胆道射频消融技术 (2).ppt
Habib EndoHPB-双极射频消融导管,恶性胆道梗阻治疗新技术,1,内容提要,射频及其在肿瘤临床中的应用；Endo-HPB是什么及其操作方法；Endo-HPB主要作用及其临床应用；Endo-HPB临床效果；,2,什么是射频,射频（RF，Radio Frequency）就是射频电流，它是一种高频交流变化电磁波的简称。频率范围从300KHz300GHz之间。每秒变化小于1000次的称为低频电流，大于10000次的称为高频电流，而射频就是这样一种高频电流。高频(大于10K)；射频（300K-300G）是高频的较高频段；微波频段（300M-300G）又是射频的较高频段。,3,正常组织,急性热凝固,凝固性坏死,通过460千赫电流，RF射频能量从发生器转移到射频电极。RF射频能量使电极附近的细胞内物质快速振荡（离子搅动）。离子搅动引起摩擦加热，该热量又在电极针临近的组织上传递扩散，从而导致细胞死亡。,肿瘤射频消融原理,4,温度与细胞死亡（肿瘤细胞对温度更为敏感）,5,射频消融在美国、欧洲、亚太肝病学会指南，射频消融可以与手术一样，作为肝癌根治疗性治疗手段。,AASLD PRACTICE GUIDELINE 2010,6,射频在肝癌等肿瘤治疗中的地位,近年以射频消融为代表的局部治疗发展迅猛，治疗小肝癌疗效不断提高，接近手术切除。RFA已经成为继手术切除和肝移植术之后小肝癌的第三种根治性治疗手段，手术切除的首选地位受到了挑战。陈敏山射频消融在小肝癌治疗中的地位Chinese Journal of Cancer,2007,26(5),7,专家评述,高温使肿瘤组织凝固性坏死，最终形成液化灶或纤维化，起到原位灭活肿瘤组织作用；高温使肿瘤周围血管闭塞并形成一个反应带，使之不能向肿瘤组织供血，可防止肿瘤复发或转移；高温灭活的肿瘤组织由于细胞免疫表形的变化而具有瘤苗作用，从而发生特殊的抗肿瘤免疫作用。,8,射频治疗肿瘤机制,微创，最大限度地保留靶器官功能；并发症少、恢复快、患者易接受；疗效确切，可重复治疗；适应症广；操作简单，定位、温控可靠。,9,射频肿瘤消融治疗特点,原位灭活：微创根治肿瘤综合治疗：联合手术、TACE、粒子植入、化疗姑息治疗：缓解症状，提高生存质量,10,提高肿瘤局部控制率,射频在临床中的应用,内容提要,射频及其在肿瘤临床中的应用；Endo-HPB是什么及其操作方法；Endo-HPB主要作用及其临床应用；Endo-HPB临床效果；,11,Endo-HPB射频消融导管,一次性使用0.9m或1.8m 长8Fr(2.6mm).035inch 英寸导丝3.2mm 内镜工作管道双极、不锈钢双环的距离间隔为8mm加热区域：25mm+/-3mm,12,全球专利及欧美认证-HPB,由英国帝国理工大学著名外科专家 Nagy Habib教授发明2007年获得全球专利(专利号WO2007135437)2009年获欧盟CE及美国FDA认证2012年获中国SFDA认证,13,Fig.4 The specimens were resected for the evaluation of microscopic findings,Fig.5 Ablation by lower power and short time(5 W and 60 s)showed insufficient ablation,EndoHPB 消融范围2.5*1cm(直径),14,Takao Itoi et al.Evaluation of effects of a novel endoscopically applied radiofrequency ablation biliary catheter using an ex-vivo pig liver。J Hepatobiliary Pancreat SciDOI 10.1007/s00534-011-0465-7,Takao Itoi et al.Evaluation of effects of a novel endoscopically applied radiofrequency ablation biliary catheter using an ex-vivo pig liver。J Hepatobiliary Pancreat SciDOI 10.1007/s00534-011-0465-7,HPB消融范围与时间、功率间的关系,15,经内镜逆行胆胰管造影(ERCP)或经皮肝穿刺胆道造影(PTC),插进导丝并通过乏特壶腹 在进行X光影像判断和评估胆道梗阻的长度后，将EndoHPB插进至肿瘤的上部。将功率设置为8-10瓦特，消融90秒-2分钟。消融组织长度为 2.5cm，宽度为0.5cm可以根据肿瘤的长度重复一次或两次消融在将射频电极移走后，放入金属支架,操作方法,16,经皮经肝胆管内射频消融,17,18,Insertion of a 0.0035”guidewire,经ERCP胆管内射频消融,18,19,Insertion of the Habib EndoHPB into bile duct,经ERCP胆管内射频消融,19,20,Insertion of the Habib EndoHPB into bile duct,经ERCP胆管内射频消融,20,21,Insertion of the Habib EndoHPB into bile duct,经ERCP胆管内射频消融,21,22,2 electrodes separated for total ablation,经ERCP胆管内射频消融,22,23,3 or 4 application times according to stricture,经ERCP胆管内射频消融,23,内容提要,射频及其在肿瘤临床中的应用；Endo-HPB是什么及其操作方法；Endo-HPB主要作用及其临床应用；Endo-HPB临床效果；,24,EndoHPB主要作用及临床应用,临床应用：解决目前管道支架容易出现的再闭塞问题放置支架前对肿瘤进行射频消融对胆道肿瘤进行射频消融后不放置支架,25,主要作用：通过射频直接杀死胆管内肿瘤细胞可有效延长支架畅通期延长患者生存时间改善患者生存质量,PTCD造影明确梗阻部位,肿瘤腔内导管射频消融,胆道支架植入,完成消融减瘤，达到解除梗阻、改善患者生存质量目的。,26,HPB消融减瘤，解除梗阻,胆道支架放置前射频消融术后即刻效果-PTCD,27,胆道支架放置前射频消融术后即刻效果-ERCP,胆管内射频消融前后(Reddy),28,胰腺癌放疗术后3月，支架阻塞获得再通,29,胰腺癌支架阻塞再通处理,30,胰腺癌支架置入前射频消融,射频电极被插进胆总管,在进行射频消融后，金属支架被放进右肝胆管,31,胰头腺癌射频消融,患有胰腺腺癌的病人，胆管造影显示胆总管下段狭窄,射频电极穿过狭窄处,胰头腺癌射频消融,32,壶腹腺癌射频消融，电极穿过肿瘤,壶腹腺癌射频消融,33,34,支架内阻塞射频消融,Metal stent金属支架,Endoablator in situ射频导管定位,Ablation with 10W 2min x 2消融：10瓦特，2分钟 2次,Ablation with 30W 3min 消融：30瓦特，3分钟,支架内阻塞射频消融-PTCD,35,36,支架内阻塞射频消融-ERCP,37,支架内阻塞射频消融-ERCP,内容提要,射频及其在肿瘤临床中的应用；Endo-HPB是什么及其操作方法；Endo-HPB主要作用及其临床应用；Endo-HPB临床效果；,38,胆道支架阻塞后射频消融临床研究,39,M.Pai et al.:Intraductal Radiofrequency Ablation for Clearance of Occluded Metal Stent。