1、精细介入治疗在肿瘤多学科中的应用精细介入治疗在肿瘤多学科中的应用Interventional Therapy为什么要提倡多学科联合治疗肿瘤?虽然虽然Various methods have unique irreplaceability,The treatment of diseases is not a way to solve.This is why we must promote the multidisciplinary combination therapyThe characteristics of interventional treatmentrepeatabilityrepe
2、atability造影导管造影导管8微导管的进步微导管的进步(1)(1)逐渐变细的透明尾端逐渐变细的透明尾端便于尖锐的导丝和栓塞物质能便于尖锐的导丝和栓塞物质能顺利插入顺利插入。(2)2mm 2)2mm 长的柔软尖端长的柔软尖端即使是弯曲的血管即使是弯曲的血管，也可以不损伤血也可以不损伤血管壁管壁，安心的操作安心的操作。(4)(4)不锈钢丝编织的管体不锈钢丝编织的管体即使在弯曲的血管内即使在弯曲的血管内，也可以防止导管扭折也可以防止导管扭折，并保持宽大并保持宽大的内腔的内腔。以保证导丝的良好的操纵性和保证将栓塞物质顺以保证导丝的良好的操纵性和保证将栓塞物质顺利送到病变部利送到病变部。(3)0.
3、9mm X(3)0.9mm X光不透过标记光不透过标记在在X X光透视下光透视下，容易识别容易识别，确定导管尖确定导管尖端的位置端的位置。从从2.9Fr2.9Fr逐渐变细到逐渐变细到2.2Fr2.2Fr（0.66mm0.66mm）球囊微导管 肝癌隐匿性高，就诊时85%属于中、晚期；肝癌中、晚期的自然生存期为3-6个月；尽管手术切除是根治的方法，能切除的不到30%；手术后复发率相当高，超过2/3的随访病人一个月至一年内出现复发灶。肝肝 癌癌 的的 临临 床床 Clinical application on HCC Clinical application on HCCThe giant live
4、r cancer can be removed？A combination of intervention and surgery Yin zhen-yong Male 50，HBV+，AFP1000 CT：huge occupiedYin zhen-yong Male 50，HBV+，AFP500CT scan after 1st TACE2nd THACE3rd.THACE4th.THACEYin zhen-yong Male 50y，CT follow up post TACEPathology ID：36784HCC cell appeared degeneration and nec
5、roses,circulated by fibro-tissue.There is no residue tumor can be seen in resection edge.2 year post resection follow up CT scan 3 years post resection follow up angiography 8 year post resection follow up angiography 14 year post resection follow up CT scan 18 year post resection follow up CT scan巨
6、块巨块HCC可以治疗吗？可以治疗吗？Male 55援助非洲工程师体检发现肝巨大占位。援助非洲工程师体检发现肝巨大占位。Aid to Africa engineer，physical examination big occupied in the liver.Body Check Up:CTAngiography:huge occupiedSuper selective TACE0.8mmF2.6TACE后后CT 复查复查坏死液引流坏死液引流2013-3-20 手术切除切除术后切除术后CT复查复查3 year post resection follow up angiography巨块巨块HCC
7、合并肝硬化可以治疗吗？合并肝硬化可以治疗吗？Male 83乙肝，肝硬化40多年，体检发现肝巨大发现肝巨大占位。占位。physical examination big occupied in the liver.83y，man，40ys.Liver scirosis，huge HCC,can not resection.Micro-cather super-selective emb.肝肝A超选择超选择TACE术后，复查造影，肿瘤血管湖消失，术后，复查造影，肿瘤血管湖消失，非肿瘤供血动脉保存。非肿瘤供血动脉保存。介入手术后介入手术后介入手术前介入手术前 造影造影3个病灶个病灶 超选择超选择TAC
8、E 造影复查造影复查39岁，男，肝癌；岁，男，肝癌；B超和超和CT只看到一个病灶只看到一个病灶手术标本手术标本病病 理理肿瘤肿瘤可以治愈吗可以治愈吗？CarcinomaPerfect embolus combination：lipiodol+partical 栓塞前栓塞后3 个月栓塞后1个月栓塞后6 个月栓塞后36个月Global HCC Incidence(2005)Global Cancer Statistics,2002.CA Cancer J Clin 2005;55;74-108In 2002,new In 2002,new cases:626,162cases:626,162525
9、2 in Chinain China，about 344,000about 344,000Mail/femail Mail/femail(2.67:1)(2.67:1)China is the China is the highest areahighest area Global HCC Incidence Section of Cancer Information(26/2/2014)0 3.0 5.3 8.3 17.6 117 Age-standardised incidence rates per 100,000 morbity(male):33.7/100,000（293,318 例
10、）Femail:10.9/100,000（101,452 例）Mortality(male):32.3/100,000（281,802例）femail:10.7/100,000（101,401例）56%HCC in China56%HCC in China62%HCC in Asia 62%HCC in Asia Question?Question?10 years passed,why the morbidity is still high and higher than before?Why the morbidity is growing 10%each year?What should we do next?CYROcare System (第三代氩氦刀 如如 何何 整整 合合 介介 入入 技技 术术？血管介入-Angio+TACE 化学消融 热消融激光、微波、射频、超声聚焦 冷冻消融-氩氦冷冻 放射粒子植入-局部放疗精细介入在肿瘤多学科治疗中的应用u 肿瘤肿瘤多学科联合的个体化治疗是永恒多学科联合的个体化治疗是永恒的主题的主题u 精准医学是系统工程，医生是临床决策的主体精准医学是系统工程，医生是临床决策的主体u 肿瘤的微创精细介入治疗在临床多学科中起到不可或肿瘤的微创精细介入治疗在临床多学科中起到不可或 缺的作用缺的作用
