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射频消融术治疗肝肿瘤
原作者：RadiologyInfo.org
发表时间：浏览量：10334评论数：3挑错数：0
本文是射频消融术治疗肝肿瘤的简介，最有价值的是介绍了这一技术的利与弊及局限性，其他还介绍了其原理、设备、前期准备、后续工作等等。
What is Radiofrequency Ablation of Liver Tumors? 什么是射频消融术？ Drawing of a 4-prong needle electrode. An electric current has caused heat around the tip.
这幅图描绘了一个四叉电极针。通过电流加热针的尖端。 Radiofrequency ablation, sometimes referred to as RFA, is a minimally invasive treatment for cancer. It is an image-guided technique that heats and destroys cancer cells. 射频消融术，缩写为RFA，是一种针对癌症的微创疗法。它是一种通过导航技术找到并加热杀死癌细胞的技术。 In radiofrequency ablation, imaging techniques such as ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) are used to help guide a needle electrode into a cancerous tumor. High-frequency electrical currents are then passed through the electrode, creating heat that destroys the abnormal cells. 在射频消融术中，通过诸如超音波，电脑断层扫描（CT）或磁共振成像（MRI）来帮助指导一个电极针进入癌肿瘤内部。然后高频电流通过电极，形成热量，从而破坏癌变细胞。 What are some common uses of the procedure? 这项技术的一些常见用途？ Radiofrequency ablation is used to treat many types of liver cancer. The two most common types are: 射频消融术能够用于治疗许多类型的肝癌。两种最常见的类型有： &&&&* hepatocellular carcinoma, which is a primary liver cancer (meaning it begins in the liver). 　　*肝细胞癌 ，这是一种原发性肝癌（这意味着癌变始与肝脏）。 &&&&* colon cancer that metastasizes or spreads from the colon to the liver. 　　*通过结肠转移到肝脏的癌症。
In general, radiofrequency ablation is most effective treating tumors that are less than one and a half inches in diameter. It may be used in addition to chemotherapy or radiation therapy or as an alternative to surgical treatment. 一般来说，射频消融术对直径小于1.5英寸的肿瘤是最有效的。它可用于化疗或放疗的辅助手段或作为外科手术治疗的替代方案。 Radiofrequency ablation is a viable and effective treatment option if you: 射频消融术是一种可行的和有效的治疗方案，如果你符合以下条件： &&&&* are not a good candidate for surgery because your tumor is difficult to reach. 　　*肿瘤位置难以接触，不适合做外科手术 &&&&* have other medical conditions that make surgery especially risky. 　　*手术有其他医疗条件方面的特别风险 &&&&* would not have enough liver tissue left for the organ to function adequately following the surgical removal of a tumor. 　　*如果做了肿瘤切除手术后就没有足够的肝组织来正常执行肝功能 &&&&* have liver tumors that have not responded to chemotherapy or that have recurred after being removed surgically. 　　*化疗无效或手术切除肝肿瘤后复发 &&&&* you have several small liver tumors that are too spread out to be removed surgically. 　　*肿瘤分布过于分散，不适合手术切除 How should I prepare? 患者应该如何准备？ You should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to local anesthetic medications, general anesthesia or to contrast materials (also known as "dye" or "x-ray dye"). Your physician may advise you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or a blood thinner for a specified period of time before your procedure. 你应向你的医生报道目前正在服用的所有药物，包括草药补充剂，如果您有任何过敏，特别是对局部麻醉药物， 全身麻醉或造影剂（也称为“染料”或“X射线造影剂”）。你的医生可能建议你在特定时间内停止服用阿司匹林，非甾体抗炎药（NSAIDs）或血液稀释剂。 Prior to your procedure, your blood may be tested to determine how well your liver and kidneys are functioning and whether your blood clots normally. 在手术前，可能进行血液测试，以了解你的肝脏和肾脏功能以及血液凝块是否正常。 Women should always inform their physician and x-ray technologist if there is any possibility that they are pregnant. Many imaging tests are not performed during pregnancy so as not to expose the fetus to radiation. If an x-ray is necessary, precautions will be taken to minimize radiation exposure to the baby. See the Safety page (www.RadiologyInfo.org/en/safety/) for more information about pregnancy and x-rays. 妇女应告知他们的医师和X射线技师 ，是否有任何怀孕的可能性。许多成像测试在怀孕期间不能执行，以免使胎儿暴露在辐射中。如果X射线检测是必要的，那么将采取预防措施，以尽量减少暴露给婴儿的辐射剂量。请查看安全页面（）中怀孕、X射线的相关信息。 You may be instructed not to eat or drink anything after midnight before your procedure. Your doctor will tell you which medications you may take in the morning. 你可能会被要求午夜后至手术前不要要吃或喝任何东西。你的医生会告诉早上该吃哪些药物。 You should plan to have a relative or friend drive you home after your procedure. 你应该计划好手术后有亲戚或朋友开车送你回家。 You may be asked to wear a gown during the procedure. 你可能被要求在手术过程中穿着长袍。 What does the equipment look like? 这个医疗设备是什么样的呢？ Drawing illustrates heat around the needle electrode.
