Controlled study of in-line ovine spleen transection assisted by radiofrequency ablation

BACKGROUND: Trauma to the spleen or tumors of the spleen often require total splenectomy for control of hemorrhage. Partial splenectomy is the preferred technique because of the short- and long-term sepsis problems in asplenic patients. Multiple techniques for partial splenectomy have been tried in the past with limited success. The authors designed the in-line radiofrequency ablation (ILRFA) probe for liver surgery. It uses radiofrequency energy to make a linear coagulative plane that allows the parenchyma of solid vascular organs to be divided. In this study, for the first time, the efficiency of ILRFA was tested with the ovine spleen. METHODS: Seven sheep were used for this study. With the sheep under general anesthesia, a laparotomy was performed. The first sheep was used for a pilot study. Eight partial splenectomies were made in the remaining six sheep using ILRFA. For a control, a matching partial splenectomy was made in each sheep using diathermy and sutures. Blood loss was measured by determining the difference in the weights of dry sponges and blood-stained sponges after resection. A paired t test was used to compare the bleeding between the control and the ILRFA techniques. RESULTS: The mean blood loss was 33.14 +/- 17 g using ILRFA and 123.43 +/- 72 g in the control group. The bleeding was significantly reduced in the ILRFA group (p = 0.0056). The time required to apply ILRFA was 12 minutes. CONCLUSION: Partial splenectomy was achieved in the ovine spleen using radiofrequency energy with minimal blood loss.     

Novel in-line multielectrode radiofrequency ablation considerably reduces blood loss during liver resection in an animal model

INTRODUCTION: Liver resection is widely used in the treatment of primary and secondary liver tumours. One of several important factors associated with mortality both in cirrhotic and non-cirrhotic patients after liver resection is operative blood loss. We evaluated the use of a prototype radiofrequency ablation probe to treat the transection plane prior to liver resection in the sheep model. METHODS: In-line radiofrequency ablation (RFA) was performed on the liver using a prototype device consisting of 11 electrodes mounted on a 8-cm base. The RITA 1500 generator was used for power delivery. Ultrasonic aspirator (UA) and clamp resection were performed on the liver of sheep with and without in-line RFA. The blood loss was measured by weighing swabs. RESULTS: A total of 26 liver resections were performed. The mean (SD) blood loss with UA resection was 0.032 g (0.011) versus 0.005 (0.005) g without and with prior in-line RFA, respectively (P = 0.001). The mean (SD) blood loss with clamp resection was 0.087 (0.10) g versus 0.01 (0.008) without and with in-line RFA, respectively (P = 0.155). CONCLUSION: In-line RFA makes liver resection easier with minimal blood loss and may make cirrhotic liver resection easier with minimal blood loss. This is likely to improve the operative safety of liver resection.     

射频治疗肝癌对患者肝功能的影响

目的:探讨肝癌射频治疗对肝功能的影响.方法:32例经皮肝癌射频治疗患者,分为小肝癌组(<3 cm)、大肝癌组(3~10 cm)和巨大肝癌组(>10 cm).对所有患者分别于术前及术后3 d进行血肝功能指标检测.结果:肝癌射频治疗对肝功能的影响与肿瘤大小、是原发性还是转移性有关.肿瘤越大,射频治疗对肝功能的影响越大,表现为巨大肝癌组大于大肝癌组,后者大于小肝癌组;射频治疗对原发性肝癌患者肝功能的影响大于转移性肝癌患者.结论:肝癌射频治疗前患者肝功能最好,处于Child-Pugh A级或B级.对于肿瘤直径大于10 cm的巨大肝癌患者,为防止术后肝功能衰竭,可对患者行分次治疗.     

