瑞芬太尼复合异丙酚静脉麻醉在肝癌射频消融术中的应用

背景与目的:经皮射频消融是治疗小肝癌的最新有效的微创手术,但手术的麻醉尚未得到重视,一般的局部麻醉或者单次使用镇痛药物均无法获得满意的效果.本研究将瑞芬太尼复合异丙酚应用于经皮射频消融治疗肝癌的麻醉,探讨其临床效果以及安全性.方法:选择射频治疗肝癌患者60例,随机分为瑞芬太尼复合异丙酚(R组)组与芬太尼复合异丙酚(F组)组,每组各30例.R组用微量泵输注瑞芬太尼0.1μg·kg-1·min-1,F组单次静注芬太尼1.5μg·kg-1,两组均以异丙酚微量泵维持麻醉.使用UT 4000型床边监护仪记录术前、手术开始时、手术开始后5 min及患者术后苏醒时的平均动脉压、心率、脉搏氧饱和度及呼吸频率,监测动脉血二氧化碳分压;记录患者苏醒时间;记录术中体动、呼吸暂停、胸肌强直次数.结果:R组患者的清醒时间[(5.0±1.8)min]显著短于F组[(10.7±3.0)min](P＜0.001).异丙酚用量R组[(172.0±37.3)mg]显著少于F组[(330.3±61.2)mg](P＜0.001).术中R组的平均动脉压下降明显低于F组(P＜0.05).术中体动R组(5例)少于F组(12例),呼吸暂停R组(12例)多于F组(6例).两组均未见胸肌强直.结论:肝癌射频消融术中应用微量泵静脉输注瑞芬太尼复合异丙酚麻醉效果确切、安全,但需要加强呼吸循环监护与管理.     

经皮肝穿刺射频热凝对复发性肝癌的治疗意义

目的 探讨对于无再次手术指征的复发性肝癌行B超引导经皮肝穿刺射频热凝(PRFA)治疗的意义。方法 1999年10月～2001年7月经病理证实为原发性肝癌，术后影像学和血清肿瘤标记物证实为肝癌复发的47患者进行B超引导PRFA治疗。复发瘤灶为单发者24例、多发者23例，其中复发灶为单发且小于3．5cm者12例。定期随访，复查AFP、肝功能和B超，1个月后复查MRI或CT了解肿瘤坏死情况，以后每3个月复查。Kaplan—Meier法计算累积生存率。结果 复发灶为单发者1、2、3年的生存率分别为65.2％、37．5％、37．5％，复发灶为单发且小于3.5cm者1、2、3年的生存率分别为83.3％、51．4％、51．4％。复发灶为多发者1、2年的生存率为41．7％、19．5％。结论 B超引导经皮肝穿刺射频热凝是肝癌综合治疗中一种重要手段，对于无再次手术指征的复发性肝癌可以根据复发瘤灶的大小、范围、复发时间，决定单独或结合TACE给予B超引导经皮肝穿刺射频热凝(PRFA)治疗，可以更加有效地控制复发、提高生存率。     

经皮肝穿刺射频消融术对肝癌的疗效观察

目的 观察经皮肝穿刺射频消融术对肝癌的热消融作用及其适应证。方法在局麻或硬膜外麻醉下及B超引导下,射频穿刺电极经皮穿刺入肝癌瘤体内,对其进行消融。结果60例患者的96个瘤体中,直径<3.5 cm的41个(42.7％)瘤体获得一次手术热消融。其中,38个完全缓解(CR),3个部分缓解(PR),有效率(CR+PR)100％。41个瘤体中,36个经CT或MRI随访6～24个月,未见复发。直径≥3.5 cm～12 cm的55个(57.3％)瘤体可分2,3次手术,术后1～3个月CT或MRI提示,瘤体CR 2个,PR 37个,CR+PR70％。结论经皮肝穿刺射频消融术治疗肝癌,对直径<3.5 em的瘤体疗效可靠,对直径≥3.5 cm的瘤体仍具有部分热消融的作用。     