这幅图描绘了电极针正在加热周边组织。 The equipment used in this procedure depends on the type of imaging used—magnetic resonance (MR), computed tomography (CT), or ultrasound. Other equipment such as needle electrodes, an electrical generator and grounding pads may also be used. 此过程中使用的设备形状取决于磁共振 （MR）、 计算机断层扫描 （CT）或超声波的成像 。其他设备还包括电极针、发电机和接地垫等等。 Radiofrequency equipment 　　射频设备 There are two types of needle electrodes: simple straight needles and a straight, hollow needle that contains several retractable electrodes that extend when needed. 有两种类型的电极针：简单的直线针和直线空心针（它包含了几个必要时可伸缩的延长电极）。 The radiofrequency generator produces electrical currents in the range of radiofrequency waves. It is connected by insulated wires to the needle electrodes and to grounding pads that are placed on the patient's back or thigh. 该射频发生器产生的指定范围内的射频波电流。由绝缘导线将电极针连接接地垫（一般放在患者的背部或大腿处）。 Computed Tomography (CT) 电脑断层扫描（CT）
The CT scanner is typically a large, box like machine with a hole, or short tunnel, in the center. You will lie on a narrow examination table that slides into and out of this tunnel. Rotating around you, the x-ray tube and electronic x-ray detectors are located opposite each other in a ring, called a gantry. The computer workstation that processes the imaging information is located in a separate room, where the technologist operates the scanner and monitors your examination. 电脑断层扫描仪通常是一个中心有孔（或短隧道）的大盒子。您将躺在一个狭窄的检查台上，然后滑进盒子中心的隧道中。有个称为龙门的环状物在你周围旋转，环上有若干对X射线管和电子X射线探测器在两侧。 图像信息处理是在一个单独的房间的在计算机工作站上，那里的技师在操作扫描仪的同时监控您的检测位置。 Ultrasound equipment 　　超声设备 Ultrasound scanners consist of a console containing a computer and electronics, a video display screen and a transducer that is used to scan the body and blood vessels. The transducer is a small hand-held device that resembles a microphone, attached to the scanner by a cord. The transducer sends out high frequency sound waves into the body and then listens for the returning echoes from the tissues in the body. The principles are similar to sonar used by boats and submarines. 超声波扫描仪由一个控制台（包含一台计算机和电子设备）、视频显示屏幕、一个传感器（用来扫描身体和血管）所组成。 该传感器是一种小型手持设备，像一个麦克风，通过连接线连接到一个扫描仪。换能器发送高频声波到体内，然后监听从体内组织返回的回声。原理类似于船和潜艇的声纳系统。 The ultrasound image is immediately visible on a nearby video display screen that looks much like a computer or television monitor. The image is created based on the amplitude (strength), frequency and time it takes for the sound signal to return from the patient to the transducer and the type of body structure the sound travels through. 超声图像可立即在附近的显示屏上看到，很像一台电脑或电视监控器。该图像是基于振幅（强度），频率和声音信号需要从病人返回到传感器的时间和身体结构类型所创建。 