转换控制多电极射频消融治疗肝肿瘤的疗效评价
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摘要
目的探讨转换控制多电极射频消融(RFA)在肝肿瘤治疗中的安全性及疗效。方法回顾性分析2016年1月至2017年12月在郑州大学第一附属医院接受转换控制多电极RFA治疗的21例肝肿瘤患者临床资料。其中男17例,女4例;年龄31～85岁,中位年龄56岁。患者均签署知情同意书,符合医学伦理学规定。在超声引导下根据术前模拟将多电极射频针穿刺至肿瘤边界,确认肿瘤边界均在射频针消融范围内后进行肿瘤消融。术后1个月复查超声、增强CT/MRI评价消融效果。观察术后并发症及肿瘤进展情况。结果本组21例患者共计26个病灶,术后1个月复查共有4个肿瘤边缘残留,完全消融率达85%。其中直径<3 cm病灶完全消融率100%(5/5),直径≥3 cm病灶为81%(17/21)。术后轻度皮肤灼伤2例,一过性肌红蛋白尿及术后急性肾损伤1例,梗阻性黄疸1例,均对症治愈。随访时间14(4～22)个月,随访期间肿瘤复发4例。结论转换控制多电极RFA系统通过提前布针构建针阵可将肿瘤完全含括在消融范围内,有效避免再次穿刺布针时的信号干扰及可能的穿刺针道转移,消融效果好,对于直径较大且不宜手术切除肝肿瘤时更具优势。
Objective To evaluate the clinical efficacy and safety of conversion-controlled multi-electrode radiofrequency ablation(RFA) in the treatment of liver tumors. Methods Clinical data of 21 patients with liver tumors who received conversion-controlled multi-electrode RFA in the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2017 were retrospectively analyzed.Among them, 17 patients were male and 4 were female, aged 31-85 years old with a median age of 56 years.The informed consents of all patients were obtained and the local ethical committee approval was received.The multi-electrode radiofrequency needle was punctured to the tumor margin according to the preoperative model with the guidance of ultrasound. RFA was performed after confirming that the tumor margin was within the ablation range of needle. the ablation effect was evaluated at postoperative 1 month by receiving ultrasound and enhanced CT/MRI examination. Postoperative complications and tumor progression were observed. Results A total of 26 lesions were detected in 21 cases. At postoperative 1 month, the peripheral residuals were detected in 4 lesions. The complete ablation rate was 85%. The complete ablation rate for lesions <3 cm of diameter was 100%(5/5), and was 81%(17/21) for lesions with a diameter ≥3 cm. 2 cases developed mild skin burns, 1 case transient myoglobinuria and postoperative acute kidney injury, and 1 case obstructive jaundice, all of which were cured with symptomatic treatments. The follow-up time was 14(4-22) months. Tumor recurrence were observed in 4 cases during the follow-up period. Conclusions The conversion-controlled multi-electrode RFA system can completely include the tumors in the ablation range by constructing a needle array preoperatively, which can effectively avoid the signal interference when repeatedly placing the needle and avoid the possible needle track metastasis. It has the advantage of good ablation effect, expecially for large unresectable liver tumors.
Objective To evaluate the clinical efficacy and safety of conversion-controlled multi-electrode radiofrequency ablation(RFA) in the treatment of liver tumors. Methods Clinical data of 21 patients with liver tumors who received conversion-controlled multi-electrode RFA in the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2017 were retrospectively analyzed.Among them, 17 patients were male and 4 were female, aged 31-85 years old with a median age of 56 years.The informed consents of all patients were obtained and the local ethical committee approval was received.The multi-electrode radiofrequency needle was punctured to the tumor margin according to the preoperative model with the guidance of ultrasound. RFA was performed after confirming that the tumor margin was within the ablation range of needle. the ablation effect was evaluated at postoperative 1 month by receiving ultrasound and enhanced CT/MRI examination. Postoperative complications and tumor progression were observed. Results A total of 26 lesions were detected in 21 cases. At postoperative 1 month, the peripheral residuals were detected in 4 lesions. The complete ablation rate was 85%. The complete ablation rate for lesions <3 cm of diameter was 100%(5/5), and was 81%(17/21) for lesions with a diameter ≥3 cm. 2 cases developed mild skin burns, 1 case transient myoglobinuria and postoperative acute kidney injury, and 1 case obstructive jaundice, all of which were cured with symptomatic treatments. The follow-up time was 14(4-22) months. Tumor recurrence were observed in 4 cases during the follow-up period. Conclusions The conversion-controlled multi-electrode RFA system can completely include the tumors in the ablation range by constructing a needle array preoperatively, which can effectively avoid the signal interference when repeatedly placing the needle and avoid the possible needle track metastasis. It has the advantage of good ablation effect, expecially for large unresectable liver tumors.
