膈顶部原发性肝癌的射频消融

目的 探讨膈顶部原发性肝癌射频消融(RFA)的治疗转归.方法 2006年2月至2008年3月,共有251例原发性肝癌患者接受了超声引导下的经皮RFA,其中42例56个肿瘤位于膈顶部,定义为A组.另有209例368个肿瘤位于非膈顶部,定义为B组.结果 初次RFA后,A、B两组的完全消融率、局部复发率及并发症发生率分别为85.7%比86.6%;9.5%比11.5%和7.1%比4.7%.差异均无统计学意义(P>0.05).将B组按肿瘤具体部位进一步分为肝实质内、包膜下、空腔脏器旁以及肝门部肿瘤,再与A组比较,显示上述5个不同部位肿瘤完全消融率两组间差异有统计学意义(P<0.05).膈顶部和非膈顶部直径<3 cm,3～5 cm和>5 cm肿瘤的完全消融率分别为90.2%,76.9%,50%和96.6%.78.1%.69.2%,两组同等直径范围肿瘤的完全消融率差异无统计学意义(P>0.05).A、B两组1年无复发生存率分别为62.3%和59.2%,总生存率分别为90.O%和92.O%.2年无复发生存率分别为56.6%和52.4%,总生存率分别为82.7%和84.2%.A、B两组1、2年无复发生存率和总体生存率之间差异无统计学意义(P>0.05).结论 尽管膈顶部肿瘤位置的特殊性影响着RFA后疾病转归,但与其他部位肿瘤相比,膈顶部肿瘤在治疗效果、治疗风险、局部复发以及生存预后方面均不逊色,膈顶部肿瘤并非RFA的禁忌证.     

微波消融联合人工腹水治疗临近膈肌肝癌临床研究

目的探讨超声引导下经皮微波消融(MWA)联合人工腹水治疗临近膈肌(肿瘤距膈肌最短距离≤0.5cm)肝癌的有效性和安全性。方法收集我院2012年7月~2014年12月行MWA治疗的肝癌患者共129例(157个灶),临近膈肌患者47例(63灶)为观察组,97.9%(46/47)患者均行人工腹水下MWA治疗,远离膈肌(肿瘤距膈肌最短距离≥1cm)肝癌患者82例(94灶)为对照组。术后比较两组肿瘤完全消融率、局部肿瘤进展率及并发症发生率。结果术后1个月增强CT/MRI或超声造影(CEUS)显示观察组及对照组均完全坏死,完全消融率为100%。观察组及对照组局部肿瘤进展率分别为4.8%(3/63)、3.2%(3/94)(P=0.61)。术后1~2天观察组出现右侧少量胸腔积液、右肩部疼痛、恶心呕吐明显高于对照组,观察组3例患者行置管引流,但均在1周内恢复正常,均未出现肝脓肿、血胸、气胸等严重并发症。结论人工腹水下消融治疗临近膈肌肝癌与一般的经皮消融治疗相比,是一种安全、准确、有效的治疗方法。     

CT导引下氩氦冷冻消融联合~(125)I放射粒子植入治疗膈顶部肝癌的临床应用

目的探讨CT引导下氩氦冷冻消融联合125I放射粒子治疗膈顶部肝癌的方法、疗效。方法选择通过3期CT增强扫描并经穿刺活检病理证实的膈顶部肝癌16例,行CT导引下氩氦冷冻消融联合125I放射粒子治疗。结果 16例膈顶部肝癌患者治疗后3个月、6个月、12个月、24个月AFP下降率依次是100%(16/16),100%(16/16),93.8%(15/16),87.5%(14/16),肿瘤局部控制率依次是100%(16/16),100%(16/16),87.5%(14/16),87.5%(14/16)。结论 CT引导下氩氦冷冻消融联合125I放射粒子治疗膈顶部肝癌,疗效可靠,是提高治疗局部控制率和生存率的有效方法。     

