents the advanced level of freezing equipments in the 1990's around the world,and it is a new revolution for the operations at ultra low temperature and an important breakthrough in the medical history.The Argon-Helium targeted cryoablation therapy with its rapid destroys to tumor tissues has been widely applied in worldwide in the treatment of solid tumors,such as liver cancer,lung cancer and achieved exciting achievements. Percutaneous cryoablation under CT conduction in the treatment of liver cancer has been widely used in our country and it achieved pretty results.The investigations of many clinical and experimental institutes have been demonstrated that using Argon-helium Cryoablation can obtain definit therapeutic effect to damage tumors.It is also confirmed that cryoablation on liver cancer can enhance bodies immunological level as well as can decrease the metastasis recurrence rate of tumor.Since cryoablation does not need to get rid of the freezing tumor tissues and the operation is simple to handle,and there are few complications after the operation,most of them do not affect the choices for other treatments.Argon-Helium cryoablation combined with,interventional therapy,radiotherapy or traditional Chinese medicine without exception can improve the effects of the treatment.As a kind of minimal invasion therapy,percutaneous targeting treatment for liver cancer has advantage of accurate therapeutic effects,especially for the patients who are not suitable for surgical resection or unwilling for operations or elderly people.However,it has been no reported how about the effects on the piping system of Glisson and pathological change of the liver tissue by percutaneous cryoablation.Related investigations are needed to provide bases for its clinical applications.Being a new kind of minimally invasive surgery,radiofrequency catheter ablation for liver cancer is developing rapidly in recent years.Its advantages include being predictable,controlling the scope of treatment,the local temperature feedback and repeat treatment of tumor recurrence,etc.Using monopolar or multipolar electrode, under CT or Ultrasonic waves conduction for percutaneous puncture and then the electrode is located at the tumor tissues and produces heat by the ion vibration and scrape of the cells in the target region induced by RF output.The local temperature can reach 80-90℃,which is enough to induce coagulative necrosis of the tumor tissues and finally gives rise to fluidity focus or fibrous tissues for effective treatments.RF treating device with cold circulation in the clinical application circulates the cooling water in it by using hollowed electrode,and the charring of tissues and the loss of water in the tissues nearby the electrode can be avoided by reducing the temperature at the tip of the electrode during the process of heating,and thus the extent of heat damages is enlarged.With the more and more extensive application of RFA technique in the comprehensive treatment of tumors,various kinds of experimental investigations have been successively carried out in the recent years and great progresses have been achieved.RFA technique has been widely used in the treatment for small or isolated solid tumors such as lung cancer,liver cancer which are unsuitable for surgical resection.Percutaneous RFA under CT conduction for the treatment of liver cancer has been widely used all over the world.It has some advantages such as minimal invasion,few adverse effects,no damages to marrow,liver and renal functions,repeat usage when compared with operation,chemotherapy and radiotherapy.These advantages can significantly reduce the symptoms of the patients and improve their living quality.It provides an alternative therapy for the patients with liver cancer who can't bear operations.It has been proven by experiments that the application of RFA in the liver tissues is safe and effective,in the mean time RFA can improve body's immunological functions which are benefit for tumor's treatment.But the following symptoms are not suitable for the application of radiofrequency therapy,including the severe liver dysfunction,jaundice,ascites,prothrombin time significantly extend, liver cancer with distant metastasis,huge liver cancer or diffuse liver cancer,cirrhosis, portal hypertension,and stomach esophagus varicosity with serious bleeding tendency,installation of a cardiac pacemaker.However,it has been no reported how about the effects on the piping system of Glisson and pathological change of the liver tissue by RFA.Related investigations are needed to provide bases for its clinical applications.MCT use local temperature to deactivate the tumors by puncturing the tumor tissues with minimal invasion,and it is a new therapy for tumors developed in the recent years.The body contains many polar molecules and charged ions,these polar molecules rotate rapidly under the effects of microwave electric field that is alternative in high rate,and the charged ions move rapidly and heat is produced by the scrape and the collision with the adjacent ions.The temperature in the target tissue is thus elevated to more than 50℃.The tumor cells in the target region are dehydrated and dried,and then develop coagulative necrosis.The embedded microwave solidification technique with,cooling air passage by inner circulating refrigerant used in clinical investigations(high pressure argon at normal temperature) can reduce the temperature of the pole and reduce the damages to the normal tissues near the puncture path during the process of MCT.With the development of microwave technique and equipments as well as continuous application of MCT in the clinical practice,MCT has been used in the treatment of some solid tumors such as liver cancer lung cancer.Among them,CT-directed percutaneous MCT in the treatment of liver cancer have been gradually carried out in the clinical practice,and particularly some clinical and experimental investigations performed in our country have obtained certain achievements.CT-directed percutaneous MCT have few side-effect on the body except local wounds by puncture and heat damages around tumor and a small quantity of normal liver tissues,as one of the minimally invasive therapies,MCT can be selected for clinical practice.Previous investigations showed that MCT can completely kill the tumor cells as well as coagulate the adjacent blood