Magnetic Resonance Imaging 　　磁共振成像 The traditional MRI unit is a large cylinder-shaped tube surrounded by a circular magnet. You will lie on a moveable examination table that slides into the center of the magnet. 传统的核磁共振装置是由一圆形磁铁包围的大型圆管。你将躺在一个可移动的检查台上，滑入进入磁铁的中心。 Some MRI units, called short-bore systems, are designed so that the magnet does not com others are open on the sides (open MRI). These units are especially helpful for examining patients who are fearful of being in a closed space and for those who are very obese. Newer open MRI units provide very high quality images for however, open MRI units with older magnets may not provide this same quality. Certain types of exams cannot be performed using open MRI. For more information, consult your doctor. 有些称为短期内孔系统的核磁共振单元，设计的磁铁并非完全环绕人身；其他两侧是开放的（开放式MRI）。 这些检查单元，特别适用于患有密闭空间恐惧症或特别肥胖的人所使用。 较新的开放式MRI检查单元能提供多种类型的高质量图像，但旧型的开放MRI单元不能提供同样的质量。某些类型的检查不能使用开放式MRI进行。欲了解更多信息，请咨询你的医生。 The computer workstation that processes the imaging information is located in a separate room than the scanner. 进行图像信息处理的计算机工作站位于与扫描器隔开的独立房间。 Other equipment that may be used during the procedure includes an intravenous line (IV) and equipment that monitors your heart beat and blood pressure. 其他可能在手术中使用的设备包括静脉通道（IV）和监控你的心跳和血压的设备。
How does the procedure work? 射频消融术是如何工作的？ Drawing depicts how the heat expands into the surrounding needles to form a thermal sphere
此图描绘的是针周围的热如何扩展到周围，形成一个热球 Radiofrequency ablation works by passing electrical currents in the range of radiofrequency waves between the needle electrode and the grounding pads placed on the patient's skin. These currents create heat around the electrode, which when directed into the tumor, heats and destroys the cancer cells. At the same time, heat from radiofrequency energy closes small blood vessels and lessens the risk of bleeding. The dead tumor cells are gradually replaced by scar tissue that shrinks over time. 射频消融术通过病人皮肤上的接地垫和电极针之间的高频电流起作用。这些电流定向加热了进入肿瘤的电极针，加热并破坏癌细胞。同时，射频能量加热能关闭细小血管，减少了组织出血的危险。死去的肿瘤细胞随着时间的推移逐渐被萎缩的疤痕组织所取代。 Ultrasound, computed tomography or magnetic resonance imaging may be used to help the physician guide the needle electrode into the tumor. 超声波、CT或磁共振成像，可用于帮助医生引导电极针进入肿瘤。 How is the procedure performed? 射频消融术是如何进行的？ Image-guided, minimally invasive procedures such as radiofrequency ablation are most often performed by a specially trained interventional radiologist in an interventional radiology suite or occasionally in the operating room. 在图像的导航下，如射频消融术之类的微创手术，经常由特别训练的介入放射科医生在介入放射装置或偶尔在手术室内进行。 Radiofrequency ablation is often done on an outpatient basis. 射频消融术经常由门诊部完成。 Drawing illustrates how liver tumors less than 2 cm can be treated with one ablation.
