微波消融治疗原发性肝癌的研究进展

微波消融联合化疗治疗恶性肿瘤的研究进展林海;王江【期刊名称】《医学综述》【年(卷),期】2012(018)008【摘要】Microwave ablation is mainly used in patients who are not suitable for surgery,including surgical resection, surgical resection difficulties or surgery intolerant early-stage hepatic carcinoma patients with no blood vessels, liver and gallbladder thrombosis or extrahepatic metastases, tumor distance to hilar or gastrointestinal tract no less than 5 cm. In unresectable solid tumors,microwave ablation combined with chemotherapy is confirmedly effective with less side effects, significantly reducing the local recurrence rate after microwave ablation. Here is to make a review on the research progress of the microwave ablation combining chemotherapy treatment in malignant tumor.%微波消融主要适用于不适合手术治疗包括不能手术切除、手术切除困难或不能耐受手术的早期肝癌患者,且无血管、肝胆癌栓或肝外转移灶,肿瘤距肝门部或胃肠道的距离至少5 cm.近年来研究表明,微波消融联合化疗对不可切除的实体瘤有着确切疗效,不良反应小,能够显著降低微波消融后局部复发率.现对有关微波消融联合化疗在恶性肿瘤治疗方面的研究进展予以综述.【总页数】5页(P1152-1156)【作者】林海;王江【作者单位】兰州军区乌鲁木齐总医院普外科,乌鲁木齐,830000;兰州军区乌鲁木齐总医院普外科,乌鲁木齐,830000【正文语种】中文【中图分类】R656.9【相关文献】1.对比CT引导微波消融与冷冻消融治疗肺恶性肿瘤 [J], LI Hongwei;JIANG Xiaofeng;ZHANG Chuan;LI Bing;XU Xiaoxue;YANG Hanfeng;DU Yong;ZHUO Lihua2.微波消融联合化疗治疗肝癌的临床观察 [J], 赵海珍;其其格;刘瑞军;奥敦托亚3.微波消融联合化疗治疗鼻咽癌肝转移的疗效分析 [J], 李国文; 古善智; 唐田; 黄满平; 黄斌; 熊正平4.微波消融联合化疗治疗中晚期非小细胞肺癌的临床观察 [J], 杨荣;夏月琴;焦爱民5.对比CT引导微波消融与冷冻消融治疗肺恶性肿瘤的效果 [J], 杨爱兰;罗刚因版权原因，仅展示原文概要，查看原文内容请购买。