引文
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[14]Rossi S,Di Stasi M,Buscarini E,et al.Percutaneous RF interstitial thermal ablation in the treatment of hepatic cancer[J].AJR Am JRoentgenol,1996,167(3):759-768.
[15]Shi M,Zhang CQ,Zhang YQ,et al.Micrometastases of solitary hepatocellular carcinoma and appropriate resection margin[J].World J Surg,2004,28(4):376-381.
[16]McGahan JP,Loh S,Boschini FJ,et al.Maximizing parameters for tissue ablation by using an internally cooled electrode[J].Radiology,2010,256(2):397-405.
[17]张艳阳,顾仰葵,黄金华,等.多电极同步射频消融与常规单电极重复射频消融效果的实验观察[J].中华医学杂志,2015,95(43):3537-3540.
[18]黄光亮,罗佳,丁茜,等.转换器介导下多电极射频消融治疗早期肝细胞癌[J].中国医师杂志,2017,19(6):810-816.
[2]陈敏山.肝癌射频消融治疗及综合治疗[J].中华医学杂志,2015,95(27):2174-2177.
[3]Xu RC,Liu HC,Li JL,et al.Long-term outcome of transcatheter arterial chemoembolization after radiofrequency ablation as a combined therapy for Chinese patients with hepatocellular carcinoma[J].Curr Med Res Opin,2015,31(8):1553-1560.
[4]Kim JS,Kim HS,Myung DS,et al.A case of diaphragmatic hernia induced by radiofrequency ablation for hepatocellular carcinoma[J].Korean J Gastroenterol,2013,62(3):174-178.
[5]Cao J,Sun WB,Tong ZC,et al.Successful treatment of acute hemorrhagic cardiac temponade in a patient with hepatocellular carcinoma during percutaneous radiofrequency ablation[J].Chin Med J,2010,123(11):1470-1472.
[6]Tateishi R,Shiina S,Teratani T,et al.Percutaneous radiofrequency ablation for hepatocellular carcinoma:an analysis of 1000 cases[J].Cancer,2005,103(6):1201-1209.
[7]El-Fattah MA,Aboelmagd M,Elhamouly M.Prognostic factors of the hepatocellular carcinoma survival after radiofrequency ablation:a US population-based study[J].United European Gastroenterol J,2017,5(2):227-235.
[8]Livraghi T,Goldberg SN,Lazzaroni S,et al.Hepatocellular carcinoma:radiofrequeney ablation of medium and large lesions[J].Radiology,2000,214(3):761-768.
[9]孙文兵.射频消融在肝细胞癌综合治疗中的作用[J].中华肝胆外科杂志,2015,21(9):591-595.
[10]杨薇,陈敏华,严昆,等.射频消融对较大肝肿瘤治疗范围与布针方案计算的研究[J].中华超声影像学杂志,2002,11(4):244-247.
[11]Kumar N,Gaba RC,Knuttinen MG,et al.Tract seeding following radiofrequency ablation for hepatocellular carcinoma:prevention,detection,and management[J].Semin Intervent Radiol,2011,28(2):187-192.
[12]Ziemlewicz TJ,Wells SA,Lubner MG,et al.Hepatic tumor ablation[J].Surg Clin North Am,2016,96(2):315-339.
[13]Brunello F,Cantamessa A,Gaia S,et al.Radiofrequency ablation:technical and clinical long-term outcomes for single hepatocellular carcinoma up to 30 mm[J].Eur J Gastroenterol Hepatol,2013,25(7):842-849.
[14]Rossi S,Di Stasi M,Buscarini E,et al.Percutaneous RF interstitial thermal ablation in the treatment of hepatic cancer[J].AJR Am JRoentgenol,1996,167(3):759-768.
[15]Shi M,Zhang CQ,Zhang YQ,et al.Micrometastases of solitary hepatocellular carcinoma and appropriate resection margin[J].World J Surg,2004,28(4):376-381.
[16]McGahan JP,Loh S,Boschini FJ,et al.Maximizing parameters for tissue ablation by using an internally cooled electrode[J].Radiology,2010,256(2):397-405.
[17]张艳阳,顾仰葵,黄金华,等.多电极同步射频消融与常规单电极重复射频消融效果的实验观察[J].中华医学杂志,2015,95(43):3537-3540.
[18]黄光亮,罗佳,丁茜,等.转换器介导下多电极射频消融治疗早期肝细胞癌[J].中国医师杂志,2017,19(6):810-816.