完全性胸腹腔内脏反位合并原发性肝癌行经皮微波消融治疗4例

目的 探讨完全性胸、腹腔内脏反位合并原发性肝癌行经皮微波消融(MWA)治疗的安全性及有效性.方法 2013年1月—2014年9月,对4例完全性内脏反位合并原发性肝癌行超声引导下经皮MWA治疗,在B型超声引导下,于左侧肋间进针,插入消融针至肿瘤体内,微波输出功率80～100W,消融时间为2～5 min,完成手术.结果 4例手术均顺利,2例因肿瘤＞3 cm,采用2根消融针行多点热消融.肿瘤均完全热消融,术中、术后患者生命体征平稳,无不适主诉.无近期并发症,无一例发生消融相关死亡,4例分别随访12、18、19、28个月,均存活.结论 超声引导下经皮MWA治疗完全性内脏反位合并原发性肝癌安全、有效.     

特殊部位小肝癌超声引导下微波消融与手术切除的对比研究

【摘要】 目的 对比研究超声引导下经皮微波消融（MWA）与手术切除治疗特殊部位原发性小肝癌的疗效。 方法 分析240例特殊部位原发性小肝癌患者的资料,对比超声引导下MWA组与手术切除组近、远期疗效。 结果 MWA组与手术切除组围手术期均未出现严重并发症,对比两组肿瘤首次完全消除率、复发率,差异均无统计学意义（P=0.072,P=0.233）。MWA组患者术后肝功能、术中出血量、手术时间、术后体温、术后住院天数以及住院费用均优于手术切除组（P＜0.05）。MWA组与手术切除组1、3、5年总生存率分别为96.6%、86.4%、64.2%,95.1%、88.0%、70.3%,P=0.852。1、3、5年无瘤生存率分别为84.4%、62.8%、42.9%,81.3%、62.0%、57.7%,P=0.341。 结论 超声引导下MWA治疗特殊部位原发性小肝癌与手术切除具有相似的生存疗效,相比于手术切除更经济微创、简便易行。     

彩色多普勒超声引导射频消融治疗肝硬化合并小肝癌的疗效观察

目的观察彩色多普勒超声引导下,射频消融治疗肝硬化合并小肝癌患者的临床疗效。方法将120例合并肝硬化的小肝癌患者采用超声引导射频消融治疗,观察其术后近、远期疗效及生存率。结果 120例患者共165个肿瘤,首次完全消融达到80.0%,术后第1、3、5年的总体无瘤生存率分别为80.0%、32.5%、30.0%。肿瘤直径≤3 cm组和>3 cm组比较,≤3 cm组近期疗效优于>3 cm组。结论彩色多普勒超声引导射频消融治疗肝硬化合并小肝癌治疗效果好,对肝功能影响小,并发症少。     

多电极组合穿刺在较大肝癌射频消融中的应用

目的 总结应用多电极组合布针+多位点叠合射频消融(RFA)治疗较大肝癌(肿瘤最大直径>4 cm)的疗效,探讨电极针应用数量和布针方式与疗效的关系.方法 2006年2月到2008年12月,共对113例失去手术机会的较大肝癌患者实施了超声引导下经皮肝RFA.所有肿瘤按大小分成A、B、C、D 4组.A组肿瘤直径4.0-5.0 cm;B组肿瘤直径5.1-6.0 cm;C组肿瘤直径6.1～7.0 cm:D组肿瘤直径7.1-9.3 cm.根据肿瘤不同直径决定应用的电极针数量及消融位点数目.术后随访评估治疗后肿瘤凝固性坏死结果及局部复发状况.结果 RFA后2个月内首次复查,A、B、C、D 4组患者的完全消融率分别为88.4%,78.6%,63.6%和40.O%,总体完全消融率为79.7%.随访3～36个月,A、B、C、D组的局部复发率分别为5.5%,10.O%,28.6%和50.O%,总体局部复发率为10.5%.残留以及局部复发的肿瘤根据不同情况接受再次RFA、TACE或放疗.结论 多电极组合布针+多位点叠合RFA治疗较大肝癌疗效确切,简单实用,但最好结合其他治疗方式以提高完全消融率.     