Cardiovasc Intervent Radiol DOI 10.1007/s00270-013-0688-x，,胆道支架阻塞后射频消融临床研究,40,M.Pai et al.:Intraductal Radiofrequency Ablation for Clearance of Occluded Metal Stent。Cardiovasc Intervent Radiol DOI 10.1007/s00270-013-0688-x，,胆道支架阻塞后射频消融临床研究,41,M.Pai et al.:Intraductal Radiofrequency Ablation for Clearance of Occluded Metal Stent.Cardiovasc Intervent Radiol DOI 10.1007/s00270-013-0688-x，,Fig.2 A.Preablation holangiogram shows stent blockage.B.Cholangiogram shows radiofrequency ablation with the HabibTM HPB inside the blocked stent.C,D Postablation cholangiogram shows patent stent,经皮胆道射频消融治疗的安全性及临床疗效研究,42,Malkhaz Mizandari Madhava Pai et al.Percutaneous Intraductal Radiofrequency Ablation is a Safe Treatment for Malignant Biliary bstruction:Feasibility and Early Results.Cardiovasc Intervent Radiol DOI 10.1007/s00270-012-0529-3,经皮胆道射频消融治疗的安全性及临床疗效研究,43,Malkhaz Mizandari Madhava Pai et al.Percutaneous Intraductal Radiofrequency Ablation is a Safe Treatment for Malignant Biliary bstruction:Feasibility and Early Results.Cardiovasc Intervent Radiol DOI 10.1007/s00270-012-0529-3,经皮胆道射频消融治疗的安全性及临床疗效研究,44,Malkhaz Mizandari Madhava Pai et al.Percutaneous Intraductal Radiofrequency Ablation is a Safe Treatment for Malignant Biliary bstruction:Feasibility and Early Results.Cardiovasc Intervent Radiol DOI 10.1007/s00270-012-0529-3,ERCP 射频消融治疗恶性胆道梗阻治疗的安全性,45,Alan W.Steel,MD,MRCP,Aymer J.Postgate，etal Endoscopically applied radiofrequency ablation appears to be safe inthe treatment of malignant biliary obstruction；Volume 73,No.1:2011 GASTROINTESTINAL ENDOSCOPY，149-153,ERCP 射频消融治疗恶性胆道梗阻治疗的安全性,46,Alan W.Steel,MD,MRCP,Aymer J.Postgate，etal Endoscopically applied radiofrequency ablation appears to be safe inthe treatment of malignant biliary obstruction；Volume 73,No.1:2011 GASTROINTESTINAL ENDOSCOPY，149-153,胆道恶性梗阻内镜下射频消融-国外回顾性研究,47,Werner Dolak Florian Schreiber et al.Endoscopic radiofrequency ablation for malignant biliary obstruction:a nationwide retrospective study of 84 consecutive applications；Surg Endosc DOI 10.1007/s00464-013-3232-9CCa cholangiocarcinoma,CHT chemotherapy,CI confidence interval,HCC hepatocellular carcinoma,mCRC metastatic colorectal cancer,PDT photodynamic therapy,RFA radiofrequency ablation,RT radiotherapy,S surgery,TACE transarterial chemoembolization,胆道恶性梗阻内镜下射频消融-国外回顾性研究,48,Werner Dolak Florian Schreiber et al.Endoscopic radiofrequency ablation for malignant biliary obstruction:a nationwide retrospective study of 84 consecutive applications；Surg Endosc DOI 10.1007/s00464-013-3232-9CCa cholangiocarcinoma,CHT chemotherapy,CI confidence interval,HCC hepatocellular carcinoma,mCRC metastatic colorectal cancer,PDT photodynamic therapy,RFA radiofrequency ablation,RT radiotherapy,S surgery,TACE transarterial chemoembolization,49,射频消融延长胰腺癌患者生存期,50,射频消融延长胰腺癌患者生存期,Thank You!,RFA,