肝动脉化疗栓塞术序贯微波消融治疗单发直径大于5 cm原发性肝癌的临床研究安建立;韩孝宇;沙俊峰;牛洪涛;邹子博;武京鹏;董艳超【摘要】Objective To observe the short-term and long-term efficacy and safety of transcatheter arterial chemoembolization (TACE) sequentially combined with percutaneous microwave ablation (MWA) in the treatment of single primary hepatocellular carcinoma (PHC) with diameter greater than 5 cm. Methods According to the random number, a total of 72 large PHC patients admitted in the First Hospital of inhuangdao from Jul. 2014 to Dec. 2016 were enrolled and divided into combined group (37 cases) and control group (35 cases). Patients in the control group were treated with TACE, the combined group was added with MWA sequentially, drug toxicities and complications during treatment were recorded, short-term efficacy and tumor load after treatment for 1 month were determined, tumor progression free survival (PFS) and overall survival (OS) during follow-up were noted. Results One month after treatment, objective response rate (ORR, 78.4% vs 62.9%)and disease control rate(DCR,97.3% vs 91.4%)in the combined group were higher than those in the control group, but the differences were not statistical significant (all P>0.05); theAFP[(4.82±0.78) ng/mL vs (5.41±0.91) ng/mL], IGF-II [(5.63±0.90) ng/mL vs (6.08±0.84) ng/mL] and IGFBP-2 [(8.08±0.92) ng/mL vs(8.54±0.96) ng/mL in the combined group were significantly lower than those in the control group (all P<0.05). The TACE frequency for effective cases in combinedgroup were significantly lower[(1.67±0.52)vs(2.00±0.66), P<0.05]than those in the control group;PFS and OS in combined group and control group were 11.0 and 16.0 months, 7.5 and 11.5 months respectively, There were statistically significant differences on PFS and OS survival curves between two groups(P<0.05).The 1-year disease-free progression ratio in the combined group(39.4% vs 10.7%),the 1-year and 2-year survivalrate(1year:69.7% vs 42.9%;2 year:30.3% vs 10.7%)were all higher than those in the control group(P<0.05).The incidence of liver pain in the combined group(67.6% vs 40.0%)was significantly higher than that in the control group (P<0.05), and the specific complications of MWA were needle channel bleeding and pleural effusion. Conclusion TACE combine with MWA can further reduce tumor burden, improve recent efficacy, reduce the TACE frequency, prolong the survival time, and the complications can be controlled.%目的观察经导管肝动脉化疗栓塞(TACE)联合经皮微波消融(MWA)治疗单发直径大于5 cm原发性肝癌(PHC)的近远期疗效与安全性.方法将2014年7月至2016年12月秦皇岛市第一医院介入治疗科收治的72例大肝癌患者按照随机数字法分为联合组(37例)和对照组(35例),对照组给予TACE治疗,联合组在TACE治疗基础上联合MWA治疗;记录治疗期间药物毒性反应与并发症,治疗1个月判定近期疗效并评估肿瘤负荷变化,随访记录肿瘤无进展生存时间(PFS)和总生存时间(OS).结果联合组治疗1个月后客观缓解率(ORR,78.4% vs 62.9%)、疾病控制率(DCR,97.3% vs 91.4%)均高于对照组,但差异均无统计学意义(P>0.05);联合组治疗1个月后AFP[(4.82±0.78)ng/mL vs(5.41±0.91)ng/mL]、IGF-II [(5.63±0.90)ng/mL vs(6.08±0.84)ng/mL]以及IGFBP-2[(8.08±0.92)ng/mLvs(8.54±0.96)ng/mL]水平均显著低于对照组(P<0.05).联合组有效病例行TACE治疗次数显著少于对照组[(1.67±0.52)次vs (2.00±0.66)次,P<0.05];联合组中位PFS、OS分别为11.0个月、16.0个月,对照组分别为7.5个月、11.5个月,两组PFS、OS生存曲线差异均有统计学意义(P<0.05).联合组1年无疾病进展比例(39.4% vs 10.7%)及1年生存率(69.7% vs 42.9%)、2年生存率(30.3% vs 10.7%)均高于对照组(P<0.05).联合组肝区疼痛发生率(67.6% vs 40.0%)显著高于对照组(P<0.05),特异性并发症为针道出血与胸腔积液.结论 TACE治疗单发大肝癌基础上序贯MWA能进一步减轻肿瘤负荷,增进TACE疗效,减少TACE治疗次数,能明显延长患者生存期,并发症可控.【期刊名称】《肝胆胰外科杂志》【年(卷),期】2018(030)003【总页数】7页(P191-196,201)【关键词】原发性肝癌;经导管肝动脉化疗栓塞术;微波消融;肿瘤标志物;生存分析;并发症【作者】安建立;韩孝宇;沙俊峰;牛洪涛;邹子博;武京鹏;董艳超【作者单位】秦皇岛市第一医院,介入治疗科河北秦皇岛 066000;秦皇岛市第一医院,心内科河北秦皇岛 066000;秦皇岛市第一医院,介入治疗科河北秦皇岛066000;秦皇岛市第一医院,介入治疗科河北秦皇岛 066000;秦皇岛市第一医院,介入治疗科河北秦皇岛 066000;秦皇岛市第一医院,介入治疗科河北秦皇岛066000;秦皇岛市第一医院,介入治疗科河北秦皇岛 066000【正文语种】中文【中图分类】R735.7直径5～10 cm的大肝癌甚至超过10 cm的巨块型肝癌在临床中常见。

