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1、,早期肺癌热消融技术 的临床应用进展,XXX XX大学XX医院XX市XX防治研究所 XX大学XX医院国际诊疗中心,热消融技术原理,射频消融（radiofrequency ablation,RFA）利用375-500kHz的高频交变电流在肿瘤组织内引 起的离子相互磨擦、碰撞而产生的热生物学效应，局 部温度可达60-120，当肿瘤组织被加热至60以 上时，可引起细胞凝固性坏死。微波消融（microwave ablation,MWA）一般采用915MHz或2450MHz两种频率。在微波 电磁场的作用下，肿瘤组织内的水分子、蛋白质分 子等极性分子产生极高速振动，造成分子之间的相互 碰撞、摩擦，在短时间
2、内产生高达60-150的高温，从而导致细胞凝固性坏死。其他消融方式（激光、高强度聚焦超声、冷冻.）,Dupuy DE et al,Am J Roentgenol.2000;174(1):57-59.,冯威健,等.中华肿瘤杂志2002;24(4).,热消融历史,Diagnostic and Interventional Imaging 2016;97:1019-1024.,疗效：RFA,The major advantage of RFA over other ablative techniques is experience.MWA has emerged as a potentially s
3、uperior treatment option to RFAdue to a much broader energy deposition capable of producing a larger zone of active heating.MWA can produce higher intratumoral temperatures.Larger tumor ablation volumes with faster ablation times.Available MWA systems vessels adjacent to lung tumors.MWA is associate
4、d with less procedural pain,perhaps from lack of electrical nerve stimulation associated withJ Thorac Imaging 2016;31(4):228-237.,疗效：WMAVs.RFA,中国肺癌杂志 2018;21(2):76-88.,中国专家共识：射频消融,中国肺癌杂志 2017;20(7):433-445.,中国专家共识：热消融,中国专家共识：英文版,J Can Res Ther,2018;14:730-744.,RFA can be considered an option for ino
5、perable patients,especially for those with stage T1N0M0.Eur Respir J 2015;45(4):1089-1097.,疗效比较：RFA VS.手术,Int J Clin Oncol 2015;20:499507.,疗效比较：RFA VS.SBRT,Respiration 2015;89(6):550-557.,手术 VS.RFA VS.SBRT,1.J Thorac Oncol.2015 Jun;10(6):960-4.2.Respir Investig.2014 Jul;52(4):221-6.3.Biomed Res Int.
6、2014;2014:152087.4.Thorac Surg Clin.2007 May;17(2):251-9.5.Lancet Oncol.2013 Jan;14(1):e28-37.6.Chest 2013;143(5)(Suppl):278S313S 7.J Vasc Interv Radiol 2013;24:476482 8.J Thorac Cardiovasc Surg 2013;145:692-99 9.Eur Respir J.2015 Apr;45(4):1089-97 10.J Vasc Interv Radiol.2015 Jun;26(6):787-91.11.J
7、Oncol Pract.2014 May;10(3):e130-6.12.Int J Radiat Oncol Biol Phys.2011 Nov 15;81(4):964-73.13.J Thorac Oncol.2015 Dec;10(12):1776-84.,手术 VS.ABVS.SBRTCost-Effectiveness Analysis Comparing SurgerySBRT&Ablation,指南推荐（NCCN）,多发,单发,Ann Oncol 2014;25(8):1462-1474.,指南推荐（ESMO）,The role of ablative therapies i
8、n the treatment of high-risk patients with stage I NSCLC is evolving.RF ablation,the most studied of the ablative modalities,has been used effectively in medically inoperable patients with small(3 cm)peripheral NSCLC that are clinical stage I.Chest2013;143(5)(Suppl):278-313.,指南推荐（CHEST）,2,支修益,等.中华肿瘤
9、杂志 2015;37(1).,指南推荐（中国诊疗规范）,Fortschr Rntgenstr2017;189:828-843.,消融：较好的非手术干预选择,左肺上叶腺癌，T1aN0M0，90岁,微波消融后随访：瘢痕形成，逐渐缩小,病例一：高龄患者,右肺上叶肉瘤，T1bN0M0，肺纤维化,微波消融后随访：结节缩小,病例二：心肺功能差,右肺上叶、右肺下叶腺癌，T1a(2)N0M0,微波消融后随访：瘢痕形成，逐渐缩小,病例三：多原发肺癌,左肺上叶腺癌（ROSE），T1bN0M0,病理现场确认后即刻行微波消融,病例四：活检后即刻消融,左肺上叶腺癌，T1aN0M0，消融后即刻活检,微波消融后随访：瘢痕形成,病例五：消融后即刻活检,左肺上叶腺癌，薄层CT显示内部实性成分为血管,“No Touch”夹持消融，消融后即刻活检,病例六：消融后即刻活检,右肺下叶腺癌，（固化）消融后即刻活检,活检后影像：活检侧固化效应明显，未出血,病例七：消融后即刻活检,Dr Graham:I believe that one day,the human for lung cancer will have a more safe and effective than surgical removal of the way.,我们还在路上.,介入,交叉融合 成就彼此,外科 放疗科,THANK YOU!,