CT引导下氩氦冷冻、射频消融和微波消融治疗肝癌的疗效对比

目的比较CT引导下氩氦刀冷冻治疗(AHC)、射频消融治疗(RF)和微波消融(MWA)治疗肝癌的消融效果及远期疗效。方法 2009年1月~2012年1月收治的肝癌患者164例,其中52例(84个结节)采用氩氦刀冷冻消融技术,56例(100个结节)采用RF消融技术,56例(114个结节)采用MWA消融技术,观察三组患者治疗后肿瘤消融率、复发率、1~2年生存率及并发症发生情况。结果AHC、RF组和MWA组的肝癌完全消融率分别为97.6%(82/84)、90.0%(90/100)和89.5%(102/114),差异无统计学意义(P=0.28)。局部复发率分别为11.5%(6/52)、14.3%(5/56)和17.8%(10/56),差异无统计学意义(P=0.83)。AHC组无并发症发生(0/52),RF组和MWA组并发症发生率为7.1%(4/56)和10.7%(6/56),差异无统计学意义(P=0.25)。三组手术治疗患者随访1年无瘤生存率分别为92.3%、88.1%和82.5%;随访2年的无瘤生存率为75.0%、65.2%、68.1%,Log-rank检验显示三组肝癌患者生存期之间的差异无统计学意义(2=0.07,P=0.97)。结论氩氦刀冷冻消融、射频消融和微波消融治疗肝癌的完全消融率、并发症和远期生存率无显著差别,在临床治疗中,要根据患者的具体情况,合理选择治疗方式,取长补短,以便达到满意的治疗效果。     

超声引导下经皮微波消融与冷冻消融治疗高风险部位肝癌的对照研究

目的：比较超声引导下经皮微波消融与冷冻消融治疗高风险部位肝癌的临床结局及术后并发症,并分析影响预后和术后复发的因素。 方法：选取2014年4月至2018年3月广州复大肿瘤医院收治的120例高风险部位肝癌患者,其中64例接受微波消融治疗（微波组）,56例接受冷冻消融治疗（冷冻组）。比较两组的治疗结局,主要包括生存、复发及术后并发症。用Cox回归模型分析预后和术后复发的影响因素。 结果：微波消融组1、3、5年总生存率分别为85.8%、63.5%、63.5%,冷冻消融组为92.0%、87.4%、74.9%,两组差异无统计学意义（P=0.141）。微波消融组1、3、5年无复发生存率分别为77.8%、49.0%、49.0%,冷冻消融组分别为81.4%、58.5%、46.8%,两组差异无统计学意义（P=0.469）。微波消融组的3、6、9、12个月的局部进展率分别为3.1%、6.3%、9.4%、15.9%,高于冷冻消融组（分别为0%、0%、3.7%、19.0%）,差异有统计学意义（P=0.003）。微波组的主要和次要并发症发生率（分别为6.3%、82.8%）均高于冷冻组（分别为0%、32.1%）,差异有统计学意义。年龄≥65岁,直径3~5 cm及Child-Pugh分级B级是肝癌术后预后较差的危险因素;直径3~5 cm、多个肿瘤以及多次消融是消融术后复发的危险因素。 结论：冷冻消融治疗高风险部位的肝癌具有与微波消融接近的生存结局,但具有更好的局部肿瘤控制率及更少的并发症,适合在临床中推广应用。     