超声引导下微波消融一线治疗原发性肝癌的疗效观察孙国政【摘要】目的:探讨超声引导下微波消融一线治疗原发性肝癌的临床疗效.方法:选取2014年1月～2017年6月本院收治的128例(136个病灶)原发性肝癌患者作为研究对象,所有研究对象均予以超声引导下微波消融一线治疗,微波消融治疗后1个月行增强CT(CECT)、磁共振(MR)或超声造影检查,观察病灶的完全消融率.随访3个月,观察微波消融治疗后的局部复发率.结果:治疗后1个月,132个病灶完全消融,完全消融率为97.06％(132/136).随访3个月,病灶直径>3cm且<5cm的局部复发率为明显高于病灶直径≤3cm的局部复发率,P<0.05.所有局部复发患者均予以微波消融再次治疗,所有患者病情均得到控制.结论:在原发性肝癌患者中施以超声引导下微波消融一线治疗,疗效确切,尤其对于单发、体积较小的癌肿,疗效更为显著.【期刊名称】《中国医疗器械信息》【年(卷),期】2018(024)009【总页数】2页(P90-91)【关键词】原发性肝癌;微波消融;超声引导【作者】孙国政【作者单位】丹东市中心医院消化科辽宁丹东 118000【正文语种】中文【中图分类】R445.1手术切除术是治疗原发性肝癌的主要治疗手段，但由于受到肝脏储备能力、患者身体状况、病灶位置和数目等因素的影响，大部分患者已经失去了手术治疗的机会，因此寻找更有效的治疗方案是肝癌治疗的重点。

随着微创医学的不断发展，消融术在原发性肝癌的应用越来越广泛，常用的能量源包括激光、微波、射频等，微波消融是近几年发展迅速的一种治疗方案[1]。

本研究旨在探讨超声引导下微波消融一线治疗原发性肝癌的临床疗效，以期为原发性肝癌患者的非手术治疗提供临床实践指导依据。

1.资料与方法1.1 临床资料选取2014年1月～2017年6月本院收治的128例（136个病灶）原发性肝癌患者作为研究对象，其中男性患者116例，女性患者12例；年龄35～75岁，平均（48.36±5.51）岁；其中无肝病病史12例，有血吸虫肝病史4例，有乙肝病史112例。

