Post on 23-Sep-2020
余俊豪醫生 Dr. Simon Yu
透視微創治療基金臨床科學中心總監Director, Vascular and Interventional Radiology Foundation Clinical Science Center
影像及介入放射科教授Professor, Department of Imaging and Interventional Radiology
治癌新突破:不可逆轉電穿孔(納米刀)
New Breakthrough in Cancer Treatment: Irreversible electroporation (Nanoknife)
肝癌 Liver cancer以往:外科切除=最佳治療Old concept: surgical resection = best treatment
消融技術治療癌症Ablative therapy for cancer treatment
肝癌 Liver cancer現在:3-5公分以下腫瘤
熱能消融=外科切除New concept: Thermal ablation = surgical resection (≤3-5cm)
消融技術治療癌症Ablative therapy for cancer treatment
Portal pressure/bilirubin
Ablation Sorafenib
PS 0, Child–Pugh A
Very early stage (0) Single< 2 cm
Early stage (A)Single or 3 nodules
< 3 cm, PS 0
End stage (D)
Transplant TACEResection
Associated diseases
YesNo
3 nodules ≤ 3 cm
↑
Normal
Single
PS > 2, Child–Pugh C
Intermediate stage (B)Multinodular,
PS 0
Advanced stage (C) Portal invasion, N1, M1, PS 1–2
PS 0–2, Child–Pugh A–B
HCC
BCLC staging system and treatment strategy
adapted from Bruix J, Sherman M. Hepatology 2011;53:1020-2
Extrahepatic metastasisMain portal vein tumor thrombus
Solitary or multifocal tumor in noncirrhoticliver or Child A cirrhosis
Sorafenib or systemic therapy trial
Resection / RFA (for
< 3 cm HCC)
Solitary tumor ≤ 5 cm ≤ 3 tumors ≤ 3 cmNo venous invasion
Child A Child B Child C Child A / B Child’s C
Transplantation TACE Supportive careLocal ablation
Confined to the liverMain portal vein patent
Tumor > 5 cm> 3 tumors
Invasion of hepatic / portal vein branches
Asia-Pacific Association for Study of Liver Consensus on Treatment of HCC
Yes No
Child A / B Child C
Omata et al. Hepatol Int 2010
熱能消融的限制Limitations of thermal ablation
破壞膽管,膽囊 膽管閉塞,膽囊破損Thermal damage to bile duct, Occlusion of bile ductgallbladder Gallbladder perforation
血管的散熱作用減弱治療效果 腫瘤殘餘,腫瘤復發(血流溫度37度=〝降熱效應〞) Residual tumor, Heat sink effect Tumor recurrence
不可逆轉電穿孔(納米刀)運作原理Mechanism of action of Nanoknife
電極針 高壓電場(3000伏特 Volt)Electrode needles produce high electric voltage
+ −
不可逆轉電穿孔(納米刀)運作原理Mechanism of action of Nanoknife
電極針 高壓電場(3000伏特 Volt)Electrode needles produce high electric voltage
+ −
不可逆轉電穿孔(納米刀)運作原理Mechanism of action of Nanoknife
超短脈衝直流電 (2/100至1/10秒)Ultra-short electric pulses (20-100 microseconds)
納米孔 細胞凋亡Nano-holes Cell apoptosis
不可逆轉電穿孔(納米刀)運作原理Mechanism of action of Nanoknife
已凋亡的細胞分解 被巨噬細胞吸收Cell apoptosis Cleared by phagocytes
不可逆轉電穿孔(納米刀)運作原理Mechanism of action of Nanoknife
不可逆轉電穿孔(納米刀)運作原理Mechanism of action of Nanoknife
已凋亡的細胞分解 被巨噬細胞吸收Cell apoptosis Cleared by phagocytes
納米刀的優點 Advantages of Nanoknife
射頻消融(熱能)治療 腫瘤細胞壞死 疤痕Thermal ablation Tumor cell necrosis Scar
納米刀 腫瘤細胞凋亡 正常細胞取代Nanoknife Apoptosis Normal cell replacement
不可逆轉電穿孔(納米刀)儀器The Nanoknife equipment
心電波監測器(Electrocardiac monitor)
電極針 (Electrode needle) 電流發射機(Generator)
不可逆轉電穿孔(納米刀)儀器The Nanoknife equipment
不可逆轉電穿孔(納米刀)儀器The Nanoknifeequipment
消融範圍(Ablation zone):4公分(cm) X 5公分(cm) X 5公分(cm)
不可逆轉電穿孔(納米刀)儀器The Nanoknife equipment
1
23
4
超聲波影像 Ultrasound
動物實驗 Animal study
大腿肌肉 動脈 靜脈 神經線Groin muscle, artery, vein, nerve
大腿肌肉 動脈 靜脈 神經線Groin muscle, artery, vein, nerve
大腿肌肉 動脈 靜脈 神經線Groin muscle, artery, vein, nerve
大腿肌肉 動脈 靜脈 神經線Groin muscle, artery, vein, nerve
腎臟 Kidney
腎臟 Kidney
腎臟 Kidney
腎臟 Kidney
肝臟 Liver
肝臟 Liver
肝臟 Liver
肝臟 Liver
胰腺癌 Pancreatic cancer
電腦掃描 CT Scan
納米刀前Before Nanoknife
納米刀一天後One day after
正離子掃描 PET Scan
納米刀前Before Nanoknife
納米刀三週後3 Weeks after
治療後三週傷口狀況Wound condition after 3 weeks