Transthoracic hepatic radiofrequency ablation

Background Radiofrequency ablation (RFA) is an alternative for the treatment of unresectable hepatic tumors. Tumors beneath the diaphragmatic dome may be difficult to access by laparoscopy. In these cases, a transthoracic transdiaphragmatic approach for delivering RFA can be used. Methods Three patients with hepatic metastatic disease were treated using a transthoracic transdiaphragmatic approach to deliver RFA therapy for tumors in liver segments 7 and 8. The patients underwent thoracoscopy. The tumors were identified using transdiaphragmatic ultrasound, and transthoracic transdiaphragmatic RFA (TTRFA) was performed. Results In three patients, TTRFA was successfully used to ablate five lesions. There were no perioperative complications, blood loss was minimal, and postoperative hospital stays ranged from 2 to 8 days. There were no recurrences during a follow-up period of 4 to 20 months. Conclusions TTRFA is a viable alternative for hepatic tumors located beneath the dome of the diaphragm that are difficult to access by laparoscopy. Online publication: 13 October 2004     

Capnography accurately detects apnea during monitored anesthesia care

Apnea and airway obstruction are common during monitored anesthesia care (MAC). Because their early detection is essential, we sought to measure the efficacy of capnography as an indicator of apnea during MAC at a variety of oxygen flow rates compared with thoracic impedance. Anesthesia care providers using standard American Society of Anesthesiologists monitors were blinded to capnography and thoracic impedance monitoring. Ten (26%) of the 39 patients studied developed 20 s of apnea; none was detected by the anesthesia provider, but all were detected by capnography and impedance monitoring. There was no difference in detection rates between the two methods. Higher oxygen flow rates decreased the amplitude of the capnograph but did not interfere with apnea detection. This pilot study revealed that apnea of at least 20 s in duration may occur in every fourth patient undergoing MAC. Although these episodes were undetected by the anesthesia provider, they were reliably detected by both capnography and respiratory plethysmography. Monitoring of nasal end-tidal CO(2) is an important way to improve safety in patients undergoing MAC.     

腹腔镜射频消融术治疗肝血管瘤

目的 :探讨腹腔镜射频消融治疗肝血管瘤的可行性及实用性。方法 :2 5例肝血管瘤患者全麻气管插管后 ,腹腔镜下行射频消融治疗 ,其中 5例同时行胆囊切除术。结果 :患者经治疗均获满意效果 ,术后无残留病灶 ,无明显并发症。结论 :腹腔镜射频消融治疗肝血管瘤安全可行 ,治疗彻底 ,是治疗肝血管瘤的微创新技术。     

Laparoscopic radiofrequency ablation of hepatic cavernous hemangioma

BACKGROUND: Radiofrequency ablation (RFA), currently used extensively for liver tumors, also has been applied successfully to hepatic cavernous hemangioma (HCH) percutaneously. The aim of this study was to assess the feasibility, safety, and efficacy of laparoscopic RFA for patients with HCHs. METHODS: Between March 2001 and March 2004, 27 patients with symptomatic and rapid-growth lesions were treated by laparoscopic RFA using the RF-2000 generator system. The treatment-related complications were observed. All the patients were followed up with helical computed tomography scans and ultrasonography at regular intervals to assess the therapeutic efficacy of laparoscopic RFA. RESULTS: This study assessed 9 men and 18 women with a mean age of 41.6 +/- 8.3 years. Three additional intrahepatic lesions missed preoperatively were found in three patients on intraoperative ultrasound. A total of 27 patients with 50 liver lesions were treated successfully with laparoscopic RFA. The mean maximum tumor diameter was 5.5 +/- 2.0 cm. The mean length of time for RFA per lesion was 20.7 +/- 11.9 min, and the mean blood loss was 134.4 +/- 88.9 ml. Laparoscopic cholecystectomy was performed simultaneously for gallstones in 13 patients and for abutting of gallbladder from hemangioma in 2 patients. In addition, 3 patients also had a laparoscopic deroofing of simple hepatic cysts. Although postoperative low-grade fever and transient elevation of serum transaminase levels were observed in 13 patients, there were no complications related to laparoscopic RFA. During a median follow-up period of 21 months (range, 12-42 months), complete lesion necrosis was achieved for all the patients. CONCLUSIONS: Laparoscopic RFA therapy is a safe, feasible, and effective treatment option for patients with symptomatic and rapid-growth HCHs located on the surface of the liver or adjacent to the gallbladder. Intraoperative ultrasonography is a useful adjunct for detecting additional liver lesions and offering more accurate targeting for RFA.     