微波消融的发展历程
微波消融技术是一种利用微波能量对肿瘤进行消融的治疗方法。

其发展历程可以追溯到20世纪70年代，当时微波技术开始被应用于治疗领域。

在早期，微波技术主要用于加热治疗，如缓解疼痛和炎症等。

后来，研究者们发现微波能量可以聚焦到肿瘤组织上，并对其进行消融。

这一发现开启了微波消融技术在肿瘤治疗领域的应用。

随着技术的不断进步，微波消融技术得到了进一步的发展和完善。

目前，微波消融已经成为一种常用的肿瘤治疗方法，尤其在肝癌、肺癌、肾癌等领域得到了广泛的应用。

在我国，微波消融技术的研究和应用起步较晚，但发展迅速。

国内的一些医院和科研机构在微波消融技术方面进行了大量的研究和
实践，并取得了一定的成果。

目前，微波消融已经成为我国肿瘤治疗领域的重要手段之一。

总之，微波消融技术的发展历程是一个不断探索、改进和应用的过程。

随着技术的进步和应用范围的扩大，相信微波消融技术将会在未来发挥更加重要的作用。

[收稿日期]2019-02-22　[修回日期]2020-02-19[作者单位]1.徐州医科大学附属连云港东方医院普外科,江苏连云港222042;2.徐州医科大学附属医院肿瘤外科,江苏徐州221000[作者简介]刘宜翔(1986-),硕士研究生,主治医师.[通信作者]牛　坚,硕士研究生导师,主任医师,教授.E⁃mail:easonliuxx@[文章编号]1000⁃2200(2021)04⁃0491⁃04㊃临床医学㊃微波消融治疗肝癌后局部肿瘤进展的危险因素分析刘宜翔1,牛　坚2[摘要]目的:分析行超声引导经皮微波消融术(MWA)后肝癌病人影响局部肿瘤进展(LTP)发生的危险因素㊂方法:选择采用MWA 治疗的肝癌病人73例共102个病灶为研究对象,对病人的临床资料和术后随访影像学检查资料进行回顾性分析㊂结果:LTP 总发生率为15.68%(16/102);单因素分析显示,LTP 与病人年龄㊁肿瘤类型及肝脏Child⁃Pugh 分级无关(P >0.05),与肿瘤大小㊁肿瘤边界是否清晰㊁肿瘤是否邻近大血管和肿瘤血流灌注程度有关(P <0.05~P <0.01);进一步多因素logistic 回归分析显示,肿瘤大小>3cm 及肿瘤邻近大血管是LTP 的独立危险因素(P <0.05)㊂结论:肿瘤大小>3cm 和邻近大血管是MWA 治疗肝癌后发生LTP 的独立危险因素,临床治疗中应采取相应措施和策略,从而提高MWA 疗效㊂[关键词]肝肿瘤;微波消融;局部肿瘤进展[中图法分类号]R 735.7 [文献标志码]A DOI :10.13898/ki.issn.1000⁃2200.2021.04.017Analysis of the risk factors of local tumor progression after liver cancer patients treated with microwave ablationLIU Yi⁃xiang 1,NIU Jian 2(1.Department of General Surgery ,Lianyungang Oriental Hospital Affiliated to Xuzhou Medical University ,LianyungangJiangsu 222042;2.Department of Oncology Surgery ,Xuzhou Medical University Affiliated Hospital ,Xuzhou Jiangsu 221000,China )[Abstract ]Objective :To analyze the risk factors of local tumor progression(LTP)after liver cancer patients treated with ultrasound⁃guided percutaneous microwave ablation(MWA).Methods :A total of 102lesions in 73cases of liver cancer treated with MWA were investigated.The clinical data of the patients and postoperative following⁃up imaging examination data were retrospectively analyzed.Results :The total incidence rate of LTP was 15.68%(16/102).The results of univariate analysis showed that the LTP was not related to the age,tumor type,and Child⁃Pugh classification of liver(P >0.05),and related to the tumor size,clear tumor boundary,tumor adjacence to large blood vessels and tumor blood perfusion degree(P <0.05to P <0.01).The results of further multivariate logistic regression analysis showed that the tumor size >3cm and tumor adjacence to large blood vessels were the independent risk factors of LTP(P <0.05).Conclusions :The tumor size >3cm and adjacence to large blood vessels are the independent risk factors of LTP after liver cancer patients treated with MWA.The corresponding measures and strategies should be taken to improve the efficacy of MWA inclinic.