Duodenopleural fistula formation after percutaneous radiofrequency ablation for recurrent hepatocellular carcinoma

Radiofrequency ablation (RFA) is a treatment option in the management of unresectable or recurrent hepatocellular carcinoma (HCC). It can be performed either through laparotomy or in a minimally invasive manner by percutaneous, laparoscopic or thoracoscopic routes. Percutaneous RFA is associated with reduced surgical trauma and thus can be performed in patients with significant comorbidities. The procedure can be repeated after short intervals for sequential ablation of multiple liver lesions. However, the associated risks should not be underestimated. This is the first report of a rare complication of duodeno-pleural fistula after percutaneous RFA of a recurrent subcapsular HCC. The risk of bowel perforation during the ablation of subcapsular HCC requires special attention, since only the position of the tip of the electrode, but not the zone of ablation, can be assessed accurately by imaging during the procedure. Our case demonstrated that there was leakage of bowel content from the duodenal injury site into the pleural cavity through the RFA track. Subsequent uncontrolled infection resulted in empyema thoracis and led to the death of the patient.     

Delayed colonic perforation after percutaneous radiofrequency ablation of hepatocellular carcinoma

Radiofrequency ablation (RFA) is an effective treatment for hepatocellular carcinoma. Colonic perforation secondary to RFA of the liver is an uncommon complication that has been reported to have an incidence between 0.1% and 0.3%. Lesions adjacent (within 1 cm) to the colonic wall and those in patients with history of upper abdominal surgery or chronic cholecystitis are particularly at risk. More importantly, thermal injury leading to colonic perforation has proved to have a fatal outcome. We present a case of percutaneous RFA in a patient with hepatocellular carcinoma that was abutting the colonic hepatic flexure. Colonic perforation was diagnosed on the eighth day postablation when the patient was readmitted with peritonitis.     

经皮射频消融治疗复发性肝癌的预后分析

目的 探讨影响经皮射频消融(PRFA)治疗复发性肝癌预后的影响因素.方法 1999年1月至2008年12月共有82例复发性肝癌患者(单个肿瘤最大径≤7 cm;多个肿瘤者最大径≤5 cm且肿瘤数目≤3个)接受PRFA治疗,收集其临床及病理学特征等12项可能影响预后的因素作回顾性单因素与多因素分析.结果 全组患者1、3、5年生存率分别是75.8%、43.9%、34.5%(从PRFA术后算起)和95.1%、63.2%、46.6%(从初次手术算起);单因素分析显示初次肿瘤大小、复发期限长短、复发肿瘤数目、复发肿瘤大小、血清谷氨酰转肽酶(GGT)和白蛋白(ALB)水平与复发性肝癌行PRFA的预后有相关性(P<0.05);进一步行Cox模型多因素分析得出与预后相关因素为复发期限长短、复发肿瘤大小、血清GGT与ALB水平(P<0.05).结论 PRFA治疗复发性肝癌疗效确切,复发期限、复发肿瘤大小、血清GGT与ALB水平为其显著性预后影响因子.     

原发性肝癌射频消融后综合征的临床观察

目的研究原发性肝癌（HCC）经皮射频消融术（RFA）后出现消融后综合征的发生率，分析其发生的原因。方法2002年7月至2006年4月，37例HCC采用经皮RFA技术进行治疗。治疗前后分别行实验室及影像学检查。观察治疗后出现的各种临床症状及持续时间。结果37例均顺利完成RFA治疗。32．4％（12／37）病人出现消融后迟发性症状。其中发热12例、寒战1例、全身不适7例、消融部位疼痛9例、恶心5例、呕吐2例、呃逆2例。治疗后3d症状最明显，均在对症处理后14d内消失。消融后症状的发生与肿瘤体积、消融区体积、射频治疗时间及血清转氨酶（AST、ALT）水平呈明显相关性（P〈0．01）。肿瘤体积〈50cm^3（直径4．5cm）共19例，均未发生消融后综合征；肿瘤体积〉50cm^3共18例，66．7％（12／18）病人发生消融后综合征。结论HCC经皮RFA治疗后，约1／3病人可发生消融后综合征，其发生率与病灶大小相关，对症处理后2周内可自行消失。     

Portal vein thrombosis after radiofrequency ablation for recurrent hepatocellular carcinoma

Recurrent hepatocellular carcinoma (HCC) deserves multidisciplinary treatment in addition to surgical resection. Radiofrequency ablation (RFA) is an evolving, localized, thermal ablative treatment for unresectable hepatocellular carcinoma (HCC). Though the preliminary results of RFA in clinical studies are encouraging, its serious complications should not be underestimated. Portal vein thrombosis as a result of direct blood vessel injury by RFA is rarely reported and is potentially fatal in patients with limited liver reserve due to underlying liver cirrhosis. We present a case of portal vein thrombosis as a complication of RFA treatment for recurrent HCC and illustrate its underlying possible mechanism.     