射频消融术辅助部分肝切除术治疗原发性肝癌的效果及复发率随访研究

目的探讨射频消融术辅助部分肝切除术治疗原发性肝癌的效果及复发率随访研究。方法以2013年3月~2015年10月我院肝胆外科收治的60例原发性肝癌为研究对象,随机数字表法将其均分为对照组及研究组各30例,对照组实施部分肝切除术治疗,研究组在对照组基础上另联合射频消融术辅助治疗,观察2组手术相关指标[手术时间、创面平均出血量、术后住院时间]、术前术后肝功能指标[谷丙转氨酶(ALT)、总胆红素(TBIL)、谷草转氨酶(AST)]、并发症发生率及随访复发率。结果研究组手术时间、术后住院时间较对照组显著短,而创面平均出血量较对照组显著低,差异有统计学意义(P0.05);术前2组ALT、TBi L、AST相较无明显差异(P0.05);术后2组ALT、TBi L、AST较术前明显降低,且术后研究组各项指标的变化程度较对照组明显(P0.05);术后研究组并发症发生率、术后1年随访复发率较对照组显著低,差异有统计学意义(P0.05)。结论射频消融术在原发性肝癌患者部分肝切除术中有明显积极作用,符合现代无血肝切除的理念,具有术中出血量少、康复时间短、保护肝功能、术后并发症及复发率低的优势,有推广应用价值。     

射频消融诱导兔VX2肝脏移植瘤细胞凋亡

目的　探讨射频消融 (RFA)对兔VX2 肝脏移植瘤的治疗机制。方法　通过VX2 肿瘤组织混悬液肝内注入法建立兔肝脏肿瘤模型 ,随机分为实验组及对照组 ,分别予以RFA治疗及假性处理 ,于治疗结束后 0、12h、1、2、4、8、16d共 7个时间点分别切取肿瘤中心组织及边缘组织为检测标本 ,进行HE染色、透射电镜检查并运用TUNEL法检测肿瘤细胞凋亡情况。结果　治疗组毁损区边缘部组织中有大量阳性细胞 ,中心部分亦有较多的阳性细胞 ,两者凋亡细胞指数差异非常显著 (P <0 .0 1)。对照组标本中仅发现极少数阳性细胞 ,且其中心区与边缘区无统计学差异 ,其凋亡细胞指数与治疗组标本相比 ,差异均非常显著 (P <0 .0 1)。于不同时间点观察 ,治疗组细胞凋亡高峰在 2 4h左右 ,而对照组细胞凋亡则无明显时间分布特征。结论　诱导肿瘤细胞凋亡是射频消融治疗肝脏恶性肿瘤的一项重要机制。其发生的部位主要是肿瘤周边区 ,时间高峰在RFA作用后 2 4h左右。     

Hepatic resection versus radiofrequency ablation for hepatocellular carcinoma in cirrhotic individuals not candidates for liver transplantation: A Markov model decision analysis

Background

Several observational studies have suggested that radiofrequency ablation (RFA) may have survival benefits similar to hepatic resection (HR) in cirrhotic patients affected by hepatocellular carcinoma (HCC) are not candidates for liver transplantation. A small randomized controlled trial confirmed these findings, although underpowered to detect a significant difference at 5-year interval.

Methods

A Markov model was created to simulate a randomized trial comparing the quality of life-adjusted survival for individuals undergoing HR versus RFA for HCCs less than 5 cm in diameter.

Results

HR was the best therapeutic option with 5.33 (standard deviation ±.42) versus 3.91 (standard deviation ±.38) quality-adjusted life years except for in individuals older than 75 years of age (P = .02, log rank test). One-way sensitivity analysis showed that RFA was the preferred strategy if the perioperative mortality of HR was more than 30%, if the percentage of patients with negative margins was less than 60%, and if RFA could be performed at least 60% of the time for recurrent disease after a previous ablation. The quality of life associated with both procedures did not influence the results of this model.

Conclusions

HR provided better quality of life-adjusted survival as ablation therapy was associated with increased risk of local recurrent disease requiring multiple sessions. For older individuals, RFA appears to be the best therapeutic option. If the probability of ablation for recurrent disease is equal in the 2 arms, survival benefits of RFA is similar to HR.     

射频消融治疗肝肿瘤315例报告

目的总结1999年6月至2003年8月用射频消融(radiofrequencyablation,RFA)治疗315例肝肿瘤病人的病例资料,探索RFA治疗肝肿瘤近远期疗效。方法采用了一次定位、多点穿刺,RFA联合肝动脉栓塞(TAE)、选择性门静脉栓塞(SPVE)治疗直径5~13cm的大肝癌,及经皮经肺经膈肌RFA治疗膈顶部肝癌。结果总并发症发生率为5.1%,无一例住院期间死亡。AFP阳性的169例肝癌病人中,RFA后有124例(73.6%)明显降低,其中有95例(56.2%)转阴。半年生存率为89.5%,1年生存率为80.1%,18个月生存率为61.4%,24个月生存率为48.3%,>36个月生存率为35.6%。结论采用TAE、SPVE及RFA一次定位多点穿刺法治疗无手术切除指征的中晚期(含大肝癌)的病人,疗效明显,总并发症发生率低。     