[Key words ]liver neoplasms;microwave ablation;local tumor progression 肝恶性肿瘤包括原发性肝癌和转移性肝癌[1],热消融技术因创伤小㊁安全性高㊁定位准确等优点成为目前临床非手术治疗肝癌常用的方法之一㊂已有相关指南建议对3cm 或更小的肝脏恶性肿瘤进行射频消融(RFA)[2-4]㊂然而,局部消融治疗难以确保单次治疗后肿瘤病变完全坏死㊂文献[5]报道肝癌局部消融后局部肿瘤进展(local tumor progression,LTP)的发生率较高,可达5.7%~39.0%,是影响局部消融效果的主要因素之一㊂肝脏RFA 后与LTP 相关的独立预测因子包括消融边缘不足㊁肿瘤大小㊁包膜下位置和血管接近度㊁肿瘤类型㊁高血清透明质酸和肝炎病毒载量㊂微波消融(MWA)已经在肝癌治疗中取得了成熟的发展[6-7]㊂具有内部冷循环系统的消融针可以实现更大的消融区域,这将MWA 指征从<3cm 的病灶扩展到5cm 及更大的病灶[8]㊂此外,与RFA 相比,MWA 显示出更高的热效率[9]㊂与RFA 后相比,这些特征可能导致肝脏MWA 后不同LTP 发生率和危险因素的潜在可能性㊂我们的研究目的是分析MWA 治疗肝癌后局影响肿瘤进展的危险因素,对改善疗效有重要的临床意义㊂1　资料与方法1.1　一般资料　以我院2014-2016年采用MWA 治疗的肝恶性肿瘤病人73例为研究对象,对病人的临床资料和术后随访影像学检查资料进行回顾性分析㊂所有病人经甲胎蛋白结合MRI或CT增强扫描确诊,部分病人经穿刺病理确诊㊂73例病人中原发性肝癌52例,转移性肝癌21例;男48例,女25例;年龄24~83岁;肿瘤直径为0.5~5.0cm㊂MWA 的纳入标准如下:(1)肿瘤少于3个,单个肿瘤直径<5cm;(2)无门静脉血栓形成或肝外转移;(3)肝功能Child⁃Pugh A或B级;(4)病人不愿手术治疗㊂1.2　仪器与消融方法　MTC⁃3C型微波消融治疗仪(南京维京九洲医疗器械研发中心),发射频率2450MHz,输出功率5~120W,逐步可调,步进5W㊂水冷微波天线MTC⁃3CA⁃II25型(辐射尖端长度3mm,直径2mm,针杆长18cm)㊂并配有热监测系统,可在消融过程中实时监测温度,探针直径为0.8mm㊂在超声引导下将消融针经皮插入肿瘤中央位置,对于长径≥3.0cm的肿瘤,分多次插入㊂在MWA期间常规使用50~60W的功率输出(根据肿瘤位置及大小选择)㊂在超声的指导下,在消融期间将热监测针插入肿瘤边缘进行实时温度监测㊂超声影像下观察热量产生的高回声水蒸气完全包围整个肿瘤,并测量的温度达到60℃或保持在54℃以上至少3min时完成消融㊂1.3　疗效评价及术后随访　术后1个月行超声造影㊁增强CT或MRI以评估消融情况,2年内每隔3个月来院复查㊂每次门诊随访均需行肝脏超声㊁血清甲胎蛋白㊁胸部X线检查,如果怀疑肿瘤肝内复发或肝外转移可能需进一步行CT㊁MRI或肝动脉造影检查㊂本研究随访时间截止至消融后24个月㊂病灶完全消融定义为原始消融灶内造影各时期未见增强影像;若原消融病灶出现造影剂增强㊁体积增大或与原始病灶相连的新病灶则定义为LTP㊂1.4　统计学方法　采用χ2检验和多因素logistic回归分析㊂2　结果2.1　病人一般情况　本组73例共102个病灶, MWA后1个月复查增强CT,99个病灶实现完全灭活,有效率97.06%㊂随访观察期间,有16个(15.68%)病灶发生LTP㊂本组病例LTP发生时间为治疗后3~24个月,中位时间为10个月㊂2.2　影响LTP的单因素分析　结果显示,肿瘤大小㊁肿瘤边界是否清晰㊁是否邻近大血管㊁肿瘤血流灌注程度对LTP发生的影响有统计学意义(P<0.05~ P<0.01),病人年龄㊁肿瘤类型以及肝脏Child⁃Pugh 分级对LTP发生的影响无统计学意义(P>0.05) (见表1)㊂表1　影响LTP的单因素分析影响因素病灶数　LTP病灶数/个　LTP发生率/%χ2P 年龄/岁　≤60　>6040627917.5014.520.16>0.05肿瘤大小/cm　≤3　>381219711.1133.33 6.23<0.05肿瘤边界　清晰　不清晰5646511　8.9323.91 4.30<0.05肿瘤类型　原发性　转移性69338811.5924.24 2.70>0.05邻近大血管　是　否16867943.7510.4714.22<0.01肝脏Child⁃Pugh分级　A级　B级72309712.5023.33 1.15>0.05血流灌注程度　高　低495312　424.497.55 5.53<0.05 2.3　影响LTP的多因素logistic回归分析　将影响LTP的单因素分析中有统计学意义的4个因素进行多因素logistic回归分析,结果显示,肿瘤>3cm及肿瘤邻近大血管为影响LTP的独立危险因素(P< 0.05)(见表2)㊂表2　局部肿瘤进展影响因素logistic回归分析自变量B Waldχ2P OR(95%CI)肿瘤大小>3cm0.8369.108<0.052.836(1.752~10.703)肿瘤边界不清晰-1.620 6.223>0.050.455(0.116~9.868)邻近大血管 