Surgically treated diaphragmatic perforation after radiofrequency ablation for hepatocellular carcinoma

We review 6 cases of diaphragmatic perforation, with and without herniation, treated in our institution. All patients with diaphragmatic perforation underwent radiofrequency ablation(RFA) treatments for hepatocellular carcinoma(HCC) performed at Kurume University Hospital and Tobata Kyoritsu Hospital. We investigated the clinical profiles of the 6 patients between January 2003 and December 2013. We further describe the clinical presentation, diagnosis, and treatment of diaphragmatic perforation. The change in the volume of liver and the change in the Child-Pugh score from just after the RFA to the onset of perforation was evaluated using a paired t-test. At the time of perforation, 4 patients had herniation of the viscera, while the other 2 patients had no herniation. The majority of ablated tumors were located adjacent to the diaphragm, in segments 4, 6, and 8. The average interval from RFA to the onset of perforation was 12.8 mo(range, 6-21 mo). The median Child-Pugh score at the onset of perforation(8.2) was significantly higher compared to the median Child-Pugh score just after RFA(6.5)(P = 0.031). All patients underwent laparotomy and direct suture of the diaphragm defect, with uneventful post-surgical recovery. Diaphragmatic perforation after RFA is not a matter that can be ignored. Clinicians should carefully address this complication by performing RFA for HCC adjacent to diaphragm.     

Locoregional recurrences are frequent after radiofrequency ablation for hepatocellular carcinoma

BACKGROUND: Enthusiasm for radiofrequency ablation (RFA) therapy for patients with unresectable hepatocellular carcinoma (HCC) has increased. The data for recurrence after RFA for patients with HCC is not well documented. The purpose of this study was to evaluate tumor recurrence patterns after RFA in patients with unresectable HCC. STUDY DESIGN: Over a 3-year period, 50 patients having RFA for unresectable HCC were identified at a single institution. Medical records and radiologic studies were reviewed and outcomes factors analyzed. RESULTS: Of the entire cohort, 46 patients underwent RFA by a percutaneous approach under CT guidance. Most patients underwent either one (n = 22) or two ablations (n = 23). At the time of this report, 14 patients (28%) were tumor-free by radiologic and biochemical (alpha-fetoprotein) parameters. Eighteen additional patients had persistence of tumor at the ablation site and 14 patients had recurrence in the liver at sites different from the ablation site. An additional four patients had recurrence in extrahepatic sites. Twelve patients underwent orthotopic liver transplantation after RFA. Of these 12, 5 (42%) demonstrated no viable tumor in the explanted liver. Independent predictors of tumor recurrence included tumor size, serum AFP levels, and the presence of hepatitis. CONCLUSIONS: These data suggest that factors such as tumor size should be considered before employing RFA therapy. In addition to treating the primary tumor, other therapies aimed at the liver's inflammatory state might also be important in achieving a durable response after RFA.     

Risk factors and prognostic factors of local recurrence after radiofrequency ablation of hepatocellular carcinoma

BACKGROUND: Local recurrence rates after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) vary from 2% to 36% in the literature. Limited data were available about the prognostic significance of local recurrence. STUDY DESIGN: Between April 2001 and March 2006, 273 patients with 357 hepatocellular carcinoma nodules underwent RFA, with radiologically complete tumor ablation after a single session of RFA. The risk factors of local recurrence and its impact on overall survival of patients were analyzed. RESULTS: With a median followup period of 24 months, local recurrence occurred in 35 patients (12.8%). By multivariate analysis, tumor size > 2.5 cm was the only independent risk factor for local recurrence. There was no notable difference in overall survival between patients with and without local recurrence. By multivariate analysis, local recurrence more than 12 months after RFA and complete response after additional treatment of local recurrence were associated with better overall survival in patients with local recurrence. CONCLUSIONS: This study demonstrated that tumor size > 2.5 cm was the main risk factor for local recurrence after RFA of hepatocellular carcinoma. Our data suggested that additional aggressive treatment of local recurrence aimed at complete tumor response improves overall survival of patients. Late local recurrence was also associated with better prognosis, suggesting different tumor biology between early and late local recurrent tumors after RFA.     