手术切除与开腹射频消融治疗大肝癌的疗效分析

目的 比较手术切除与开腹射频消融治疗大肝癌的疗效。方法 收集2012年1月至2015年9月我院原发性大肝癌患者58例,其中行开腹肝癌切除术35例,开腹射频消融术23例。比较两组患者术前及术后的相关临床指标及术后生存率。结果术前,开腹切除组肝功能分级（P=0.021）、凝血酶原时间（P=0.034）、总胆红素（P=0.016）和肝硬化程度（P=0.033）明显好于开腹射频消融组。而术中输血量（P=0.025）、术后第2 天ALT（P=0.008）及AST（P=0.017）指标,开腹切除组显著差于开腹射频消融组。两组术后严重并发症发生率及术后生存率无明显差别（P=0.652）。结论 对于肝功能稍差的大肝癌患者,开腹射频消融术有利于减小手术风险,控制术后并发症,医师可根据患者综合情况进行术式选择。     

加强型射频消融治疗肝血管瘤的疗效及预后分析

目的 评估加强型射频消融术治疗肝血管瘤的疗效及预后.方法 回顾性分析1999年6月至2012年11月我院经皮射频消融术治疗病灶直径≥5.o cm的118例肝血管瘤患者的病例资料,根据手术治疗方法分为行常规射频消融术组(A组,n=54)和行加强型射频消融术组(B组,n=64),统计分析两组手术时间、并发症发生率、病灶完全毁损率、住院时间和随访结果(瘤体缩小率及局部复发率).结果 术后A组出现并发症14例(25.93％),B组14例(21.88％),A组与B组并发症差异无统计学意义(P=0.382).A组中病灶完全毁损41例(75.93％),B组58例(90.63％),两组间差异有统计学意义(P=0.043).随访结果,A组平均瘤体缩小率为66.95％,B组为83.21％,两组间差异有统计学意义(P＜0.001);肝血管瘤局部复发17例(14.41％),其中A组局部复发12例(22.22％),B组5例(7.81％),两组之间差异有统计学意义(P=0.035).结论 加强型射频消融术治疗肝巨大血管瘤可提高病灶毁损率并获得更好的远期疗效,是巨大肝血管瘤患者较好的选择.     

水媒射频切割闭合器在肝切除中的应用

目的总结水媒射频切割闭合器在肝切除中的应用。方法总结了12例应用水媒射频切割闭合器行肝切除的病人的资料,对其断肝的结果进行了分析。结果12例病人分别行不同类型的肝切除,术中断肝时间为30~130min,平均76min;出血量为20~300ml,平均85ml;术中术后均未输血。术后患者均无胆漏、腹腔内残余感染等并发症发生。有3例患者有术后一过性转氨酶升高,最高达550IU/L。切开手术标本检查见切缘凝固变性组织深度3~5mm。切缘肝组织经病理学检查发现从表面往内呈坏死区、变性坏死过渡区、充血水肿区和相对正常的移行改变。管道周围肝组织变性坏死程度较其它邻近区域明显,沿管道区呈放射状分布。结论应用水媒射频切割闭合器行肝切除是一种较满意的方法。     

冷循环射频消融联合肝动脉栓塞化疗治疗不宜手术切除的肝癌

目的:总结冷循环射频消融术联合经导管肝动脉栓塞化疗术(transcatheter arterial chemoembolization,TACE)治疗不宜手术切除肝癌的效果和经验.方法:采用冷循环射频消融术联合TACE治疗手术不宜切除肝癌31例(共44个肿瘤结节).结果:肝功能指标中除术后ALT水平较术前明显升高(P<0.05)外,其他各项指标均无统计学差异(各P>0.05).术中、术后发生窦性心动过缓、高钾血症及急性胰腺炎各1例(3/29,10.3%),无手术死亡.术后CT检查显示:44个肿瘤结节中,37个病灶(占84.1%)为完全坏死,5个病灶(占11.4%)为不完全坏死,2个(占4.5%)病灶为部分坏死.随访3~28个月,术后1年肿瘤复发率为20.7%(6/29),1年生存率为89.7%(23/29).结论:冷循环射频消融联合TACE治疗不宜手术切除的肝癌是安全有效的.     

