实体肿瘤射频消融研究进展ppt课件

实体肿瘤射频消融 研究进展,1,苏格拉底格言,如果药物治不好病人就用手术治疗 如果手术治不好病人就用热来治疗 如果热也治不好，这病人就没治了,(Hippocrates 460-377 B.C. Translated by Overgaard 1985),2,Cautery treatment in the Middle Ages with the “ferrum candens”.,3,Use of a ring-shaped hot iron to cauterize a tumorous lesion of the breast in the seventeenth century. Armamentarium chirurgicum of Johann Schultes, Amsterdam 1672 (Paris, Bibliothque de Facult Mdecine),4,5,射频组织灭活机理,离子振荡,电阻产热,热传导,6,射频能量转换及产热,7,RFA 电极演进,第一代电极: 灭活范围 1.6 cm 原始电极 Goldberg SN. Acda Radiol 1995; 2:399 第二代电极: 灭活范围 3-5 cm 双极电极 McGahan JP. Acad Radiol 1996; 3:418 冷却电极 Lorentzen T. Acda Radiol 1996; 3:556 盐水电极 Miao Y. J Surg Res 1997; 73:19 伞状电极 Rossi S. Am J Radiol 1998; 170:1015,8,RFA 电极演进,第三代电极（复合电极）: 灭活范围 7 - 10 cm 集束电极 Goldberg SN. Radiology 1998; 209:371 冷却-盐水电极 Miao Y. Invest Radiol 2000; 35:438 伞状-盐水电极 Miao Y. Eur Radiol 2000; 11:1841 双极-盐水电极 Fernando B Radiol, 2003;229:447 第四代电极: 灭活范围 10 cm ？,9,商品化电极,10,RITA Expandable Electrode,11,Radionics Cool-tip RF System,12,冷循环中空电极工作原理,冷却水流出道,冷却水流入道,13,-,+,Electrode,RFA Lesion,Ground Pad,Liver,Perfusion Pump,In Flow,Out Flow,RF Generator,冷循环电极工作流程,Cooling Water,14,盐水增强电极,15,集束2电极,16,双极盐水增强电极,17,肿瘤消融重叠治疗,肿瘤 3 cm,肿瘤 3 cm,18,RFA面临的问题,缺少系统的临床前研究 组织消融范围仍较小 治疗过程监控 并发症预防和处理,19,优化RF能量释放增大组织 消融范围,20,盐水增强电极RFA （可输注盐水的中空电极）,Miao Y, et al. J Surg Res, 1997; 71:19,21,盐水增强电极工作流程,-,+,Saline,Electrode,RFA Lesion,Ground Pad,Liver,Pump,RF Generator,22,组织内“液体”电极,MRI,平片,23,电阻,24,能量输出,25,组织消融范围,26,27,盐水增强电极工作机理,28,伞状盐水电极 （可张开的伞状电极 + 盐水输注）,Miao Y, et al. Eur Radiol, 2001; 11:1841,29,电阻,30,输出功率,31,组织消融范围,32,伞状盐水电极RFA,33,冷却盐水电极 （冷循环电极增加盐水输注功能）,Miao Y, et al. Ivest Radiol, 2000; 35:438 US patent (6,514,251 B1) Feb, 04.2003,34,冷却盐水电极示意图,盐水输注通道,冷却水流入通道,冷却水流入通道,35,冷却盐水电极工作流程,-,+,5% Saline,Electrode,RFA Lesion,Ground Pad,Liver,Perfusion Pump,Infusion Pump,In Flow,Out Flow,RF Generator,Cooling Water,36,电阻,37,能量输出,38,电极组织界面温度,39,组织消融范围,40,冷却盐水电极体内实验,有血流灌注组织,Pringels 肝门阻断,41,冷却盐水电极机理,42,影像组织对应研究 （ VX2 肿瘤模型）,Miao Y. Experimental research on radiofrequency tissue ablation as an alternative in cancer therapy. Leuven university press. Leuven, Belgium,2000,43,肝脏肿瘤 RFA 治疗,Miao Y,et al. Eur Radiol, 2000; 10:188,44,肝VX2肿瘤RFA MRI表现,45,肝动脉造影,46,RFA病灶镜下所见 (H-E),47,动脉造影,活瘤,已消融肿瘤,48,“鬼影”现象 (H-E),活瘤,已消融肿瘤,49,HE vs.组化染色,H-E,NADH,50,Open RFA of HCC,Pre,1M post,51,Pre,2W,3M,9M,52,TAE+ RFA for HCC,Pre,1 W post,53,CT Guided RFA for HCC,54,Laparoscopic RFA,55,CT of RFA Lesion,pre,1M post,56,肾肿瘤 RFA 治疗,Miao Y, et al. Ann Surg Oncol,2001; 8:651,57,MRI动态观察,T1-w,T2-w,CE,58,肾动脉造影&大体标本,59,TAE RFA for Renal Tumor,Hall WH, et al. AJR, 2000; 174:1592,60,61,颅内肿瘤 RFA 治疗,Miao Y, et al. J Neur Oncol, 2002; 56:119,62,Pre-RFA,1 h,1 M,3 M,T1,CE,T2,63,大体标本,64,65,肺肿瘤 RFA 治疗,Miao Y, et al. J Surg Res, 2001; 99:265,66,肺动脉造影,67,MRI观察,T1,CE,T2,治疗前,治疗后,68,Microscorpy (H-E),69,肺肿瘤灭活MRI动态观察,70,病理所见,71,Dupuy DE, et al. AJR 2000; 174:57-59,72,Stefanie S. Arch Surg. 1999;134:1064,RFA of Breast Cancer,73,Dupuy DE, et al. AJR, 2000; 175:1266,RFA of Spine Tum