vessels near the tumors at the same time which can directly cut down the blood supplication to the tumors.A reaction zone formed between the normal tissues and the cancer tissue wrap up the rumor and function in the prevention of tumor metastasis in some degree.Besides this,MCT can achieve long-term effect for preventing the tumor metastasis via activating the body's immunological status. However,it has been no reported how about the effects on the piping system of Glisson and pathological change of the liver tissue by MCT.Related investigations are needed to provide bases for its clinical applications.This study includes three parts:1,The Influence Of Targeted ar-he Cryablation On The Area Of The Porta HepatisObjective:To discuss an impact of targeted ar-he cryablation over the first hepatic portals area by observing the pathological change of the hepar Glisson pipeline system first grading branch tissue in order to provide a theory basis to clinical practice.Methods:The 14 healthy dogs ablated by the percutaneous puncture hepar targeted ar-he cryablation were individed into A and B groups randomly.These dogs of the two groups were put to death in batches in 3 days and 28 days after ablation, respectively.Then the pathological change about the ablation target area and the first grading branch of the Glisson pipeline system was observed.Results:The obvious damage was not found in the portal vein blood vessel wall by the naked eyes or the light microscope;however,the blood vessel vicinity of liver tissue was damaged to necrosis entirely.Though the injuries in different degrees were seen in the one-level bile duct system after ar-he cryablation operation,we had not found sever damages,such as perforation,negrosis,and most of the injuries were reversible.The size of the ablated area in 28 days is smaller than that of 3 days obviously (p＜0.05).And on the acute stage(1-3d),ALT and AST increased more highly than those of pre-radio frequency operation(p＜0.05).However after operation(l-4w), there was no statistical difference comparing with preablation.Moreover,The cryablated area is mainly consistent with the pathological necrosis range(p＞0.05). Conclusion:Targeted ar-he cryablation can not only cause the blood vessel vicinity of liver tissue necrosed entirely,but also let the portal vein blood vessel wall undamaged under the protection of hot pool effection.And the ar-he cryablation injury effect on bile duct of hepatic portal section is relatively light.Moreover,ar-he cryablation has no obvious damage to the liver function.The range of necrosis could also be forecasted by the size of freezing area.Therefore,ar-he cryablation is a safe minimal invasive operation with reliable therapeutic effect.2,The Influence Of Radio Frequency Ablation On The Area Of The First Porta HepatisObjective:To discuss an impact of radio frequency over the first hepatic portals area by observing the pathological change of the hepar Glisson pipeline system first grading branch tissue in order to provide a theory basis to clinical practice.Methods:The 14 healthy dogs ablated by the percutaneous puncture hepar radio frequency ablation were individed into A and B groups randomly.These dogs of the two groups were put to death in batches in 3 days and 28 days after ablation, respectively.Then the pathological change about the ablation target area and the first grading branch of the Glisson pipeline system was observed.Results:The obvious damage was not found in the portal vein blood vessel wall by the naked eyes or the light microscope;hoyvever,the blood vessel vicinity of liver tissue was damaged to necrosis entirely,and injury was seen in the one-level bile duct system after radio frequency operation.The size of the ablated area in 28 days is smaller than that of 3 days obviously.And on the acute stage(1-3d),ALT and AST increased more highly than those of pre-radio frequency operation(p＜0.05).However after operation(l-4w), there was no statistical difference comparing with preablation.Conclusion:Though RFA can not only cause the blood vessel vicinity of liver tissue necrosed entirely,but also let the portal vein blood vessel wall undamaged under the protection of hot pool effection,the RFA injury effect on bile duct of hepatic portal section is very obvious. Therefore,we should pay more attention to protecting bile duct system during radio frequency operation.Another conclusion we draw is that the effect of radio frequency on liver function is little significant.3,Study On Reliability And Safety Of PMCT In The Area Of First Porta HepatisObjective:To discuss an impact of targeted microwave ablation on the first hepatic portals area by observing the pathological change of the hepar Glisson pipeline system first grading branch tissue in order to provide a theory basis to clinical practice.Methods:The 12 healthy dogs ablated by the percutaneous puncture hepar targeted microwave ablation were individed into A and B groups randomly.These dogs of the two groups were put to death in batches in 3 days and 28 days after ablation,respectively.Then the pathological change about the ablation target area and the first grading branch of the Glisson pipeline system was observed.Results:The obvious damage was not found in the portal vein blood vessel wall by the naked eyes or the light microscope;however,the blood vessel vicinity of liver tissue was damaged to necrosis entirely.The injuries,to some degree,were seen in the one-level bile duct system after ar-he cryablation operation.The size of the ablated area in 28 days is smaller than that of 3 days obviously(p＜0.05).And on the acute stage(l-3d),ALT and AST increased more highly than those of pre-radio frequency operation (p＜0.05).However after operation(l-4w),there was no statistical difference comparing with preablation.Moreover,The cryablated area is bigger than the pathological necrosis range(p＞0.05).Conclusion:Targeted microwave ablation can not only cause the blood vessel vicinity of liver tissue necrosed entirely,but also let the portal vein blood vessel wall undamaged under the protection of hot pool effection.Moreover,microwave ablation has no obvious damage to the liver function.Because of the damages to the hepar Glisson pipeline system,we should protect the system carefully during the targeted microwave ablation operation. |
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