水媒射频切割闭合器在肝切除中的应用

目的总结水媒射频切割闭合器在肝切除中的应用。方法总结了12例应用水媒射频切割闭合器行肝切除的病人的资料，对其断肝的结果进行了分析。结果12例病人分别行不同类型的肝切除，术中断肝时间为30～130min，平均76min；出血量为20～300ml，平均85ml；术中术后均未输血。术后患者均无胆漏、腹腔内残余感染等并发症发生。有3例患者有术后一过性转氨酶升高，最高达550IU／L。切开手术标本检查见切缘凝固变性组织深度3～5mm。切缘肝组织经病理学检查发现从表面往内呈坏死区、变性坏死过渡区、充血水肿区和相对正常的移行改变。管道周围肝组织变性坏死程度较其它邻近区域明显，沿管道区呈放射状分布。结论应用水媒射频切割闭合器行肝切除是一种较满意的方法。     

机器人辅助腹腔镜下射频消融术治疗肾肿瘤的临床观察

目的:总结机器人辅助腹腔镜下射频消融术的手术经验,并初步探讨此手术在临床中的应用价值。方法:回顾性分析2016年3月~2017年5月于我院泌尿外科接受机器人辅助腹腔镜下肾肿瘤射频消融术的19例患者的临床资料,术中完全暴露肿瘤相应位置,采用超声及超声造影实时监测肾肿瘤射频消融治疗,对于与集合系统位置关系紧密的患者采用输尿管导管灌注低温盐水进行集合系统物理降温。术后复查血肌酐及肾小球滤过率(GFR),定期行CT、MRI随访。手术前后数据比较采用配对t检验。结果:19例患者均顺利完成手术,手术时间61~172min,中位时间103min,射频时间6~36min,中位时间17min;术后1周血肌酐基本维持术前水平,术后3个月行GFR检查与术前比较差异无统计学意义,影像学检查未见肿瘤残留及复发。结论:机器人辅助腹腔镜下射频消融术对于位置复杂的肾肿瘤治疗安全有效,相较于传统腹腔镜辅助下射频消融具有更为广泛的应用,局限性为手术花费较高,需严格把控手术指征。     

Bimodal electric tissue ablation-modified radiofrequency ablation with a le veen electrode in a pig model

Radiofrequency ablation (RFA) is a method of treating non-resectable liver tumors by use of a high-frequency alternating electrical current. Concerns have been raised as the local recurrence rates following treatment have been reported to be as high as 47%. The size of the ablation is limited by charring of adjacent tissues. It is hypothesized that by hydrating the liver, we can reduce charring, thus producing larger ablations, and that this can be achieved by addition of a direct electrical current to the electrical circuit. Using a pig model, standard RFA control ablations were created in the left lobe of the liver. Ablations using the modified circuit were created in the right lobe. At the end of the procedure, the pig was killed by lethal injection and the liver harvested. From the explanted liver, the diameter of each ablation was measured and the modified ablations were compared with controls using restricted maximum likelihood variance analysis. From 4 pigs, 14 controls and 12 modified ablations were produced. The mean diameter of the controls was 27.78 mm (+/- SE 3.37 mm). The mean diameter of the modified ablation was 49.55 mm (+/- SE 3.46 mm), which was significantly larger than the controls (P < 0.001). This study has shown that by modification of the standard RFA circuit with the addition of a direct electrical current, significantly larger ablations can be produced. By using this technique, the number of ablations required to treat one tumor would be less and it is anticipated this could reduce the rate of local recurrence.     