此图描绘了小于2厘米的肝肿瘤是如何在一次射频消融术中治愈 You will be positioned on the examining table. 你将被固定在检查台上。 You will be connected to monitors that track your heart rate, blood pressure and pulse during the procedure. 在手术中你将连接到监视器，以便跟踪你的心率，血压和脉搏。 A nurse or technologist will insert an intravenous (IV) line into a vein in your hand or arm so that sedation medication can be given intravenously. 一名护士或技师将把静脉通道（IV）插入手或手臂中，使你可以进行镇静药物的静脉注射。 The area where the electrodes are to be inserted will be sterilized and covered with a surgical drape. 插入体内的电极将要经过消毒和外科悬垂覆盖。 Your physician will numb the area with a local anesthetic if the procedure is to be done while you are awake. If general anesthesia is used, you will have a breathing tube placed through your mouth and into your trachea after you are asleep. The breathing tube will be connected to a breathing machine while you are asleep. 如果手术时需要你保持清醒，则医生会对你进行局部麻醉。如果采用全身麻醉，你将进入睡眠状态，通过进入气管的呼吸管来呼吸。呼吸管将连接到呼吸机。 A very small nick may be made in your skin to make it easier to pass the RFA electrode into your liver. 你的皮肤上可能会开一个非常小的缺口，以便射频消融电极更容易进入肝脏。 Radiofrequency ablation is performed using one of three methods: 射频消融术通常使用以下三种方法完成： &&&&* Surgically. 　　*外科手术 &&&&* Percutaneous, in which needle electrodes are inserted through the skin and into the site of the tumor. 　　*经皮——电极针经皮肤进入肿瘤部位。 &&&&* Laparoscopic, in which needle electrodes within a thin, plastic tube is threaded through a small hole in the skin in a procedure called a laparoscopy. 　　*腹腔镜检查方式——其中电极针通过一个小孔在很细的塑料管进入组织。& Drawing shows how liver tumors 2-3 cm in diameter are treated by six overlapping ablations.
此图显示了如何由六重消融术治疗直径2-3厘米的肝肿瘤。 Using imaging-guidance, your physician will insert the needle electrode through the skin and advance it to the site of the tumor. 利用成像导航，医生通过皮肤电极针插入并将其推进到肿瘤部位。 Once the needle electrode is in place, radiofrequency energy is applied. For a large tumor, it may be necessary to do multiple ablations by repositioning the needle electrode into different parts of the tumor to ensure no tumor tissue is left behind. 当电极针到位，射频能量将释放。对于一个大的肿瘤，它可能需要通过到不同肿瘤部位的电极针做多次消融，以确保没有留下肿瘤组织。 At the end of the procedure, the needle electrode will be removed and pressure will be applied to stop any bleeding and the opening in the skin is covered with a dressing. No sutures are needed. 在手术结束时，电极针将被撤离，同时敷料覆盖在皮肤的开口处并施加压力，防止术后出血。无需对伤口进行缝合。 Your intravenous line will be removed. 静脉通道将被移除。 Each radiofrequency ablation takes about 10 to 30 minutes, with additional time required if multiple ablations are performed. The entire procedure is usually completed within one to three hours. 如果需要多次消融，则每次射频消融需要额外约10至30分钟的时间。整个过程通常在一至三个小时内完成。 What will I experience during and after the procedure? 患者在术中和术后会有什么体验呢？ Devices to monitor your heart rate and blood pressure will be attached to your body. 监测您的心率和血压的设备将被连接到你的身体。 Drawing illustrates the treatment of a large liver tumor with 'thermal cylinders' during RFA.
此图描绘了在治疗一个较大的肝癌肿瘤时射频消融术形成的“热柱”。 You will feel a slight pin prick when the needle is inserted into your vein for the intravenous line (IV) and when the local anesthetic is injected. 当静脉通道（IV）插入到你的静脉，以及进行局部麻醉时你会感到轻微的刺痛。