腹腔镜下冷循环射频消融治疗肝癌

目的探讨腹腔镜下冷循环射频消融在肝癌治疗中的价值. 方法肿瘤位于肝脏脏面不适于在B超引导下进行射频治疗的原发性肝癌12例,转移性肝癌3例,肝癌破裂出血4例,全身麻醉,术中先腹腔镜探查,明确肿瘤位置确定穿刺点,然后在腹腔镜引导下,穿刺肿瘤行射频消融治疗. 结果全组未发生手术并发症.4例肝癌破裂出血停止,术后复查肿瘤缩小,血AFP显著下降.术后1个月32个肝癌病灶,完全消融27个,消融不全5个,完全消融率84.4%(27/32).3个月后CT示9例肿瘤病灶完全坏死,AFP降至正常;6例病灶部分坏死.随访2～18个月,平均8.2月,15例生存,4例死亡(3例肝功能衰竭,1例消化道大出血). 结论腹腔镜引导下冷循环射频消融治疗肝癌比B超引导下射频治疗定位更加准确,治疗效果肯定,手术并发症发生率低.     

Laparoscopic radiofrequency ablation of unresectable hepatic malignancies

BACKGROUND: Radiofrequency ablation (RFA) of hepatic malignancies has been performed successfully via a percutaneous route or at laparotomy. We analyzed the efficacy and utility of laparoscopic intraoperative ultrasound and RFA in patients with unresectable hepatic malignancies. METHODS: Between November 1997 and November 1999, 27 patients with unresectable hepatic malignancies and no evidence of extrahepatic disease were entered in a phase 2 trial of laparoscopic intraoperative ultrasound and RFA. Real-time ultrasonography was used to guide RFA, and lesions were ablated at a temperature of 100 degrees C for 10 min. Overlapping ablations were performed for larger lesions. RESULTS: Additional tumors were identified in 10 (37%) of the 27 study patients by laparoscopy and laparoscopic intraoperative ultrasound despite extensive preoperative imaging. Radiofrequency ablation of 85 hepatic tumors yielded no mortality and only one case of postoperative bleeding. During a mean follow-up period of 14 months, four tumors (4.7%) locally recurred. Of the 27 patients, 11 (41%) remain free of disease at this writing; (22%) are alive with disease; and 10 (37%) have died with disease. CONCLUSION: Laparoscopic RFA and intraoperative ultrasound constitute a safe and accurate method for ablation of unresectable hepatic tumors.     

Intraoperative radiofrequency ablation or cryoablation for hepatic malignancies

BACKGROUND: The majority of patients with primary or metastatic malignancies confined to the liver are not candidates for resection because of tumor size, location, multifocality, or inadequate functional hepatic reserve. Cryoablation has become a common treatment in select groups of these patients with unresectable liver tumors. However, hepatic cryoablation is associated with significant morbidity. Radiofrequency ablation (RFA) is a technique that destroys liver tumors in situ by localized application of heat to produce coagulative necrosis. In this study, we compared the complication and early local recurrence rates in patients with unresectable malignant liver tumors treated with either cryoablation or RFA. PATIENTS AND METHODS: Patients with hepatic malignancies were entered into two consecutive prospective, nonrandomized trials. The liver tumors were treated intraoperatively with cryoablation or RFA; intraoperative ultrasonography was used to guide placement of cryoprobes or RFA needles. All patients were followed up postoperatively to assess complications, treatment response, and local recurrence of malignant disease. RESULTS: Cryoablation was performed on 88 tumors in 54 patients, and RFA was used to treat 138 tumors in 92 patients. Treatment-related complications, including 1 postoperative death, occurred in 22 of the 54 patients treated with cryoablation (40.7% complication rate). In contrast, there were no treatment-related deaths and only 3 complications after RFA (3.3% complication rate, P<0.001). With a median follow-up of 15 months in both patient groups, tumor has recurred in 3 of 138 lesions treated with RFA (2.2%), versus 12 of 88 tumors treated with cryoablation (13.6%, P<0.01). CONCLUSIONS: RFA is a safe, well-tolerated treatment for patients with unresectable hepatic malignancies. This study indicates that (1) complications occur much less frequently following RFA of liver tumors compared with cryoablation of liver tumors, and (2) early local tumor recurrence is infrequent following RFA.     