多次肝动脉化疗栓塞术联合射频消融在肝癌治疗中的临床应用

目的评价多次肝动脉化疗栓塞(TACE)联合射频消融(RFA)治疗肝癌的临床疗效。方法对经多次TACE治疗后仍有肿瘤残余的10例肝癌患者分别行B超引导下射频消融治疗,术后随访监测甲胎蛋白(AFP)的动态变化及肝脏CT表现来评价疗效。结果 RFA治疗后3~6个月,生存率为100%,其中9例患者AFP<400 ng/mL,CT检查无肿瘤复发征象者8例,有肿瘤复发征象者2例。9~12个月复查,8例患者AFP<400 ng/mL,CT增强扫描未发现肿瘤复发征象;有肿瘤复发征象的患者2例,再次行射频消融治疗。8例患者随访时间达到24个月,其中6例患者AFP<400 ng/mL,CT增强扫描未发现肿瘤复发者7例;1例患者死亡。结论多次TACE联合射频消融为中晚期肝癌治疗提供了新的治疗思路与途径。     

Comparison of two different thermal techniques for the treatment of hepatocellular carcinoma

Purpose

To compare the safety and efficacy of radiofrequency ablation (RFA) and microwave ablation (MWA) in treating hepatocellular carcinoma (HCC) while conforming to the Milan criteria.

Materials and methods

The study was approved by the Institutional Review Board, and informed consent was waived due to the retrospective study design. One hundred ninety-eight patients met the inclusion criteria and were included in the study. Eighty-five patients with 98 lesions received RFA, and 113 patients with 131 lesions underwent MWA. Complete ablation rates, local recurrence rates, disease-free survival rates, cumulative survival rates, and major complications were compared between the two treatment groups.

Results

Complete ablation rates were 99.0% for RFA and 98.5% for MWA (P = 1.000). Local recurrence rates were 5.2% for RFA and 10.9% for MWA (P = 0.127). Disease-free survival rates at 1, 2, 3, and 4 years were 80.3%, 61.8%, 39.5%, and 19.0% in the RFA group and 75.0%, 59.4%, 32.1%, and 16.1% in the MWA group, respectively (P = 0.376). Cumulative survival rates at 1, 2, 3, and 4 years were 98.7%, 92.3%, 82.7%, and 77.8% in the RFA group and 98.0%, 90.7%, 77.6%, and 77.6% in the MWA group, respectively (P = 0.729). Major complication rates were 2.4% and 2.7% in the RFA group and the MWA group, respectively (P = 1.000). There were no patient deaths due to treatment.

Conclusion

RFA and MWA have the same clinical value in treating HCC conforming to the Milan criteria. RFA and MWA are both safe and effective techniques for HCC as clinical application.     

Small hepatocellular carcinoma in cirrhosis: randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection

PURPOSE: To compare the effectiveness of radio-frequency (RF) thermal ablation with that of percutaneous ethanol injection (PEI) for the treatment of small hepatocellular carcinoma (HCC) in patients with cirrhosis. MATERIALS AND METHODS: A series of 102 patients with hepatic cirrhosis and either single HCC 5 cm in diameter or smaller or as many as three HCCs each 3 cm or smaller (overall number of lesions, 142) randomly received either RF ablation (n = 52) or PEI (n = 50) as the sole first-line anticancer treatment. Mean follow-up was 22.9 months +/- 9.4 (SD) in the RF group and 22.4 months +/- 8.6 in the PEI group. Prognostic value of treatment techniques was assessed with univariate and multivariate Cox proportional hazards regression models. RESULTS: One- and 2-year survival rates were 100% and 98% in the RF group and 96% and 88% in the PEI group, respectively (univariate relative risk [RR] = 0.20; 95% CI: 0.02, 1.69; P =.138). One- and 2-year local recurrence-free survival rates were 98% and 96% in the RF group and 83% and 62% in the PEI group, respectively (univariate RR = 0.17; 95% CI: 0.06, 0.51; P =.002). One- and 2-year event-free survival rates were 86% and 64% for the RF group and 77% and 43% for the PEI group, respectively (univariate RR = 0.48; 95% CI: 0.27, 0.85; P =.012). RF treatment was confirmed as an independent prognostic factor for local recurrence-free survival rates with multivariate analysis (adjusted RR = 0.20; 95% CI: 0.05, 0.73; P =.015). CONCLUSION: RF ablation is superior to PEI with respect to local recurrence-free survival rates.     