If the case is done with sedation, the intravenous (IV) sedative will make you feel relaxed and sleepy. You may or may not remain awake, depending on how deeply you are sedated. 如果加了镇静剂，则静脉注射（IV）会使你感到放松和昏昏欲睡。你是否保持保持清醒则取决于你的镇静程度。 If you are put under general anesthesia, your throat may be sore after you wake up. This is caused by the breathing tube that was placed in your throat while you were asleep. 如果进行了全身麻醉，可能是在醒后会感觉喉咙疼痛。这是由你睡着时放置在你的喉咙的呼吸管所造成的。 Pain immediately following radiofrequency ablation can be controlled by pain medication given through your IV or by injection. Afterward any mild discomfort you experience can be controlled by oral pain medications. Patients may feel nauseous, but this can also be relieved by medication. 射频消融后的立即疼痛可通过静脉或注射止痛药来控制。 术后遇到任何轻微的不适，可通过口服止痛药控制。患者可能会感到恶心，但也可以通过药物缓解。 You will remain in the recovery room until you are completely awake and ready to return home. 你会留在恢复室，直到你完全清醒，准备回家。
You should be able to resume your usual activities within a few days. 你应该能够在几天内恢复日常活动。 Only about ten percent of patients will still have pain a week following radiofrequency ablation. 只有约百分之十的病人在射频消融治疗后1周仍然有疼痛感。 Who interprets the results and how do I get them? 谁来解释手术结果，我如何取得相关报告？ Computed tomography (CT) or magnetic resonance imaging (MRI) of the liver is performed within a few hours to a month following radiofrequency ablation. A radiologist will interpret these CT or MRI scans to detect any complications and to ensure that all of the tumor tissue has been destroyed. 射频消融治疗后对肝脏的电脑断层扫描（CT）或磁共振成像（MRI）在接下来的1个月会耗费几个小时时间。放射科医生将解释这些CT或MRI扫描图，以及时发现任何并发症，并确保所有的肿瘤组织已被摧毁。 You will undergo CT or MRI scans every three to four months to check for new tumors. 你将每3至4个月接受一次CT或MRI扫描来检查是否有新的肿瘤。 What are the benefits vs. risks? 这项技术有什么优势和风险？ Benefits 优势 &&&&* Radiofrequency ablation can be an effective treatment for primary liver cancer and for cancers that have spread to the liver in select patients whose liver tumors are unsuitable for surgical resection. 　　*射频消融术是原发性肝癌或已进行扩散到肝脏的不适合手术切除的癌症的一种有效的治疗方法。 &&&&* In most studies, more than half of the liver tumors treated by radiofrequency ablation have not recurred. The success rate for completely eliminating small liver tumors is greater than 85 percent. 　　*在大多数研究中，通过射频消融治疗肝肿瘤的患者超过一半都没有复发。 彻底消除小型肝肿瘤的成功率大于85% &&&&* Treatment-related serious complications are infrequent and discomfort is minimal. 　　*治疗相关的严重并发症很罕见，术中的不适是最小的。 &&&&* Radiofrequency ablation may be used repeatedly to treat recurrent liver tumors. 　　*射频消融术可反复使用以治疗复发性肝肿瘤。 &&&&* The percutaneous method of radiofrequency ablation, in which electrodes are inserted through the skin, is minimally invasive, produces few complications, and does not require hospital admission. 　　*射频消融术中通过皮肤电极经皮插入的方法，属于微创手术，很少产生并发症，并且不需要住院。 &&&&* RFA is a relatively quick procedure and recovery is rapid so that chemotherapy may be resumed almost immediately in patients who need it. 　　*RFA是一个比较快的手术，恢复速度也很快，即便化疗的患者也可以几乎立即恢复。 &&&&* Radiofrequency ablation is less expensive than other treatment options. 　　*射频消融术费用低于其它治疗方案。 &&&&* No surgical incision is needed—only a small nick in the skin that does not have to be stitched closed. 　　*无需外科手术式的大切口，只需在皮肤开个小切口，术后不须缝合。& Risks 风险 &&&&* Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000. 　　*任何穿透皮肤的手术都存在感染的风险。受感染且需要抗生素治疗的机会看起来小于千分之一。 &&&&* Depending on the site of treatment, radiofrequency ablation may cause brief or, rarely, long-l inflammation of the gallbladder that subsid damage to the bile ducts resulting in or thermal damage to the bowel. 　　