经皮肝穿刺射频热凝治疗肝脏恶性肿瘤

Objective To study the therapeutic efficay of percutaneous radiofrequency ablation(PRFA)for hepatic malignancies and to definr its indications and its criteria of the curative effect.Methods In 100 patients with histologically of clinically confirmed hepatocellular carcinoma(HCC)or liver metastases we performed PRFA under ultrasound guidance using Le Veen multipolar array meedle electrode and RF 2000 generator.All patients were followed to identify complications and to assess treatment response.Results PRFA was performed in 76 patients with HCC and in 24 with liver metastases.The Alpha-fetoprotein(AFP)levles of the AFP positive HCC patients with inoperable small HCCs decreased to normal in 75.0%(21/28)and decreased markedly in 21.4%(6/28).Complete necrosis of small hepatic malignancies,documented by magnetic resonance imaging(MRI)was achieved in 85.9%(61/71).If the tumor shows iso-or hyper-intensity on Ti-weighted images,and relative hypointensity on T2-weighted images,and no enhanced intensity on dynamic contrast-enhanced MR imaging,it is considered completely coagulated.Conclusion PRFA is a novel local thermal palliative therapy for small hepatic malignancies that is minimally invasive,safe and effective.In patients with large lesions it can be combined with transarterial chemoembolization(TACE).Critera for curative treatment are normalization of serum AFP and /or MRI or CT scan findings showing complete necrosis.     

经皮微波热凝治疗肝癌的疗效观察

目的 经皮微波肝穿刺对肝癌进行热凝损毁,观察其对肝癌的作用疗效。方法 52例患者在局麻或硬膜外麻醉下,使用2450MHz微波微型穿刺天线,在B超引导下直接经皮穿刺进入肝癌瘤体内,对其进行热凝固。结果 52例患者的97个瘤体中,直径均＜3cm的肿块61个（62．9％）能1次手术热凝损毁,其中57个（93．4％）经CT或MRI检查,并随访6－12个月,提示瘤体热损毁后未见复发;3－5cm的肿块36个（37．1％）,分2次手术,术后6个月CT或MRI检查提示,27个热凝损毁（75．0％）,9个大部分热凝损毁（25．0％）。经皮微波热凝治疗（PMCT）的患者均未见明显的副作用和其他并发症。结论 PMCT治疗肝癌,尤其对直径＜3cm的瘤体疗效可靠,对＞3．5cm或＜5cm的瘤体仍具有大部分或完全热损毁的作用。     

老年肝癌患者的射频消融治疗

目的 比较射频消融治疗老年和非老年肝癌患者的临床疗效。方法回顾性分析比较2004年3月~2007年8月77例老年和非老年肝癌患者射频消融的治疗效果,年龄≥60岁者为老年组(n=31),＜60岁者为非老年组(n=46)。结果 老年组与非老年组比较,肿瘤完全清除率87.1％vs 82.6%(P=0.832),1~3年复发率分别为44.4％、59.8％、71.3％vs 56.4％、70.7％、78.1％(P=0.464)。1~3年生存率分别为89.6％、63.8％、35.9％vs 78.9％、46.6％、20.1％(P=0.114)。并发症的发生比率分别为29.0％vs 26.1％(P=0.776)。肿瘤个数、初治时是否复发及治疗后是否再复发是影响预后的危险因素,而年龄、肿瘤直径不是预后的影响因素。结论 对于老年肝癌患者PRFA治疗可以获得与非老年患者相当的长期生存率,而其微创、重复性好的优势更适合老年肝癌患者,尤其是复发癌患者。     

