Buscarini L, Buscarini E, Di Stasi M, Quaretti P, Zangrandi A
Department of Gastroenterology, Hospital of Piacenza, Italy.
Ultraschall Med. 1999 Apr;20(2):47-53. doi: 10.1055/s-1999-14233.
To evaluate whether the combination of hepatic segmental transcatheter arterial embolization (TAE) with percutaneous radiofrequency (RF) ablation can increase the volume of coagulation necrosis to treat patients with large hepatocellular carcinoma (HCC).
Fourteen patients with cirrhosis and HCC whose greatest diameter ranged from 3.8 to 6.8 cm (mean, 5.2 cm) underwent segmental TAE followed within 3 days by RF interstitial thermal ablation with an expandable needle electrode inserted into the tumour under sonographic guidance, after local anesthesia. We made one or more needle electrode insertions depending on tumor shape. Posttreatment necrosis was evaluated by ultrasonography, dynamic computed tomography (CT) and alpha-fetoprotein dosage in all cases, repeated every three to four months.
Tumor ablation was obtained in one session in 11 (78%) patients (with one needle electrode insertion in 8 patients), in two sessions in 1, in three sessions in 2. In a mean follow-up of 13.2 months (range 6-23) two patients died from unrelated causes; one patient showed multinodular HCC 6 months after the treatment; 4 patients developed new lesions, treated by a new course of RF ablation (3 cases) or by surgery (1 case); therefore 11/12 patients still in follow-up were disease-free. No fatal complications were observed. One month after the treatment, fluid collection at the site of the ablated tumor was observed in one patient which was percutaneously drained.
Percutaneous RF thermal ablation performed after TAE effectively treated HCCs larger than tumors suitable for segmental TAE or RF application alone; the result was achieved in two thirds of the cases in a single session with only one needle electrode insertion.
评估肝段经导管动脉栓塞术（TAE）与经皮射频（RF）消融联合应用是否能增加凝固性坏死体积，以治疗大肝细胞癌（HCC）患者。
14例肝硬化合并HCC患者，肿瘤最大直径为3.8至6.8厘米（平均5.2厘米），先行肝段TAE，然后在3天内于局部麻醉下，在超声引导下将可扩张针状电极插入肿瘤内进行RF间质热消融。根据肿瘤形状插入一个或多个针状电极。所有病例均通过超声、动态计算机断层扫描（CT）和甲胎蛋白检测评估治疗后坏死情况，每三到四个月重复一次。
11例（78%）患者一次消融成功（8例插入一个针状电极），1例两次消融成功，2例三次消融成功。平均随访13.2个月（6至23个月），2例患者死于无关原因；1例患者在治疗后6个月出现多结节HCC；4例患者出现新病灶，其中3例接受新的RF消融疗程治疗，1例接受手术治疗；因此，12例仍在随访的患者中有11例无疾病进展。未观察到致命并发症。治疗后1个月，1例患者在消融肿瘤部位出现积液，经皮引流。
TAE后行射频热消融可有效治疗大于单独适合肝段TAE或射频消融的肿瘤；三分之二的病例通过单次插入一个针状电极即可取得效果。
