激光臨床應(yīng)用現(xiàn)狀與進(jìn)展

置管無水

聚桂醇熱消融

放射粒子納米刀超聲介入治療熱消融射頻消融微波消融激光消融氬氦刀冷凍消融技術(shù)HIFUApplicationsBreastThyroidLiverKidneyPancreasBone

MetsPancreasProstateBone

MetsThyroidLiverKidneyEvidence-based

medicine循證醫(yī)學(xué)

級別CONCLUSIONThis

is

the study

that

validates

the

use

of

LA

for

thetreatment

of

HCC.

LA

resulted

not

inferior

to

RFA

in

achieving

the

CTA

and

therefore

it

should

be

considered

asan

evaluable

alternative

for

thermal

ablation

of

small

HCCin

cirrhotic

patients

/肝臟消融激光是所有熱消融中最不易引起疼痛大樣本隨機對照甲狀腺良性結(jié)節(jié)激光消融多中心研究多中心長時間隨訪已有大量的熱消融臨床研究Pubmed

甲狀腺良性結(jié)節(jié)消融文獻(xiàn)搜索組織經(jīng)激光消融后，失去活性成為壞死組織。病理學(xué)研究發(fā)現(xiàn)，組織壞死后轉(zhuǎn)歸通常不外乎三種結(jié)局：結(jié)局一、溶解吸收這是機體處理壞死組織的基本方式。來自壞死組織本身和中性粒細(xì)胞的溶蛋白酶將壞死物質(zhì)進(jìn)一步分解、液化，然后由淋巴管或血管加以吸收，不能吸收的碎片則由巨噬細(xì)胞加以吞噬消化。結(jié)局二、分離排出

壞死組織如位于皮膚或粘膜、腎、肺等內(nèi)臟

，壞死灶周圍的白細(xì)胞

溶蛋白酶，加速邊緣的溶解，使壞死灶與健康組織分離，從而可經(jīng)相應(yīng)管道排出。些肌瘤消融后，壞死組織經(jīng)陰道排出就是例證。結(jié)局三、機化

壞死組織如不能完全溶解吸收或分離排出，則由周圍組織新生毛細(xì)血管和纖維母細(xì)胞等組成肉芽組織，長入壞死，逐漸加以溶解、吸收和取代，最后成為瘢痕組織，這種過程稱為機化。根據(jù)臨床實踐和病理機制可以清晰地得出結(jié)論，甲狀腺結(jié)節(jié)激光消融后被凝固壞死的組織逐漸縮小的最主要原因是溶解吸收。特別是術(shù)后前3個月，不僅免疫細(xì)胞迅速啟動，而且主要還是由于壞死組織結(jié)構(gòu)崩塌、分解、液化，然后被淋巴管系統(tǒng)迅速吸收的病理基礎(chǔ)。隨后的組織碎片

則由巨噬細(xì)胞逐漸加以吞噬消化?！俺曇龑?dǎo)下經(jīng)皮激光消融治療甲狀腺微小狀癌.”“Ultrasound-Guided

Laser

Ablation

ofIncidental

Papillary

ThyroidMicrocarcinoma:

A

Potential

Ther

uticApproach

in

Patients

at

Surgical

Risk”＠THYROIDVolume

26,

Number

1,

2016?

Amenican

Thyroid

Association?nn

Liebert,

Inc.:

10.1089/

hy.2015.0020SPECIAL

ARTICLE20115

American

Th1yroid

Ass,ociation

Man1agementGuidelines

for

Adult

Patients

with

Thyroid

No,dulesand

!Differentiated

Thyro,id

CancerThieAmerican

Thyroi,d

Association

G1uidelines

Task

Forceon

Thyroid

Nodules

and

Diifferentiated

Thyroid

CancerB「yan

R.Haugren;·*

Erik

IK.Alexander,2

Keith

C.Bible,3

Gerard

M.Doherty,4

Susan

J.Mandel,5Yuri

E.Nikiforov,6

IFurio

Pacini,7

Gregory

W.Randolph,8

Anna

M.Sawka,9

Ma「tin

Schlumberger,10Kathryn

G.Schuff,11

Steven

I.

Sherman,12

Julie

Ann

Sosa,13

David

L.

Steward,14R.

Michael

Tuttle,15

and

Leonard

Wartofslky16@Creastivitay

inoHealthcareet2015版ATA

對甲狀腺微小

狀癌處理明顯趨于保守ATA新版指南不主張對T1、T2的

區(qū)淋

進(jìn)行預(yù)防性清掃。預(yù)防性

區(qū)淋

清掃尤其是雙側(cè)清掃后，出現(xiàn)并發(fā)癥風(fēng)險很高，喉返神經(jīng)損傷率高達(dá)25%（

）。Ultrasound-guid,e,d

percuta:n,eous

las,er

ablation

of

unifocalTlNOMO

papillary

thyroid

microcarcinoma:

Preliminary

resultsw

n

z

h

o

u

1

嚕

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h

a

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11

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i

an

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(2016)

el-e7Conten比lists

ava.ilable

at

Scienc:eDirnctELSEVIERClinical

Radiologyjourna

I

ho.mepag1e:

inicai

rad

iologyone.

netk·入DIC.'.今）＇｝＇，＇cir．己才·Percutaneous laser

ablation

for

treatment

oflocally

recurrent

papillary

thyroid

carcinoma<15mmW.