Hepatocellular carcinoma treated by percutaneous hot saline injection

Percutaneous ethanol injection therapy (PEI) is one of the local methods widely used for hepatocellular carcinoma (HCC) ablation. However, this method is limited by the toxicity of ethanol and severe pain derived from irritation of the peritoneum of the liver capsule. Therefore, we have focused on the heat coagulation necrosis effect of boiled hot saline and devised percutaneous hot water injection therapy (PHoT) as a new local treatment method. PHoT was performed in 17 patients with HCC (total 24 nodules: 11 nodules <2 cm in diameter, 10 nodules from 2-4 cm, and 3 nodules >4 cm). Changes in the AFP values, and both CT and ultrasonography (US) findings before and after treatment were investigated. All 24 tumors received 1 or more treatments (average, 3.3 treat-ments) of PHoT. The injection volume ranged from 3-26 ml (average, 11.2 ml). The total volume of the injection per tumor ranged from 10-37.2 ml (average, 37.2 ml). The AFP values decreased in all patients who initially showed high values. On CT scanning, all lesions receiving PHoT became hypodense. The disappearance of the tumor was also confirmed by contrast-enhanced CT. No severe complications, excluding mild abdominal pain and skin burning, were observed during the procedure. In conclusion, PHoT shows good anti-tumor effects despite a small number of punctures and holds promise as a curative local treatment method for small HCCs.     

经皮穿刺瘤内注射碘油吡柔比星乳剂治疗外生型肝癌的疗效观察

目的探讨经皮穿刺瘤内注射碘油吡柔比星乳剂治疗外生型肝癌的疗效和安全性。方法 7例外生型肝癌接受经皮穿刺瘤内注射碘油吡柔比星乳剂治疗,治疗后评价肿瘤反应及毒副反应。结果所有7例患者共顺利完成10次经皮穿刺瘤内注射碘油吡柔比星乳剂治疗,初次术后3个月后评价疗效,其中CR 2例,PR 4例,SD 1例,有效率为85.7%,无严重毒副反应发生。结论应用经皮穿刺瘤内注射碘油吡柔比星乳剂治疗外生型肝癌患者耐受性良好,且有较好的近期疗效,可以作为经动脉灌注化疗栓塞术治疗的补充。     

Ablative techniques for hepatocellular carcinoma.

The optimal management of hepatocellular carcinoma (HCC) is resection, but this is feasible in only a minority of patients for a variety of reasons, including metastatic disease, major vascular invasion, end-stage liver disease, and poor hepatic reserve. Inoperable patients may be candidates for ablative procedures that may eradicate tumor while minimizing the loss of functioning hepatic tissue that is inevitable with surgical resection. Percutaneous ethanol injection (PEI), hepatic arterial chemoembolization, cryoablation, radiofrequency ablation (RFA), and microwave coagulation offer the potential of local tumor control and sometimes achieve long-term disease-free survival. This review will discuss the indications, anticipated benefits, and limitations of current ablative techniques and place these procedures in proper perspective as options for patients with HCC.     

The validity of radiofrequency ablation for hepatocellular carcinoma

Radiofrequency ablation therapy (RFA) has now become the mainstream percutaneous local treatment for hepatocellular carcinoma (HCC). RFA is superior to both percutaneous ethanol injection (PEI) and percutaneous microwave coagulation therapy (PMCT) because of the large coagulation area obtained by a single session of RF ablation. In addition, the local recurrence rate after RFA is lower than that after PEI. Recently, to improve tumor ablation efficacy, several devices have been reported. We also designed RFA with balloon occlusion of the hepatic artery (balloon-occluded RFA, BoRFA). The coagulation area obtained by BoRFA was significantly larger than that obtained by standard RFA. In Japan, the results for RFA remain insufficient because of the short follow-up periods after treatments. Within a few years, we expect to clarify the indications for RFA treatment for HCC and the choice between RFA and other local treatments.     