射频消融治疗肝肿瘤的并发症

RFA作为一种有效的微创治疗肝肿瘤技术而被接受，病死率为0%～3％，并发症的发生率为0.9％～17％。重要并发症包括出血、感染、胆管损伤、胸腔积液、肝功能不全及血栓形成等;轻微并发症包括皮肤烧伤、胆汁瘤、胆道出血等。轻微并发症和副反应发生率多于严重并发症且大多具有自限性。笔者综述Medline文摘，Ovid全文，EBESCO，维普中文科技期刊等数据库于2003年1月—2006年3月有关射频消融（RFA）治疗肝肿瘤并发症的报道文献，分析RFA治疗肝肿瘤术后并发症的种类及其预防策略。     

经皮肝穿刺射频热凝治疗原发性小肝癌

目的：探讨经皮肝穿刺射频热凝（PRFA）治疗肝癌的效果和适应证。方法：对16例原发性小肝癌患者行PRFA治疗的临床资料进行回顾性分析。结果：16例肝癌的直径均≤3cm。PRFA治疗后甲胎蛋白转阴者占93．3％（14／15）。B超，CT复查肿瘤缩小，并有包膜形成。0．5，1，2年生存率分别为93．8％，100％，100％。结论：PRFA是一种具有微创、时间短、安全方便、疗效可靠的治疗小肝癌的新方法。尤其适于有手术禁忌症，或有手术指征但位于肝中央区、临近腔静脉或肝门区的小肝癌。     

射频消融治疗肝脏恶性肿瘤急性热损伤的MRI表现及疗效判定

目的探讨肝脏恶性肿瘤射频消融后急性热损伤的MRI表现及疗效判定。方法回顾性分析MRI引导下158例共266个肝脏恶性肿瘤病灶的射频消融术后即刻MRI表现。结果147个原发性肝癌及59个肝转移癌病灶消融后表现为T2WI低信号、T1WI低信号;2个原发性肝癌及55个肝转移癌病灶消融后表现为T2WI呈稍高信号,T1WI低信号;3个原发性肝癌消融后T2WI呈低信号,而T1WI呈高信号。瘤周消融带均呈短T1短T2信号,周边见薄环状长T2-信号环绕。151个原发性肝癌及106个转移癌病灶被瘤周消融带完全包绕,1个原发性肝癌及8个肝转移癌病灶未完全被瘤周消融带包绕。结论肝脏恶性肿瘤射频消融后急性热损伤的即刻MRI表现具有特征性,据以评价疗效确切、可靠。     

Solitary hepatic gastrinoma treated with laparoscopic radiofrequency ablation.

BACKGROUND: This is a case of a solitary hepatic gastrinoma in a 65-year-old male. The patient was diagnosed with Zollinger-Ellison syndrome in 1991. He had negative radiologic and surgical explorations at that time. He was maintained on proton-pump inhibitors for the next 10 years without symptoms. METHODS: A computed tomographic (CT) scan done in April 2001 demonstrated a 5-cm right hepatic lesion. Radionucleotide scanning with octreotide demonstrated intense activity in the same area in the right hepatic lobe. His serum gastrin was 317 pg/mL. He underwent laparoscopic radiofrequency ablation of the lesion. RESULTS: Treatment resulted in a 6-cm ablative area giving a 1-cm margin on the tumor. One- and 3-month follow-up CT scans demonstrated adequate ablation of the tumor. An octreotide scan done 3 months postoperatively did not reveal any areas of abnormal uptake. CONCLUSION: We report success with laparoscopic radiofrequency ablation as an alternative to major hepatic resection in patients with a solitary hepatic gastrinoma.     