Resection vs thermal ablation of small hepatocellular carcinoma: What's the first choice?

Nowadays, hepatocellular carcinoma (HCC) is frequently diagnosed at an early stage, opening good perspectives to radical treatment by means of liver transplantation, surgical resection, or percutaneous ablation. Liver transplantation is considered the best option, but the lack of liver donors represents a major limitation. Therefore, surgical resection, offering a 5-year-survival rate of over 50%, is considered the first-choice treatment for patients with early stage HCC, whereas percutaneous ablation is usually reserved to patients who are not candidate to surgery. However, in the recent years some trials showed that percutaneous radiofrequency ablation (RFA) can be as effective as surgical resection in terms of overall survival and recurrence-free survival rates in patients with small HCC, and a retrospective comparative study reported 1-, 3-, and 5-year overall survival rates and recurrence-free survival rates significantly better in patients with central HCC measuring 2 cm or smaller treated with RFA than in those treated with surgical resection. RFA is less expensive, less invasive, with lower complication rate and shorter hospital stay than surgical resection, and on the basis of the results of these studies it should be considered the first option in the treatment of very early HCC. However, RFA is size-dependent, so at present the need to achieve an adequate safety margin around the tumor limits to about 2 cm the diameter of the nodules that can be ablated with long-term outcomes comparable to or better than surgical resection. The main goal of the next technical developments of the thermal ablation systems should be the achievement of larger ablation areas with a single needle insertion. In this regard, the recent improvements in microwave energy delivery systems seem to open interesting perspectives to percutaneous microwave ablation, which could become the ablation technique of choice in the next future.     

Percutaneous microwave ablation for hepatocellular carcinoma adjacent to large vessels: A long-term follow-up

Purpose

To retrospectively evaluate the effectiveness and safety of ultrasound (US)-guided percutaneous microwave ablation (MWA) in the treatment of hepatocellular carcinoma (HCC) adjacent to large vessels.

Materials and methods

From February 2006 to February 2013, 452 patients with 605 HCC nodules were treated with US-guided percutaneous MWA. Into large vessels group (Group L), 139 patients with 163 lesions (diameter, 1.0–7.0 cm; mean, 2.5 ± 1.1 cm) located less than 5 mm away from large vessels were enrolled. And 313 patients with 442 lesions (diameter, 1.0–8.0 cm; mean, 2.5 ± 1.2 cm) located more than 5 mm away from hepatic surface, large vessels, gallbladder and gastrointestinal tract were included in control group (Group C). During the ablation, the temperature of marginal ablation tissues was monitored and controlled.

Results

The median follow-up time was 24.5 months (range 2.1–87.7 months) in Group L, and 25.7 months (range 1.6–93.9 months) in Group C. Technical effectiveness was achieved in 157 of 163 (96.3%) tumors in Group L and 429 of 442 (97.1%) tumors in Group C, respectively (p > 0.05). The 1-, 3- and 5-year local tumor progression rates and the 1-, 3- and 5-year accumulative survival rates in the two groups have no significantly statistical differences. In addition, no immediate or periprocedural major complications, no delayed complication of vessels or bile ducts injury were found in both of the two groups.

Conclusions

With strict temperature monitoring, US-guided percutaneous MWA is an efficient and safe technology in treating hepatocellular carcinoma adjacent to large vessels.     