多功能喉罩与气管插管在日间手术小细胞肝癌经皮射频消融术中的应用比较

背景与目的：经皮射频消融术(percutaneous radiofrequency ablation，PRFA)治疗小细胞肝癌(small hepatocellular carcinoma，HCC)效果得到认可并在日间手术室得到广泛开展。随着加速康复外科(enhanced recovery after surgery，ERAS)概念的兴起，选择合适的麻醉方法变得日益重要。比较多功能喉罩(multi-function intubating laryngeal mask，multi-function ILM)与气管插管在日间手术PRFA中的麻醉安全性。方法：择期全麻下经皮肝脏射频消融术患者140例，随机分为多功能喉罩组(A组)和气管插管组(B组)，记录并比较两组患者在麻醉诱导前(T₀)、插入喉罩/气管导管前(T₁)、插入喉罩/气管导管即刻(T₂)、插入后5 min(T₃)、10 min(T₄)、15 min(T₅)、拔出喉罩及气管导管即刻(T₆)的收缩压(systoLnc blood pressure，SBP)、舒张压(diastoLnc blood pressure，DBP)及心率(heart rate，HR)，同时记录平均气道压(P_mean)、气道峰压(P_peak)和P_ETCO₂，并观察呛咳、反流误吸、躁动、气道分泌物、拔管后低氧血症及咽喉疼痛等并发症，记录苏醒时间及患者术后满意度。结果：A组插入喉罩及气管导管即刻(T₂)的SBP、DBP及HR显著低于B组，波动更小，差异有统计学意义(P<0.05)；两组的苏醒时间差异有统计学意义(P<0.05)，A组苏醒更快；A组患者气道分泌物增多、喉咙疼痛等并发症明显少于B组，差异有统计学意义(P<0.05)，两组各时点通气效果、术中不良反应发生率及经济效益差异无统计学意义(P<0.05)。结论：多功能喉罩在行PRFA日间手术麻醉中通气效果良好，术后并发症少，安全可靠。对患者血流动力学影响较小，血压波动较小。苏醒期时间更短，有提高患者满意度、降低患者治疗时间的可能，在日间手术中有一定的优势。     

Percutaneous radiofrequency ablation for the treatment of hepatocellular carcinoma in the caudate lobe

Aims

This study aimed to evaluate the efficacy and safety of percutaneous radiofrequency ablation (PRFA) for hepatocellular carcinoma (HCC) in the caudate lobe.

Patients and methods

Between January 2001 and December 2006, 17 patients (twelve males and five females) who were between 33 and 68 years old (mean 54.3), with caudate lobe HCC [2.0–6.5 cm in diameter (mean 3.1)] were treated with either PRFA alone (n = 14), or PRFA with percutaneous ethanol injection (n = 3) under ultrasound guidance. The right or the anterior approach was used in 12 and 5 patients, respectively.

Results

All procedures were performed successfully. There was no mortality and major morbidity due to PRFA. Fourteen tumors (82%) were completely ablated after one to two sessions of treatment. During follow-up (range 3–60, mean 29.1 months), two (14%) developed local recurrence. Intrahepatic metastases developed in 9 of 17 patients (53%). No distant metastasis was found. Four patients died (24%), 3 from tumor progression and 1 from hepatic failure. The 1-, 2-, and 4-year overall survivals were 88%, 80%, and 72%, respectively, and the progress free survivals were 47%, 20%, and 10%, respectively.

Conclusions

PRFA is efficacious and safe for patients with HCC in the caudate lobe.     