超声引导下射频消融治疗肝转移瘤的疗效观察

目的评价超声引导下射频消融（RFA）治疗结直肠癌肝转移瘤（MLC）的疗效。方法采用超声引导下RFA治疗结直肠癌MLC患者60例134个病灶,其中91个病灶≤3.0 cm,43个〉3.0 cm。术前39例血清癌胚抗原（CEA）增高,21例正常。采用CEUS检查结合增强CT、穿刺活检及CEA值的动态变化综合评价肿瘤治疗效果。结果术后3个月复查CEA,37例增高,23例正常。术后30 min CEUS检查显示127个射频消融病灶呈无灌注区,近期有效率达94.78%（127/134）。术后1个月CEUS检查显示8个病灶局部增强,考虑复发,经超声引导下穿刺活检及细胞学检查证实而行第2次治疗。术后1个月增强CT复查显示126个（126/134,94.03%）射频消融病灶呈无灌注区,为完全坏死的转移病灶;部分坏死病灶为8个,与CEUS结果一致。结论超声引导下RFA是治疗MLC的一种安全有效的局部微创治疗方法。     

B超引导经皮肝穿刺射频治疗肝癌

目的：探讨B超引导经皮肝穿刺射频（PRFA）治疗肝癌的价值。方法：1999年10月－2000年3月对70例肝癌患者进行了B超引导PRFA治疗,并于治疗后每个月进行肿瘤标记物和B超检查,治疗后1个月复查MRI或CT。结果：患者肝功能分级Child A级53例,B级15例,C级2例,原发性肝癌53例,继发性肝癌17例,原发性小肝癌（小于等于5cm,未手术）21例,其中AFP阳性17例,PRFA术后转阴12例,明显降低4例,未降低1例。MRI显示肿癌完全凝固性坏死16例,根治率76．2％,小肝 癌各组PRFA术后3,6个月生存率均为90．5％－100％,大肝癌各组术后3,6个月生存率分别为66．7％－72．7％和27．6％－72．7％,结论：射频作为肿瘤透热治疗的一种方法,对于肝癌尤其是无手术指征,或有手术指征但位于肝中央区,临近腔静脉或肝门区的小肝癌,PRFA具有微创,时间短,安全方便,疗效可靠,对于大肝癌,PRFA可与肝动脉介入化疗栓塞联合应用,以提高疗效。     

腹腔镜下射频消融术治疗原发性肝癌的效果探讨

目的:探讨腹腔镜下射频消融术(laparoscopic radiofrequency ablation,LRFA)治疗原发性肝癌的临床效果及对患者血清甲胎蛋白(alpha-fetoprotein,AFP)、干扰素-γ(interferon-γ,IFN-γ)及细胞免疫水平的影响。方法:选取2011年1月至2013年1月治疗的60例原发性肝癌患者,其中30例行LRFA(LRFA组),30例行传统手术(传统组),对比两组临床效果。结果:术后复查,LRFA组肿瘤完全坏死率86.67%、肿瘤不完全坏死率10.00%、肿瘤部分坏死率3.33%,传统组术后复查,均成功切除病灶。治疗前、治疗后2周、治疗后4周,两组患者血清AFP水平差异无统计学意义(P>0.05);治疗后2周、治疗后4周,LRFA组血清IFN-γ、CD3~+、CD4~+、CD4~+/CD8~+水平高于传统组(P<0.05);LRFA组2年生存率(50.00%)高于传统组的23.33%(P<0.05)。结论:LRFA治疗原发性肝癌的临床疗效与传统手术相当,并能改善患者的早期免疫学指标。     

腹腔镜手术与射频消融治疗肝血管瘤的临床疗效对比分析

目的评价腹腔镜手术与射频消融治疗肝血管瘤的临床疗效对比研究,探讨其临床适用性。方法 2009年5月至2014年5月就诊的57例肝血管瘤患者随机分为腹腔镜组29例和射频消融组28例,采用SPSS13.0进行数据统计,手术时间、住院时间和术中出血量,治疗前后疼痛评分比较采用t检验;术后并发症比较采用χ~2检验,P0.05时差异具有统计学意义。结果对于直径在5~10 cm的肝血管瘤,射频消融组患者的手术时间和术中出血量均明显低于腹腔镜组,差异有统计学意义(t=30.131、47.868,P=0.000);治疗后疼痛评分两组均明显改善,且腹腔镜组患者的改善情况优于射频消融组(t=7.918,P=0.000)。射频消融组患者并发症发生率为14.28%(4/28),腹腔镜组患者并发症发生率为13.79%(4/29),差异无统计学意义(χ~2=0.00,P=0.957 3);对于直径在10 cm以上的肝血管瘤,射频消融组所有患者均需进行2次的射频消融术,其中1例患者因首次手术后发生溶血性黄疸未进行第2次手术,腹腔镜组患者1例出现大出血而中转开腹手术。所有患者均未出现肝功能衰竭、腹腔出血等严重并发症,未出现死亡病例。结论两种手术方法在治疗较小的肝血管瘤方面疗效相当,但腹腔镜手术较射频消融术术后疼痛明显轻,对于较大的肝血管瘤腹腔镜手术相对有优势。     

