Современные методы абляции злокачественных новообразований печени

Целью настоящего обзора является демонстрация возможностей и целесообразности выполнения различных методов абляции у пациентов с первичными и метастатическими злокачественными новообразованиями печени на основе данных мировой медицинской литературы.

В качестве возможных вариантов местного воздействия у пациентов с нерезектабельными первичными и вторичными опухолями печени и неоперабельных больных в настоящее время разработаны и применяются различные абляционные методики, позволяющие добиться локального контроля над заболеванием и увеличить показатели продолжительности жизни данной группы пациентов. К ним относятся: радиочастотная абляция, микроволновая абляция, высокоинтенсивная фокусированная ультразвуковая терапия, лазерная абляция, криотерапия, химическая деструкция опухоли, необратимая электропорация, стереотаксическая лучевая терапия. Эффективность данных методов абляции зависит от размера и локализации опухолевого очага, а для термических методик — также от его расположения относительно крупных сосудов. Абляционные методики имеют максимальную эффективность (в ряде случаев аналогичную хирургическому вмешательству) при воздействии на ранние формы первичного рака или вторичные опухолевые образования печени при наличии солитарного узла максимальными размерами до 5 см либо не более 3 очагов с максимальным размером до 3 см. Эффективность локальной деструкции опухолевых образований печени большего диаметра повышается за счет проведения абляции вторым этапом после выполнения химиоэмболизации печеночной артерии либо путем сочетания различных методик локального воздействия.

Применение в медицинской практике различных современных методов абляции солидных первичных и вторичных опухолей печени позволяет расширить возможности противоопухолевого лечения данной категории больных.

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