射频消融与手术再切除治疗复发性肝癌的比较

目的:比较射频消融和手术再切除治疗原发性肝癌手术切除后复发癌患者的临床疗效.方法:分析比较2002年5月至2007年10月76例原发性肝癌手术切除后复发癌患者射频消融(n=45)和手术再切除(n=31)的临床疗效,引入COX比例风险模型初步分析探讨影响再复发和复发后患者生存期的可能因素.结果:消融组与再手术组比较,肿瘤完全清除率分别为88.9%和100%(P=0.147),1、2、3、5年复发率分别为45.2%、71.6%、80.1%、86.7%和39.6%、60.9%、77.6%、83.2%(P=0.711),1、2、3、5年复发后生存率分别为81.8%、60.1%、40.3%、24.2%和82.9%、64.7%、46.4%、34.8%(P=0.599).复发间期(复发癌距初次手术切除的时间)及复发癌结节个数是影响再手术切除和消融治疗后再复发的危险因素(P=0.035,P=0.005),复发癌结节个数及再复发时间是影响复发后患者生存期的危险因素(P=0.006,P=0.000).消融组并发症的发生率为13.3%,再手术组为29.0%(P=0.091).消融组患者无需输血而再手术组需输血的比率为35.5%(P=0.000).住院时间消融组为7.0天±0.8天,较之再手术组21.9天±1.6天明显缩短(P=0.000).结论:对于原发性肝癌切除术后复发癌患者射频消融术亦可以获得与手术再切除相当的长期生存率,而且具有微创、经济、重复性好的优势,适合于复发癌患者的治疗.     

Examination of percutaneous microwave coagulation and radiofrequency ablation therapy for metastatic liver cancer

Percutaneous microwave coagulation therapy (PMCT) and radio frequency ablation therapy (RFA) as treatments for metastatic liver cancer were examined. PMCT or RFA was administered for 18 metastatic liver cancer lesions (primary lesion: 11 colon rectal cancer, one esophagus cancer, one thyroid cancer, one pancreatic cancer, one pheochromocytoma) in 16 patients from July 1999 to March 2002. RFA was performed 1 time for 12 minutes in principle, using a Cool-tip RF system from Radionics. Patients had a mean age of 58.8 years and the mean diameter of the neoplasms was about 22 mm. Critical complications were not seen. The rate of partial recurrence was 35.3% as of March, 2002, in an average observation period of 7.3 months. On the other hand, with the medical treatment for the hepatocellular carcinoma provided during this period, the rate of partial recurrence was 14.8%. The treatment of metastatic liver cancer by PMCT and RFA is associated with a high rate of a recurrence as compared with hepatocellular carcinoma, and needs to be examined to discover ways of adaptation and improvement of the technology.     

Risk factors of survival after percutaneous radiofrequency ablation of hepatocellular carcinoma

AIMS: This study aimed to determine the risk factors of survival in patients with hepatocellular carcinoma (HCC) undergoing percutaneous radiofrequency ablation (PRFA). PATIENTS AND METHODS: Between August 1999 and May 2005, 281 patients (250 males and 31 females) who were 33-80 years old (mean 65.3 years) received PRFA only or PRFA in combination with percutaneous ethanol injection (PEI) in our center. Patients were treated with PRFA or PEI by a percutaneous approach with ultrasound (US) guidance and were evaluated at regular intervals to determine disease recurrence and survival. The survival curves were constructed by the Kaplan-Meier method and compared by the log-rank test. The relative significance of the variables in the risk factors of overall survival was assessed by multivariate Cox proportional hazards regression analysis. RESULTS: At the end of the study, 189 patients were alive, and 92 were dead. Median survival was 48.7 months. The overall 1-, 3-, and 5-year survival rates were 89%, 54%, and 43%, respectively. The overall 1-, 3-, and 5-year survival rates for small tumor (size < or = 3cm) were 97.8%, 65.7%, 58.6%, respectively, for medium tumor (size 3.1-5cm) 94.1%, 57.1%, 37.1%, respectively, and for large tumor (size >5cm) 62.8%, 40.3%, 0%, respectively. Survival of patients treated with PRFA was dependent on tumor size (p<0.001; risk ratio [RR] 9.6, 95% CI 5.2-17.8), number of tumors (p=0.003; RR 1.6, 95% CI 1.2-2.0), combination with PEI (p=0.01; RR 0.6, 95% CI 0.4-0.9), Child-Pugh class (p=0.002; RR 2.0, 95% CI 1.3-3.0) and safety margin (p=0.0026; RR 0.6, 95% CI 0.4-0.9). CONCLUSIONS: PRFA is an effective treatment for HCC. This study showed after PRFA, tumor size, number of tumors, combination with PEI, safety margin, and Child-Pugh class were independent risk factors of survival.     

