射频消融(RFA)辅助的无血切肝技术

肝细胞癌(HCC)是世界上最常见的实体癌之一,而且肝脏是除淋巴结之外最常见转移癌的脏器.肝癌的治疗仍以手术切除为首选,根治性切除术后病人的5年生存率可达40%左右,然而肝切除对于外科医生的技术要求较高,有时术中出血极其难以控制.射频消融广泛地用于治疗无法手术切除的肝癌,甚至在部分病人身上取得了较好的远期效果.Habib第一次描述了RFA辅助的肝切除,他使用单极RFA探针预先处理切除面,术中出血明显地减少(30±10)ml.Morris在此基础上设计了一种新颖的双极RFA设备--InLine,其工作原理是双极RFA探针产生了一条精确的凝固带,进而封闭大到4 mm的动脉和静脉,肝切除随之可以在这个无血管的平面进行,取得接近不出血的结果.在最近完成的一项国际多医疗中心研究中,笔者发现经过InLine治疗后,术中出血减少了63.88%.该文重点讲述了射频辅助的肝切除技术的原理,使用以及临床结果.射频消融辅助的肝切除可以适用于解剖和非解剖切除.这项技术易于使用,同时术后病人恢复良好.

Bloodless liver resection assisted by radiofrequency ablation

Hepatocellular carcinoma(HCC)is one of the most common solid cancers in the world.Furthermore,the liver is second only to lymph nodes as a common site of metastasis from other solid cancers.Surgical resection offers the best chance for long-term survival for patients with hepatocellular carcinoma or colorectal cancer liver metastases.which can result in significant 5-year survival benefit in 40% of patients.However,liver surgery remains a technically demanding procedure since sometimes intraoperative blood loss is hard to control.Radiofrequency ablation(RFA)has been widely used for unresectable liver tumors,long-term survival can be achieved in some selected patients.Professor Habib first described the RFA assisted liver resection.He used a monopolar RFA probe to pre-treat the resection plane,the intraoperative blood loss has been dramatically reduced to 30±10 ml.Based on such theory,Professor Morris designed a novel bipolar RFA device-InLine.The principle of the In-Line RFA device is that a very precise RFA area is created between electrodes of alternating polarity leading to localized heating and coagulation of tissue including blood vessels up to approximately 4 mm,this transection plane is then dissected almost bloodlessly.In our recently finished international multi-center study,we have shown that intraoperative blood loss has been reduced to 63.88 % comparing to the control group.This paper reviews the mechanism of RFA assisted liver resection and the clinical application.This technique can be used in anatomical and non-anatomical liver resection.It is easy to learn and use,and patients underwent uneventful recovery.