经皮肝穿刺冷循环射频消融治疗肝癌疗效分析

目的观察经皮肝穿刺冷循环射频消融术（Cool-tipRFA）对肝癌的热消融作用,探讨其适应证。方法在局麻下及B超引导下,射频电极经皮穿刺入肝癌瘤体内,对其进行消融。结果28例患者的38个瘤体中：直径≤3cm的26个瘤体,24个获得完全热消融,热消融率为91．9％;直径为3～5cm的7个瘤体中5个瘤体获得完全热消融,热消融率为71．4％;直径为5～8cm的5个瘤体中2个瘤体获得完全热消融,热消融率为40％。无明显术后并发症发生。术后6月、1年、2年及3年生存率分别为96．4％,89．3％,78．6％及60．7％。结论经皮肝穿刺冷循环射频消融术对直径≤5cm的肝癌疗效可靠,是一种安全、有效治疗肝癌的方法。     

Radiofrequency-assisted liver resection

Radiofrequency (RF)-assisted thermal ablation has been used with increasing frequency for unresectable hepatic tumors. This new approach employs RF energy to coagulate the liver at the hepatic resection line after which hepatic resection is performed with the use of a common scalpel. This procedure was used in three patients with hepatocellular carcinoma and in five patients with colorectal metastasis to the liver. These eight patients underwent a total of two left bisegmentectomies, three segmentectomies, and seven wedge resections. Mean operative time was 220 minutes. A mean of 78 sessions of RF-assisted ablation were required for these resections. Mean blood loss was 46 ml; no device other than RF ablation was required to obtain hemostasis. None of the patients needed a blood transfusion. Preoperative hemoglobin was 12.8 gm/dl and postoperative hemoglobin was 11.3 gm/dl. There were no perioperative deaths. Postoperative complications occurred in two patients: a liver abscess in one and heart failure in the other. The mean hospital stay was 9.4 days. This new approach, integrated with other techniques, reduces blood loss and coagulates the margins of resection during liver surgery. This new technique has two limitations: (1) it cannot be applied near main portal pedicles, and (2) it requires a long operative time. The best indication for this technique is when segmentectomy is required in patients with cirrhosis. Its role in major hepatic resections has yet to be determined. Further progress in the development of thermal ablation techniques and experience gained during the learning curve should help reduce the operative time, thereby improving the safety and efficacy of this procedure. Presented at the Third International Meeting, "Hepatocellular Carcinoma: Eastern and Western Experience," Lodi, Italy, November 21–22, 2002.     

西咪替丁对肝癌射频消融患者细胞免疫功能的影响

目的研究西咪替丁(Cim)在短期内对肝癌射频消融(RFA)患者细胞免疫功能的影响。方法 39例肝癌患者随机分成RFA加Cim组(治疗组)和RFA组(对照组),用乳酸脱氢酶释放法测定入院时、RFA术前、术后第2天和第7天的NK细胞活性。结果 39例肝癌患者外周血NK细胞活性明显低于正常人(P< 0．01)。入院时和RFA术前治疗组与对照组间各基本指标无显著性差别(P>0．05)。术后第2天,两组NK 细胞活性均较入院时明显降低(P<0．05)。术后第7天,治疗组NK细胞活性较入院时和术后第2天明显增高 (P<0．01),治疗组NK细胞活性明显高于对照组(P<0．05)。结论肝癌患者细胞免疫功能下降,RFA术后细胞免疫功能进一步受到损害;Cim能在短期内增强机体的细胞免疫功能,可作为肝癌患者RFA术的一种重要辅助治疗。     

InLine radiofrequency ablation-assisted laparoscopic liver resection: first experiment with stapling device

BACKGROUND: In liver surgery, the increase in advancement of laparoscopic equipment has allowed the feasibility and safety of complex laparoscopic liver resection. However, blood loss and the potential risk of gas embolism seem to be the main obstacles. In this study, we successfully used the InLine radiofrequency ablation (RFA) device to carry out laparoscopic hand-assisted liver resection in pigs. METHODS: Under general anaesthesia with tracheal intubation, pigs underwent InLine RFA-assisted laparoscopic liver resection. After installation of Hand Port and trocars, the InLine RFA device was introduced through Hand Port system and inserted into the premarked resection line. Then the generator was turned on and the power was applied according to the power setting. The resection was finally carried out using diathermy or stapler. For the control group, resection was simply carried out by diathermy or stapler. RESULTS: Eight Landrace pigs underwent 23 liver resections. Blood loss was reduced significantly in the InLine group (P<0.001) when compared with control group in both surgical methods (diathermy and stapler). CONCLUSION: In this study, we successfully carried out InLine RFA-assisted laparoscopic liver resection in both stapled and diathermy group. We showed that there was a highly significant difference between InLine and other liver resection techniques laparoscopically.