肝裸区肝细胞癌经皮射频消融治疗的疗效和安全性

目的 探讨CT引导下经皮射频消融(percutaneous radiofrequency ablation,PRFA)治疗肝裸区肝细胞癌(hepatocellular carcinoma in the bare area,HCCBA)的疗效和安全性.方法 回顾性总结作者在2000年4月至2009年6月间收治的肝细胞癌(hepatocellular carcinoma,HCC)病人的临床资料,共有26例早期HCCBA病人接受了CT引导下PRFA治疗,作为HCCBA组;在右肝非裸区HCC病人中,以癌灶距肝包膜、胆囊和第一肝门主要分支的距离≥1.0 cm为条件,纳入26例作为对照组.两组病人的年龄、性别、基础肝病原因、肝功能分级、癌灶直径等方面的差异无统计学差异(P>0.05).癌灶残留采用PRFA后1个月增强CT和(或)甲胎蛋白(alpha-fetoprotein,AFP)追踪判定,将完全消融至局部肿瘤复发的间隔时间作为无瘤生存时间.用t检验比较癌灶直径,用MannWhitney U检验比较年龄、肝病原因、肝功能分级、AFP水平和穿刺次数等指标,用χ2检验比较完全消融率和局部无瘤生存率等指标.结果 两组术后并发症、穿刺次数和完全消融率无统计学差异(P>0.05).HCCBA组1年、3年和5年局部无瘤生存率分别为88.5%、46.2%和19.2%,对照组分别为92.3%、53.8%和15.4%,两组间亦无统计学差异(P>0.05).结论 CT引导下PRFA治疗HCCBA是安全和有效的,可以作为治疗方案之一.     

射频消融治疗初发小肝癌的疗效及预后因素分析

目的 分析射频消融治疗初发小于5 cm 肝细胞癌的疗效和预后因素,探索射频消融治疗小肝癌的适应证及进一步提高疗效的方法 .方法 采用回顾性队列研究方法 ,分析2001年10月至2006年12月期间,124例在中山医院肝癌研究所行射频消融治疗初发小于5 cm肝细胞癌135个病灶,随访期至2008年3月.结果 中位随访期22个月,中位、平均总体生存期为46个月、(42.7± 2.7)个月;1、2、3、4、5年的总体生存率为86.8%、66.5%、56.5%、45.6%、36.5%.与总体生存相关的独立危险因素有:白蛋白(P=0.007,r=2.227)和凝血酶原时间(P=0.035,r=2.010).白蛋白≤35 g/L且凝血酶原时间＞13 s(45例)和白蛋白＞35 g/L且凝血酶原时间≤13 s(42例)两组病人5年生存率和中位生存时间分别为25%、21个月和67%、63个月.结论 白蛋白和凝血酶原时间正常的初发小肝癌病人接受射频消融治疗能获得较高的5年生存率.     

腹腔镜联合经皮超声射频消融治疗肝细胞肝癌的疗效探讨

目的:探讨腹腔镜联合经皮超声射频消融术治疗肝癌的临床应用价值。方法:2011年5月至2015年10月为56例肝癌患者行腹腔镜下联合经皮超声射频消融术,记录术后肝功能、甲胎蛋白、生命体征及1个月后影像学检查结果。结果:56例患者、108个病灶均完成射频消融治疗,术后无针道出血、肝功能衰竭及邻近脏器损伤等严重并发症发生,102个病灶消融满意,6个病灶周围有残存,2个病灶在超声造影指引下予以再次消融,4个病灶在CT引导下再次消融,再次消融效果满意。结论:腹腔镜联合经皮超声射频消融治疗特殊部位的肝癌具有消融完全,避免针道出血、周围脏器损伤等特点,具有良好的临床应用价值。     