对比观察不可逆电穿孔与射频消融治疗肝癌

目的 对比观察不可逆电穿孔(IRE)与射频消融治疗肝癌的安全性及疗效。方法 前瞻性纳入48例肝癌患者,随机将其分为试验组及对照组,每组24例。对试验组于全身麻醉下行CT引导下IRE消融;对照组于局部麻醉下行CT引导下射频消融;记录术中及术后不良反应,对比评价疗效。结果 对2组患者均顺利完成治疗,试验组1例死于对比剂过敏性休克,其余患者均未发生治疗相关3～4级严重不良反应及并发症。组间术后7天肿瘤消融成功率(96.43%vs. 96.97%)、术后30天(96.43%vs. 93.94%)及90天(89.29%vs. 90.91%)局部无复发率差异均无统计学意义(P均>0.05);术后各时间点总缓解率及疾病控制率差异亦无统计学意义(P均>0.05)。结论 IRE消融治疗肝癌效果明确、安全性高、不良反应轻,其局部控制肿瘤效果与射频消融治疗相当。     

射频凝固器在肝癌肝切除术中的应用

目的 探讨射频凝固器与传统钳夹法行肝癌肝切除术对术中出血和术后并发症的影响.方法 回顾性分析2011年1月至2012年6月第三军医大学西南医院收治的130例肝癌患者的临床资料,采用配对病例对照研究方法,将65例采用射频凝固器进行肝切除术的肝癌患者设立为射频凝固器组;同时根据肿瘤的大小、部位和Child-Pugh分级在肝癌数据库中配对选取65例临床病理特征类似的采用传统钳夹法进行肝切除术的患者设立为传统钳夹组.对两组患者术中和术后的相关参数进行统计学对比分析.计量资料用中位数加范围表示,均数比较用方差分析;计数资料比较用x2检验,当例数＜ 10时采用Fisher确切概率法.结果 射频凝固器组患者的术中断肝时间和肝门阻断时间分别为28 min(12～55 min)和10 min(0～ 15 min),明显短于传统钳夹组的45min(25 ～92m in)和15 min(10～32min),两组比较,差异有统计学意义(F=10.35,9.05,P＜0.05);射频凝固器组患者的术中出血量和术中输血量分别为150ml(50 ～350ml)和0ml,显著少于传统钳夹组的450 ml (250～ 2500 ml)和550 ml(0～2000 ml),两组比较,差异有统计学意义(F=15.86,P＜0.05);射频凝固器组65例患者未输血,显著多于传统钳夹组的48例(x2=19.58,P＜0.05).射频凝固器组患者术后第3、7天AST和TBil,术后第3天PT、Clavien外科并发症分级、住院时间分别为302 U/L(89 ～823 U/L)、54 U/L(16 ～325 U/L)、37 μmol/L(18～112 μmol/L)、24 μmol/L(9～66 μmol/L)、15 s(11 ～20 s)、22％(14/65)、12 d(8 ～36 d),与传统钳夹组的253 U/L(63～876 U/L)、62 U/L(22 ～ 376 U/L)、41 μmol/L(19 ～ 105 μmol/L)、25tμmol/L(11 ～59 μmol/L)、14 s(11 ～21 s)、26％ (17/65)、13 d(9 ～35 d)比较,差异无统计学意义(F =2.59,1.93,3.96,1.58,2.35,x2=0.381,F=1.58,P＞0.05);射频凝固器并发症发生率为17％(11/65),显著低于传统钳夹组的52％(34/65),两组比较,差异有统计学意义(x2=17.38,P＜0.05).其中射频凝固组只有2例患者发生术后出血,显著少于传统钳夹组的22例.但射频凝固器组有8例患者发生断面包裹性积液,其中5例需穿刺引流.传统钳夹组有2例患者发生肝功能不全;射频凝固器组有2例患者发生血红蛋白尿.结论 与传统钳夹法比较,射频凝固器行肝切除术具有出血少、安全、快捷的优点.