超声引导下经皮微波消融治疗肝癌胸腹壁种植转移

目的：探讨超声引导下经皮微波消融治疗肝癌胸腹壁种植转移的有效性和可行性。 方法：选取2007年1月至2017年1月在中国人民解放军总医院出现肝癌胸腹壁种植转移后接受超声引导下经皮微波消融治疗的患者15例,男13例,女2例,平均年龄（57.2±17.6岁）。收集种植转移的人口和肿瘤特征,分析患者治疗情况,采用Log-Rank χ²检验统计分析种植灶消融后的局部进展率及患者的总生存率,采用多因素Cox回归分析肝癌胸腹壁种植转移患者总体生存情况的危险因素。 结果：15例患者的中位随访27.8（3.8~67.2）个月,消融治疗后种植肿瘤患者的0.5、1、2年的累积局部进展率分别为6.7%、23.0%、23.0%;1、3、5年的累积总生存率分别为80.0%、61.7%、46.3%。多因素Cox回归分析显示年龄>65岁、肝内病灶控制差及肿瘤分型差是影响肝癌胸腹壁种植转移患者总体生存情况的危险因素。 结论：超声引导下经皮微波消融治疗肝癌胸腹壁种植转移能够产生令患者满意的肿瘤结局,但延长患者生存时间还主要依靠对肝内病灶的控制。     

Percutaneous Radiofrequency Ablation and Transcatheter Arterial Chemoembolization for Hypervascular Hepatocellular Carcinoma: Rate and Risk Factors for Local Recurrence

PURPOSE: To analyze local recurrence-free rates and risk factors for recurrence following percutaneous radiofrequency ablation (RFA) or transcatheter arterial chemoembolization (TACE) for hypervascular hepatocellular carcinoma (HCC). METHODS: One hundred and nine nodules treated by RFA and 173 nodules treated by TACE were included. Hypovascular nodules were excluded from this study. Overall local recurrence-free rates of each treatment group were calculated using the Kaplan-Meier method. The independent risk factors of local recurrence and the hazard ratios were analyzed using Cox's proportional-hazards regression model. Based on the results of multivariate analyses, we classified HCC nodules into four subgroups: central nodules < or =2 cm or >2 cm and peripheral nodules < or =2 cm or >2 cm. The local recurrence-free rates of these subgroups for each treatment were also calculated. RESULTS: The overall local recurrence-free rate was significantly higher in the RFA group than in the TACE group (p = 0.013). The 24-month local recurrence-free rates in the RFA and TACE groups were 60.0% and 48.9%, respectively. In the RFA group, the only significant risk factor for recurrence was tumor size >2 cm in greatest dimension. In the TACE group, a central location was the only significant risk factor for recurrence. In central nodules that were < or =2 cm, the local recurrence-free rate was significantly higher in the RFA group than in the TACE group (p < 0.001). In the remaining three groups, there was no significant difference in local recurrence-free rate between the two treatment methods. CONCLUSION: A tumor diameter of >2 cm was the only independent risk factor for local recurrence in RFA treatment, and a central location was the only independent risk factor in TACE treatment. Central lesions measuring < or =2 cm should be treated by RFA.     

人工气胸联合肋间神经阻滞用于减轻近胸膜肺肿瘤微波消融术疼痛的疗效分析

目的 探讨人工气胸联合肋间神经阻滞用于减轻近胸膜肺肿瘤微波消融(MWA)术中及术后疼痛的疗效.方法 将30例近胸膜肺肿瘤患者分为3组,每组10例,A组MWA前先实施人工气胸联合肋间神经阻滞,B组MWA前单纯实施人工气胸,C组MWA前单纯行肋间神经阻滞.用疼痛视觉模拟评分(VAS)评定各组患者术中及术后0、6、12和24 h的疼痛程度,记录患者术后不良反应出现情况.结果 3组患者术中VAS评分无明显差异(P=0.885);C组患者在术后6、12和24 h的VAS评分均明显增高(P=0.014,0.006,0.006).A组和B组患者实施人工气胸后均未出现胸闷症状;A组和B组中共6例患者术后仍有少量无症状残余气胸,约1周后残余气胸自行吸收消失,1例患者术后抽气后仍存在较大范围气胸,经行胸腔闭式引流3d后痊愈.无其它严重人工气胸相关并发症.结论 人工气胸联合肋间神经阻滞能够有效减轻近胸膜肺肿瘤患者MWA术中及术后疼痛,安全性高.     