*根据治疗的具体情况，射频消融术可能会导致短暂的肩部疼痛，长期疼痛很罕见；胆囊发炎几个星期后就会消退；胆道梗阻引起胆管的损害；或者肠道的热损伤 。 &&&&* Roughly one in four patients may develop a "post-ablation syndrome" with flu-like symptoms that appear three to five days after the procedure and usually last about five days. An occasional patient may remain ill for two to three weeks. Acetaminophen or ibuprofen taken by mouth is commonly used to control fever and other symptoms. 　　*大约四分之一的患者可能产生“消融后综合症”，症状类似流感，在手术后3至5天出现，一般持续5天左右。偶尔有病人可能会保持两到三周时间。通常口服乙酰氨基酚或布洛芬来控制发烧等症状。 &&&&* Some cases of bleeding have been reported but it usually stops on its own. If bleeding is severe, an additional procedure or surgery may be needed to control it. 　　*一些病例中报告了出血，但通常最后自行停止了。如果出血严重，可能需要额外的程序或手术来控制它。 &&&&* Organs and tissues near the liver, such as the gallbladder, bile ducts, diaphragm and bowel loops, are at risk of being injured. Although this occurs only 3 to 5 percent of the time, it may require surgical correction. The risk of this complication is related to the location of the liver tumor that is treated. 　　*肝组织附近的器官和组织，如胆囊 ，胆管， 膈肌和肠循环，有被误伤的风险。虽然可能出现这种情况只占整个手术时间的3-5%，但它可能需要外科手术去矫正。这种并发症的危险性与肝肿瘤的位置有关。 &&&&* Less than one percent of patients may develop a localized infection (abscess) at the site of the tumor ablation three to four weeks after the treatment. A liver abscess will require tube drainage and antibiotics to cure. Patients who have had a surgical procedure in which the liver bile duct has been connected to a loop of bowel are at much greater risk of developing a liver abscess after ablation. 　　*在肿瘤消融3至4周后，少于百分之一的患者可能产生局部感染（溃疡）。肝脓肿，需要管引流及抗生素治疗。 经历过肝脏胆管连接肠循环手术的患者具有更大的风险使得消融治疗后并发肝脓肿。 &&&&* Women should always inform their physician or x-ray technologist if there is any possibility that they are pregnant. See the Safety page (www.RadiologyInfo.org/en/safety/) for more information about pregnancy and x-rays. 　　*妇女应告知他们的医师和X射线技师 ，是否有任何怀孕的可能性。请查看安全页面（www.RadiologyInfo.org/en/safety/）中怀孕、X射线的相关信息。 &&&&* This procedure may involve exposure to x-rays. However, radiation risk is not a major concern when compared to the benefits of the procedure. See the Safety page (www.RadiologyInfo.org/en/safety/) for more information about radiation dose from interventional procedures. 　　*这个手术可能涉及到暴露在X射线下的辐射问题。然而，与它的优势相比，辐射的风险并不是一个大问题。请查看安全页面（ www.RadiologyInfo.org/en/safety/）中有关介入辐射过程辐射剂量的更多信息。 &&&&* Severe pain after RFA is uncommon, but may last a few days and require a narcotic to provide relief. 　　*RFA后的剧烈疼痛是罕见的，但一旦发生可能会持续数天，需要麻醉剂来缓解痛苦。& What are the limitations of Radiofrequency Ablation of Liver Tumors? 射频消融术治疗肝肿瘤有那些局限性？ There is a limit to the volume of tumor tissue that can be eliminated by radiofrequency ablation. This is due to limitations with current equipment. Hopefully technical advances will permit larger tumors to be treated in the future. Radiofrequency ablation also cannot destroy microscopic-sized tumors and cannot prevent cancer from growing back. 射频消融术对肿瘤组织的大小有限制。希望技术的不断进步将较大的肿瘤纳入这种方法的适用范围。射频消融术也不能破坏太小的微型肿瘤，也不能防止癌症的复发。
相关译文来自无觅插件
国内关于这项技术的介绍过分鼓吹它的优势，吹得神乎其神，巴不得患者不顾自身情况赶紧掏钱进行治疗。
而国外的介绍则客观、细致、全面。详细给出这项技术的弊端，副作用，局限性，适用人群等等，故翻译出来供有需要的人参考，以免被见钱眼开的无良医师忽悠。
据我所知，复发率还是挺高的
据我所知，复发率还是挺高的
无视文中的优势一栏吧，王婆卖瓜，自卖自夸，这在哪都可以理解——他们可以用自己的标准对数据进行筛选。
“超过一半都没有复发”肯定有问题，因为他并未给出标准，比如，1年后复发算不算进去？或者他们的标准是1个月内？——这样复发率肯定低。
不过风险和局限性还是值得参考，他们可以修饰，但却不能隐瞒。
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