Less invasive medical therapy for hepatocellular carcinoma

Since hepatocellular carcinoma (HCC) usually occurs in chronic liver disease, especially viral cirrhosis, it often recurs even after surgical resection. Because of the high recurrence rate of HCC, less invasive therapies have become more common recently, including percutaneous ethanol injection (PEI), percutaneous microwave coagulation therapy(PMCT), and radiofrequency ablation(RFA). A PEI needle or a coagulation electrode is usually inserted into an HCC nodule under ultrasonographic-guidance, and chemical or heat ablation is carried out with local or general anesthesia. A patient with a few numbers of small HCCs of 3 cm or less in diameter is a good candidate for these therapy modalities. Although RFA is the easiest and most effective of these therapies the best therapy for each patient is selected according to the number, size, and location of target lesions.     

Radiofrequency ablation of adrenal tumors and adrenocortical carcinoma metastases

BACKGROUND: The current study was performed to analyze the feasibility, safety, imaging appearance, and short-term efficacy of image-guided percutaneous radiofrequency ablation (RFA) of primary and metastatic adrenal neoplasms including adrenocortical carcinoma. METHODS: The procedure was performed using 36 treatment spheres on 15 adrenocortical carcinoma primary or metastatic tumors in eight patients over 27 months. Tumors ranged from 15 to 90 mm in greatest dimension with a mean of 43 mm. All patients had unresectable tumors or were poor candidates for surgery. Mean follow-up was 10.3 months. RESULTS: All patients were discharged or were free of procedure-related medical care 6-48 hours after the procedures without major complications. All treatments resulted in presumptive coagulation necrosis by imaging criteria, which manifested as loss of previous contrast enhancement in ablated tissue. Eight of 15 (53%) posttreatment thermal lesions lost enhancement and stopped growing on latest follow-up computed tomographic scan. Three of 15 (20%) demonstrated interval growth and four did not change in size. Of these four lesions, two showed contrast enhancement. For smaller tumors with a mean greatest dimension less than or equal to 5 cm, 8 of 12 (67%) tumors were completely ablated, as defined by decreasing size and complete loss of contrast enhancement. Three of 15 (20 %) tumors and related thermal lesions were found to have disappeared nearly completely on imaging. CONCLUSIONS: Percutaneous, image-guided RFA is a safe and well tolerated procedure for the treatment of unresectable primary or metastatic adrenocortical carcinoma. The procedure is effective for the short-term local control of small adrenal tumors, and is most effective for tumors less than 5 cm. The survival rate for patients with adrenocortical carcinoma improves when radical excision is performed in selected patients. Aggressive local disease control may potentially influence survival as well. However, further study is required to evaluate survival impact, document long-term efficacy, and to determine if RFA can obviate repeated surgical intervention in specific clinical scenarios.     

Predictive factors for intrahepatic recurrence after percutaneous ethanol injection therapy for small hepatocellular carcinoma