1.23715.336<0.054.804(1.241~18.599)血流灌注程度高-0.690 1.062>0.050.572(0.122~4.583)3　讨论 虽然肝切除是早期肝脏代偿功能良好病人的首选治疗方式[10],但其他非手术治疗,如局部消融治疗,由于其微创㊁疗效满意且具有可重复性,因此作为手术替代疗法越来越受欢迎[7]㊂RFA是最常用的技术,在20世纪90年代初便开始应用[11]㊂文献[12]报道RFA对<3cm的病灶特别有效,肿瘤的完全消融率最高报道接近97.8%,5年总生存率约为71.4%,但对于>3cm的肿瘤,RFA的成功率降低㊂MWA原理与RFA相似,但因其热效率更高㊁消融范围更广,逐渐替代RFA成为一种新的治疗选择㊂尽管热消融技术在肝癌治疗上获得的效果令人满意,但仍然有不少病例发生LTP,进一步研究LTP 发生的危险因素对临床治疗有重要的指导意义㊂评估肿瘤消融效果的指标主要有肿瘤完全消融率㊁肿瘤进展率和生存率㊂受随访时间限制,本研究未纳入生存率指标㊂本研究共纳入73例病人共102个病灶,1个月后影像学复查,97.06%的病灶完全消融㊂经过3~24个月随访,15.68%的病灶发生LTP,高于有关研究[13]的报道㊂本研究结合文献报道对可能影响MWA术后LTP因素进行分析,研究指标包括病人年龄㊁肿瘤大小㊁肿瘤边界是否清晰㊁肿瘤类型㊁是否邻近大血管㊁肿瘤血流灌注程度及肝脏Child⁃Pugh分级情况㊂发现肿瘤邻近大血管及肿瘤大小>3cm是影响LTP 的独立危险因素,与其他研究[13-14]结果相似㊂原因可能是与较大的肿瘤有分离的隔膜和卫星结节有关[15];而肿瘤靠近大血管,血管内血流会带走一些治疗热量形成 热沉效应”[16],致使热量无法在消融范围内有效累积,进而增加肿瘤残存概率,同时为了避免大血管热损伤,不能满足消融的安全界限,造成治疗后肿瘤残存的机会增加㊂有研究[17]显示可采取辅助技术如血管内栓塞㊁门静脉球囊阻断㊁阻断肿瘤滋养动脉的策略来降低 热沉效应”㊂文献[18-19]报道热消融治疗前行肝动脉化疗栓塞治疗可以使肿瘤的完全灭活率提高并减少局部复发概率㊂文献[20]中还报道,对于靠近肝门的肿瘤可采用热消融联合无水乙醇瘤内注射的方法,效果显著且安全,术后复发率低㊂一些研究人员认为肝肿瘤热消融后的LTP对于原发性和转移性肿瘤是不同的㊂可能的原因是,在原发性小肝肿瘤病人中,肿瘤周围的肝硬化组织可能表现得像一个绝热体,增加肿瘤内的热量滞留,防止肿瘤外侧发热,而对于无热障的转移,血液流量减少了消融性病变的程度[21]㊂然而,我们的研究表明肿瘤类型不是预后的危险因素㊂另有研究[22]发现,HBV DNA阳性是肝癌MWA后复发的独立危险因素,可能的原因是HBV的主动复制导致活动性肝炎,其引起更多局部炎症因子并增加肝癌细胞的侵袭性,活动性肝炎可能与活跃的肝细胞炎症损伤和修复有关,增加了肿瘤复发的机会㊂本研究中在随访期内LTP结节本身并没有直接影响病人的生存㊂肿瘤大小㊁是否邻近血管是MWA治疗肝癌后发生LTP的独立危险因素,临床治疗中应采取相应措施和策略,从而提高疗效㊂[参考文献][1]　SIEGEL RL,MILLER D,JEMAL A.Cancer statistics,2017[J].CA Cancer J Clin,2017,67(1):7.[2]　EI⁃SERAG HB.Advances in the management of hepatocellularcarcinoma[J].Clin Adv Hematol Oncol,2017,9(8):2 [3]　MCGHANA JP,DODD GD3rd.Radiofrequency ablation of theliver:current status[J].AJR AM J Roentgenol,2001,176(1):3.[4]　KIM GA,SHIM JH,KIM MJ,et al.Radiofrequency ablation as analternative to hepatic resection for single small hepatocellularcarcinomas[J].Brit J Surg,2016,103(1):126..[5]　ALLAIRE M,REKIK S,MUMANA A,et al.Determinants of longterm survival and recurrence patterns after radiofrequency ablationfor hepatocellular carcinoma developed on cirrhosis[J].JHepatol,2017,66(1):S446.[6]　XU Y,SHEN Q,LIU P,et al.Microwave ablation for thetreatment of hepatocellular carcinoma that met up⁃to⁃sevencriteria:feasibility,local efficacy and long⁃term outcomes[J].EurRadiol,2017,27(9):3877.[7]　WANG T,LU XJ,CHI JC,et al.Microwave ablation ofhepatocellular carcinoma as first⁃line treatment:long termoutcomes and prognostic factors in221patients[J].Sci Rep,2016,6:32728.[8]　THAMTORAWAT S,HICKS RM,Yu J,et al.Preliminary outcomeof microwave ablation of hepatocellular carcinoma:breaking the3⁃cm barrier?