Long-term Outcomes of Patients with Hepatocellular Carcinoma Who Underwent Microwave Ablation after Downstaging with Transarterial Chemoembolization to Barcelona Clinic Liver Cancer Stage A

PurposeTo compare the clinical results of microwave ablation (MWA) between patients downstaged to Barcelona Clinic Liver Cancer (BCLC) Stage A with transarterial chemoembolization (TACE) and those initially classified as BCLC Stage A.Materials and MethodsFrom January 2012 to May 2017, 1,087 patients were reviewed retrospectively using propensity score matching (1:1): 86 patients underwent MWA as a curative treatment after downstaging to BCLC Stage A by TACE (downstaging group) and 86 patients initially classified as BCLC Stage A underwent MWA (control group). The overall survival (OS) and disease-free survival (DFS) between the 2 groups were compared.ResultsThe 1-, 3-, and 5-year OS rates were 95.3%, 79.1%, and 58.1%, respectively, in the downstaging group and 93.0%, 81.4%, and 61.6%, respectively, in the control group (hazard ratio [HR], 0.75; 95% CI, 0.50–1.13; P = .162). The 1-, 3-, and 5-year DFS rates were 80.2%, 50.0%, and 24.4%, respectively, in the downstaging group and 77.9%, 52.3%, and 27.9%, respectively, in the control group (HR, 1.08; 95% CI, 0.76–1.53; P = .678). No significant differences were found in OS and DFS.ConclusionsThe long-term prognosis in patients with HCC who underwent MWA after downstaging to BCLC Stage A using TACE was similar to that in patients with initial BCLC Stage A.     

Combined utility of one lung ventilation and artificial pneumothorax in thermal ablation of hepatic dome tumor: a technical note

Radiofrequency ablation and microwave ablation are established treatment modalities for smaller (<3 cm) or isolated hepatic tumors. Transthoracic ablation of hepatic dome lesions is a well described technique. We report the use of one lung ventilation to facilitate the successful percutaneous transthoracic microwave ablation of a segment 8 hepatic dome lesion after induction of artificial pneumothorax. This involved the use of general anesthesia and insertion of a double lumen endotracheal tube to allow isolated ventilation of one lung, followed by creation of an artificial pneumothorax under computed tomography (CT) guidance. Complete ablation of the lesion was confirmed on CT liver at 1 and 7 months with no local recurrence. The combined techniques of one lung ventilation and artificial pneumothorax enabled a safe and accurate transthoracic targeting of the hepatic dome lesion.

Thermal ablation techniques such as radiofrequency ablation (RFA) and microwave ablation (MWA) are alternative treatment options for patients with small (<3 cm) or isolated lesions. Transthoracic ablation of lesions is safe and effective for treatment of hepatic dome lesions.Current standard of practice in most centers is the administration of local anesthesia with moderate conscious sedation for percutaneous RFA or MWA. Thermal ablation under sedation is poorly tolerated in patients whose lesions are more than 3 cm in size or in the sub-diaphragmatic location, commonly requiring conversion to general anesthesia due to pain on ablation and/or need for controlled apnea to allow for accurate targeting of the lesion (1). Additionally, incomplete ablation of tumors is more common in procedures with sedation compared to general anesthesia (1).Even under general anesthesia, hepatic dome lesion targeting is affected by the constant respiratory movements of the liver and diaphragm. We report the use of one-lung ventilation (OLV) to facilitate safe and successful transthoracic percutaneous computed tomography (CT)-guided MWA of a hepatic dome hepatocellular carcinoma (HCC) lesion after induction of artificial pneumothorax to avoid injury to the lung and visceral pleura.