原发性肝癌射频治疗后局部免疫功能的变化及其临床意义

目的对原发性肝癌（hepatocellular carcinoma，HCC）射频消融治疗（radiofrequency ablation，RFA）前后肿瘤内部及边缘热休克蛋白70（heat shock protein，HSP70）的表达、CD8^＋T细胞数量的变化以及RFA治疗后，肿瘤边缘HSP70表达与肿瘤边缘CD8^＋T细胞数量之间的关系进行观察，探讨RFA治疗对原发性肝癌局部免疫功能状态的影响及其可能的临床意义。方法对17例HCC分别在RFA治疗前、后1个月，于肿瘤内部和肿瘤边缘超声引导下穿刺活检取样；采用PowerVision^TM二步染色法进行免疫组化分析，测定HSP70的表达、CD8^＋T细胞的数量；随访HCC复发／新生情况。结果RFA治疗后肿瘤边缘组织HSP70表达增强（Z=3．337，P=0．001）、CD8^＋T细胞数量增多（Z=1．996，P=0．049）；RFA治疗后，≤4cm肿瘤组的占位边缘CD8^＋T细胞数量高于〉4cm肿瘤组（Z=1．966，P=0．048）。RFA治疗后，边缘组织HSP70表达与CD8^＋T细胞数量之间呈正相关关系（r=0．489，P=0．046）；RFA治疗后，无复发或新生组的占位边缘组织HSP70表达和CD8^＋T细胞数量分别高于复发或新生组（Z=2．009，P=0．045；Z=2．007，P=0．045）。结论RFA治疗后边缘HSP70表达增强、CD8^＋T细胞数量增多，显示RFA治疗后局部免疫原性提高，抗肿瘤效应细胞浸润增加。     

经皮微波和射频消融治疗肝细胞性肝癌的临床比较研究

目的探讨经皮微波和射频消融治疗肝癌临床效果的差异。方法以相同的纳入标准,回顾性比较了肝细胞性肝癌经超声引导经皮微波消融49例98个结节和射频消融53例72结节的局部疗效、并发症和远期生存率。结果微波组与射频组比较,肿瘤完全消融率分别为94.9%(93/98)和93.1%(67/72)(P=0.75),局部复发率为11.8%(11/93)和20.9%(14/67)(P=0.12)。主要并发症发生率分别为8.2%(4/49)和5.7%(3/53)(P=0.71)。1、2、3年无瘤生存率微波组分别为45.9%、26.9%和26.9%,射频组为37.2%、20.7%和15.5%(P=0.53)。1、2、3、4年累积生存率微波组分别为81.6%、61.2%、50.5%和36.8%,射频组为71.7%、47.2%、37.6%和24.2%(P= 0.12)。结论经皮微波和射频消融治疗肝癌的局部疗效、并发症和远期生存率无显著差别,均为安全有效的肝癌治疗手段。     

腹腔镜下射频消融治疗肝细胞肝癌

目的 评价分析腹腔镜下射频消融(radiofrequency ablation,RFA)治疗原发性肝癌的安全及疗效性.方法 回顾性研究分析2008年5月至2010年7月中日友好医院应用腹腔镜下RFA治疗原发性肝癌78例,全部病例均在腹腔镜超声引导下至少一个病灶穿刺活检确诊为肝细胞肝癌.其中男41例,女37例,年龄31～87岁(中位年龄57岁).统计分析肿瘤坏死情况、肿瘤局部复发对总生存率的影响.结果 78例患者中位随访16个月.肿瘤直径、是否邻近大血管、周围是否有卫星灶及是否联合经导管肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)是影响肿瘤复发的主要因素.直径＜3 cm的肿瘤完全消融率90.5％(38/42),明显比＞3 ～5 cm的肿瘤消融率71.4％ (20/28)高,二者比较差异有统计学意义(x2 =4.291,P=0.038).肿瘤未邻近大血管组的肿瘤消融率91.9％ (61/67),高于肿瘤邻近大血管组的消融率63.6％ (7/11),二者相比差异有统计学意义(x2 =6.351,P=0.012).RFA组和联合TACE组的肿瘤消融率分别为75.0％和88.9％,两者相比,差异无统计学意义(x2=1.567,P=0.211).RFA治疗后平均总生存期(48.7±2.4)个月,术后1、2、3、4、5年的总生存率分别为86.1％、76.9％、60.3％、51.8％、33.1％.结论 RFA是肝脏恶性肿瘤安全、有效的治疗手段,而腹腔镜下RFA,能够更好的判断肿瘤大小、数目以及肿瘤与周围血管的关系,使穿刺更加准确,从而获得更好的远期疗效.