[J].J Vasc interv Radiol,2016,27(5):623. [9]　VOGL TJ,FARSHID P,NAGUIB NN,et al.Ablation therapy ofhepatocellular carcinoma:a comparative study betweenradiofrequency and microwave ablation[J].Abdom Imaging,2015,40(6):1829.[10]　GERBES A,ZOULIM F,TILG H,et al.Gut roundtable meetingpaper:selected recent advances in hepatocellular carcinoma[J].Gut,2018,67(2):380.[11]　BUSCARINI L,ROSSI S,FORNARI F,et paroscopicablation of liver adenoma by radiofrequency electrocauthery[J].Gastrointest Endosc,1995,41(1):68.[12]　GAO J,WANG SH,DING XM,et al.Radiofrequency ablation forsingle hepatocellular carcinoma3cm or less as first⁃line treatment[J].World J Gastroentero,2015,21(17):5287. [13]　YU J,LIANG P,YU X L,et al.Local tumour progression afterultrasound⁃guided microwave ablation of liver malignancies:riskfactors analysis of2529tumours[J].Eur Radiol,2015,25(4):1119.[14]　MA S,DING M,LI J,et al.Ultrasound⁃guided percutaneousmicrowave ablation for hepatocellular carcinoma:clinicaloutcomes and prognostic factors[J].J Cancer Res Clin,2017,143(1):131.(下转第498页)的毗邻关系对减压区域的划分,从安全区到危险区有序地进行椎板切除,此方法能提高手术安全性,有效降低硬膜损伤的发生率;同时,椎弓根钉置入可矫正并维持胸椎矢状序列,有效防止局部后凸的加重㊂由于此术式临床应用时间短,样本数量少,尚未总结出手术的适应证及禁忌证,这有待大样本㊁多中心的临床研究去总结及证实㊂[参考文献][1]　NING S,CHEN Z,FAN D,et al.Genetic differences in osteogenicdifferentiation potency in the thoracic ossification of theligamentum flavum under cyclic mechanical stress[J].Int J MolMed,2017,39(1):135.[2]　UEI H,TOKUHASHI Y,OSHIMA M,et al.Efficacy of posteriordecompression and fixation based on ossification⁃kyphosis anglecriteria for multilevel ossification of the posterior longitudinalligament in the thoracic spine[J].J Neurosurg Spine,2018,29(2):150.[3]　WANG T,DU C,ZHENG X,et al.Surgical strategies for thoracicmyelopathy due to ossification of ligamentum flavum:a technicalnote based on radiological type[J].Turk Neurosurg,2017,20.doi:10.5137/1019-5149.[4]　LIU X,LI T,SHI L,WU Z,et al.Application of the piezosurgeryin en bloc laminectomy for the treatment of multilevel thoracicossification of ligamentum flavum[J].World Neurosurg,2019,126:541.[5]　段大鹏,卫文博,孙正明,等.改良椎板截骨回植与传统椎板截骨回植治疗腰椎间盘突出症合并腰椎不稳的疗效比较[J].中国骨伤,2018,31(8):757.[6]　陈建民,刘国印,贾小宝,等.椎板回植椎管重建内固定术的生物力学研究[J].中国矫形外科杂志,2017,25(24):2262.[7]　包同新,王宇峰,郭文杰,等.胸腰段脊柱压缩骨折远隔部位疼痛与胸腰段压缩骨折的关系研究[J].蚌埠医学院学报,2018,43(8):1000.[8]　杨升东,罗小辑,林豪,等.后路减压植骨融合内固定术治疗胸椎管狭窄症的疗效及安全性[J].骨科临床与研究杂志,2018,3(5):258.[9]　邹辉,黄俊武,吴陈欢.经伤椎置钉治疗单节段胸腰椎骨折18例疗效分析[J].