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肝癌消融技术管理与多元化的肝癌消融治疗团队的构建
DOI: 10.3969/j.issn.1001-5256.2021.03.001
利益冲突声明：所有作者均声明不存在利益冲突。
作者贡献声明：符艳负责撰写论文、筛选文献和资料整理；张晓武、曹家玮负责筛选文献、资料整理和修改论文；李肖负责拟定写作题目、指导写作思路、修改论文并最终定稿。
Management of ablation techniques for liver cancer and establishment of a diverse team for liver cancer ablation
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摘要: 消融是肝癌治疗的重要手段之一。规范的消融技术、科学合理的治疗策略以及密切的团队合作是取得良好疗效的重要前提。尽管近年来肝癌消融治疗的效果随着消融技术的不断改进而逐渐提高，但肿瘤复发率仍较高，因此亟需能更好地提高肝癌消融治疗的效果和改善患者预后的治疗策略。多元化的肝癌消融治疗团队的构建是根据肝癌消融治疗的需求，在常规肝癌消融治疗团队的基础上提出的新概念。由于多元化的肝癌消融治疗团队较常规肝癌消融治疗团队具有更多的潜在优势，因此其是一个具有潜力的消融团队构建的新模式。Abstract: Ablation is one of the important treatment methods for liver cancer, and standard ablation techniques, scientific and rational therapeutic strategy, and close teamwork are important premises for a good clinical effect. Although the efficacy of ablation therapy for liver cancer has gradually increased with the continuous improvement of ablation techniques, there remains a high tumor recurrence rate, and therefore, there is an urgent need for the therapeutic strategies that can improve the efficacy of ablation therapy for liver cancer and the prognosis of patients. Establishment of a diverse team for liver cancer ablation is a new concept put forward on the basis of a conventional team for liver cancer ablation to meet the requirements of ablation therapy for liver cancer. Since a diverse team for liver cancer ablation has potential advantages over a conventional team, it may be a promising mode for establishing a team for liver cancer ablation.
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Key words:
- Liver Neoplasms /
- Ablation Techniques /
- Team
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表 1 消融技术类型及特点
消融类型 作用机理 技术特点 临床应用/研究现状 化学消融[4-5, 7] 化学损伤 操作简单、费用低，但弥散不均匀、消融范围小(＜2 cm)、肿瘤复发率高 适用于无法进行射频消融及其他消融治疗的小肿瘤(＜2 cm)、良性病变 射频消融[4-5, 7] 高温损伤(60~100 ℃) 技术成熟、但热沉积效应影响较大、潜在正常组织热损伤、不可用于邻近血管或胆管等重要组织的消融 目前临床最主要、最常用的消融方法 微波消融[4-5, 7] 高温损伤(＞150 ℃) 可快速升温、消融温度高、消融面积大、受热沉效应影响小，但操作复杂、技术要求高、免疫激活效应较弱于冷冻及射频消融、潜在正常组织热损伤、不可用于邻近血管或胆管等重要组织的消融 目前常用的消融方法、对于体积大的肿瘤(＞3 cm)疗效较射频消融好，但需更有力的循证医学证据 冷冻消融[4-5, 7] 低温损伤 消融范围术中可观察、免疫激活效应好、具有一定的止痛效果，但费用高、冷休克(常见于早期的冷冻消融仪或当肿瘤消融面积较大时) 前期研究表明，冷冻消融的疗效不优于射频消融，但其疗效仍需循证医学证据 激光消融[4-5] 高温损伤 MRI兼容性好，可用于MRI引导的肿瘤消融，但激光组织穿透性弱、消融面积小、技术要求高 前期研究表明，激光消融的疗效不优于射频消融，但其疗效仍需循证医学证据 超声消融[4-5] 高温损伤 技术可控性好、快速升温、正常肝组织损伤小，但消融针直径较大 缺乏可靠的临床研究数据 不可逆电穿孔[4-5] 电穿孔损伤 对神经、胆管、血管等纤维结缔组织损伤小、无热沉积效应，操作需要全身麻醉、可诱发心律失常及肌肉收缩，费用高 适用于邻近胆管或血管等特殊位置的肿瘤消融 
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