BACKGROUND: Percutaneous ethanol injection therapy has been used widely for small hepatocellular carcinoma. This study was undertaken to determine factors predictive of local recurrence or new nodular recurrence in patients with small hepatocellular carcinoma treated with percutaneous ethanol injection. METHODS: The authors studied 73 nodules treated with percutaneous ethanol injection in 49 patients with small hepatocellular carcinoma. The usefulness of predictive factors for recurrence was assessed with the Kaplan-Meier method. The clinicopathologic variables examined included age, gender, Child-Pugh classification, number of tumors (single vs. multiple), tumor size, degree of tumor differentiation, ultrasonographic findings such as peripheral hypoechoic band (so-called 'halo'), intratumoral echo pattern, tumor staining on enhanced computed tomography, combination therapy with transcatheter arterial embolization, and serum alpha-fetoprotein level. RESULTS: The local recurrence rates were 19%, 27%, 33%, 33%, and 33%, respectively, and the new nodular recurrence rates were 19%, 51%, 74%, 83%, and 83%, respectively, at 1, 2, 3, 4, and 5 years after percutaneous ethanol injection therapy. The frequency of local recurrence was associated with the histologic differentiation of more than moderately differentiated (P < 0.001), presence of a sonographic halo (P < 0. 005), an intratumoral heterogeneous echo pattern (P < 0.001), and positive tumor staining on enhanced computed tomography (P < 0.01). Multivariate analysis showed that the presence of a halo and an intratumoral heterogeneous echo pattern were the most important variables for predicting local recurrence. The frequency of new nodular recurrences was related to the presence of multiple tumors (P < 0.01) and a high serum alpha-fetoprotein level (P < 0.001). Multivariate analysis showed that a high serum alpha-fetoprotein level was a reliable predictor of new nodular recurrence. CONCLUSIONS: This study showed that the presence of a halo and an intratumoral echo pattern on ultrasonography were useful predictors for local recurrence after percutaneous ethanol injection therapy for small hepatocellular carcinoma, and that a high serum alpha-fetoprotein level was associated with a higher frequency of new nodular recurrences.     

Comparison of percutaneous microwave coagulation area under interruption of hepatic arterial blood flow with that under hepatic arterial and venous blood flow for hepatocellular carcinoma

The study subjects were 49 patients with hepatocellular carcinoma. Twenty-nine patients underwent hepatic arterial blood flow block via thrombosis of the cancer-bearing area with a gelatin sponge, while the other 20 patients underwent a combination of hepatic arterial block and partial blood flow block of the portal vein with a hepatic venous balloon. Percutaneous microwave coagulation therapy (PMCT) was performed on these patients according to the type of hepatic blood flow block, and the diameters of the coagulation areas in the two groups were compared using CT images taken under portal venography. The 29 patients who underwent hepatic arterial block (A-PMCT) had a mean tumor diameter of 19.2 +/- 8 mm, while the 20 patients who underwent hepatic arterial and hepatic venous block (AV-PMCT) had a mean tumor diameter of 25.3 +/- 8.3 mm. PMCT was performed at 60 W. The mean coagulation time and the mean coagulation diameter were 4.2 +/- 1.1 min and 36.3 +/- 12.3 mm, respectively, for the A-PMCT group and 5.5 +/- 1.8 min and 43.9 +/- 9.8 mm, respectively, for the AV-PMCT group. A comparison of the coagulation diameters indicated that the AV-PMCT group had a significantly greater coagulation area than the A-PMCT group (p < 0.05).     

A clinical study of endoscopic local coagulation therapy for hepatocellular carcinoma (HCC)

Eighteen subjects with cases of HCC who underwent endoscopic local coagulation therapy at Hiroshima City Hospital between 1998 and 2004 were studied and compared with 6 cases of HCC patients who underwent laparoscopic partial hepatectomy during the same period. The subjects composed of 10 cases of laparoscopic microwave coagulation therapy (L-MCT), 5 cases of laparoscopic radio frequency ablation therapy (L-RFA), and 3 cases of thoracoscopic microwave coagulation therapy (T-MCT). The operation time was 114 minutes for L-MCT and 92 minutes for L-RFA, both of which were significantly shorter than 208 minutes for resection cases. No complications were developed in any of the cases and the postoperative hospitalization period of the cases was 13.1 days, 8.2 days, and 13.0 days, respectively. Although each case of local recurrence was observed both in L-MCT and L-RFA groups, one case displayed observation difficulty from the liver surface and the other required a daughter nodule. The three-year survival rate was 71.4%, while the five-year survival rate was 53.6%. Endoscopic local coagulation therapy is not too invasive and useful for hepatocellular carcinoma in which percutaneous RFA is difficult. However, it is well indicated when the scope is evident with observation being feasible from the liver surface.