蚌埠医学院学报,2015,40(1):77. [10]　ZHOU SY,YUAN B,QIAN C,et al.Evaluation of measuringmethods of spinal canal occupation rate in thoracic ossification ofligamentum flavum[J].World Neurosurg,2018,110:e1025.[11]　彭祥平,魏运栋,苑乾,等.超声骨刀辅助下"揭盖式"椎管后壁整块切除治疗胸椎黄韧带骨化症[J].脊柱外科杂志,2019,17(2):105.[12]　周盛源,李学斌,苑博,等.胸椎黄韧带骨化合并硬膜囊骨化的影像学特征和病理学表现[J].中华骨科杂志,2019,39(3):129.[13]　AIZAWA T,SATO T,SASAKI H,et al.Results of surgicaltreatment for thoracic myelopathy:minimum2⁃year follow⁃upstudy in132patients[J].J Neurosurg Spine,2007,7(1):13.[14]　吴德鹏,裴磊,袁伟,等.胸椎黄韧带骨化症的临床特点及手术治疗[J].中华骨与关节外科杂志,2018,11(1):30. [15]　JU JH,KIM SJ,KIM KH,et al.Clinical relation among duraladhesion,dural ossification,and dural laceration in the removal ofossification of the ligamentum flavum[J].Spine J,2018,18(5):747.(本文编辑　刘璐)(上接第493页)[15]　OKUSAKA T,OKADA S,UENO H,et al.Satellite lesions inpatients with small hepatocellular carcinoma with reference toclinicopathologic features[J].Cancer,2002,95(9):1931. [16]　HUANG L,DODD GD3RD,LANCTOT AC.Radiofrequencyablation of the liver:effect of variation of portal venous blood flowon lesion size in an in vitro perfused bovine liver[J].AcadRadiol,2012,19(8):1018.[17]　DODD GD3RD,DODD NA,LANCTOT AC,et al.Effect ofvariation of portal venous blood flow on radiofrequency andmicrowave ablations in a blood⁃perfused bovine liver model[J].Radiology,2013,267(1):129.[18]　HU H,CHEN GF,YUAN W,et al.Microwave ablation withchemoembolization for large hepatocellular carcinoma in patientswith cirrhosis[J].Int J Hyperthermia,2018,34(8):1351. [19]　SMOLOCK AR,CRISTESCU MM,HINSHAW A,et al.Combination transarterial chemoembolization and microwaveablation improves local tumor control for3⁃to5⁃cm hepatocellularcarcinoma when compared with transarterial chemoembolizationalone[J].Abdom Radiol(NY),2018,43:2497. [20]　REN H,LIANG P,YU X,et al.Treatment of liver tumors adjacentto hepatichilum with percutaneous microwave ablation combinedwith ethanol injection:A pilot study[J].Int J Hyperthermia,2011,27(3):249.[21]　NISHIKAWA H,INUZUKA T,TAKEDA H,et al.Percutaneousradio⁃frequency ablation therapy for hepatocellular carcinoma:aproposed new grading system for the ablative margin andprediction of local tumor progression and its validation[J].JGastroenterol,2011,46(12):1418.[22]　CHEN XX,CHENG JW,HUANG A,et al.The effect of antiviraltherapy on patients with hepatitis B virus⁃related hepatocellularcarcinoma after curative resection:a systematic review and meta⁃analysis[J].Onco Targets Ther,2017,10:5363.(本文编辑　周洋)。