Zhout

L

Zhan .

Zhan*,

S.

Jiang,

Y.

Zhu,

S.

XuDepartment

of

Ul打asou11d,.Rui

Jin

Hosp呵，School

of

Mediciri,e,Shanghai

Jiao

1i卯g

University,Shanghai,.China`＇工9

..1eCreativity

in

Healthcare甲狀腺

狀微小癌激光消融與手術(shù)治療對比的前瞻性多中心研究A

Multicenter

Prospective

Controlled

Trial

of

LaserAblation

versus

Surgery

for

the

Treatment

of

PapillaryThyroid

Microcarcinomakuma醫(yī)院甲狀腺微小CA看病經(jīng)歷我就不潤色了，全來干貨！本人當(dāng)天上午做完b超，CT,洗檢查，下午與伊脖醫(yī)生面診，本

人左側(cè)o_s,cm微小CA,經(jīng)過評估距離食道經(jīng)不近，可觀察，半年一次B超（可在國內(nèi)偵），如長到1cm或發(fā)現(xiàn)淋巴轉(zhuǎn)移，再偵手術(shù)不遲，醫(yī)生說曰本針對

狀微CA，在他們院90％選擇觀察，最長有觀察20年的，如選擇手術(shù)要承擔(dān)旁腺和喉反神經(jīng)損傷，雖然此院手術(shù)數(shù)據(jù)顯示旁椋

損傷率2%，喉反神經(jīng)損傷率02%，但仍存在風(fēng)險，我當(dāng)時問了—些問題給各位！Ra.yChen1

026會員如果觀察，在滿足什么條件下就必須手術(shù)？大千1cm或發(fā)黑淋巴轉(zhuǎn)移淋巴轉(zhuǎn)移到什么程度會有異常？腫大或無癥狀手術(shù)中發(fā)現(xiàn)有淋巴轉(zhuǎn)移，切—半還是全部？要看術(shù)中情況而定甲狀腺—側(cè)有病灶，另—側(cè)也有的可能性大嗎？有這種可能性如果切—半，以后如何判斷是否復(fù)發(fā)？可否通過測腫瘤標(biāo)記物確認(rèn)？B超如果轉(zhuǎn)移到下額，手術(shù)刀口痙否會很長？4到7厘米不手術(shù)遠(yuǎn)處轉(zhuǎn)移的概率有多

頭微小遠(yuǎn)轉(zhuǎn)概率極低曰本觀察的人，也都做過宇剌了嗎？做過觀察中有分化型轉(zhuǎn)未分化型的可能嗎？不可能早期手術(shù)是否雯容易根冶？未必現(xiàn)在也開始保守觀察了嗎？是的腫瘤離包膜近不近？

不近，如果近則需手術(shù)吃飯要注意無礁鹽和無海鮮么？觀察期間不需注意如果手術(shù)中發(fā)現(xiàn)淋巴轉(zhuǎn)移，會清掃吏多區(qū)域嗎？術(shù)中視情況重離子機器對這個病有用么？無意義觀察是否會墻加后續(xù)手術(shù)的難度和風(fēng)險？不會觀察中是否可要小孩？可以，遺傳概率5%，后代可以elCare甲狀頸部淋轉(zhuǎn)移等.超聲在激光消融甲狀腺狀癌頸部轉(zhuǎn)移性淋，

，中的應(yīng)用價值.學(xué)理論與實踐,2014,13(3),298-302甲狀旁腺激光消融Minimally-invasive

thermal

ablationof

early-stage

breast

cancer:

A

systemic

review,

Z.

Zhao,

F.

Wu

Published

onEJSO

36

(2010)

1149e1155The

ysis

of

the

literature

involved

38

clinical

studies

(two

type)published

from

1994

to

2009,

and

844

patients

with

breast

cancerunderwent

minimally-invasive

thermal

ablation.Thermal

ablation

was

usually

indicated

inpatients

with

small,

well-localized

breast

cancer,

which

was

diagnosedwith

imaging

modalities

and

histologically

confirmed

by

biopsy.The

majority

of

the

tumors yzed

were

in

the

early

stage,

and

thebreast

lesions

ranged

from

0.5

to

2.0

cm

in

size,

with

a

demarcatedmargin.

The

ablation

procedure

was

usually

guided

by

either

ultrasoundor

MR

imaging.Laser

ablation

of

breast

tumors,

,

.超聲引導(dǎo)下雜志,2014.16(5),360癌激光組織間照射治療,臨床超聲醫(yī)學(xué)＿Creativity

in

Healt