Siperstein A, Garland A, Engle K, Rogers S, Berber E, String A, Foroutani A, Ryan T
Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Surg Endosc. 2000 Apr;14(4):400-5. doi: 10.1007/s004640000067.
Radiofrequency thermal ablation is a new technology for the local destruction of liver tumors. Since we first described laparoscopic radiofrequency ablation (LRFA) for the treatment of liver tumors, much has been learned about patient selection, laparoscopic ultrasound (LU) guided placement of the ablation catheter, monitoring of the ablation process, and patient follow-up.
Since January 1996 we have performed LRFA of 250 tumors in 67 patients including 85 adenocarcinomas, 107 neuroendocrine tumors, 34 sarcomas, 1 melanoma, and 11 hepatomas. We used LU to guide placement of the ablation catheter and to monitor the ablation process. Most of the patients had two trocars (camera and laparoscopic ultrasound) with the 15-gauge ablation catheter (RITA Medical Systems, Mountain View, CA, USA) placed percutaneously.
The LRFA procedure was completed successfully in all patients, with 1 to 14 lesions per patient, ranging in size from 0.5 to 10 cm in diameter. The entire liver could be examined by LU via right subcostal ports. Criteria for successful ablation were 5-min ablation times at 100 degrees C with 1-min cool-down temperatures of 60 degrees to 70 degrees C. Outgassing of dissolved nitrogen, monitored by ultrasound, was useful in confirming the zone of ablation. Intralesional color-flow Doppler, seen before ablation, was eliminated after ablation. Placement of the grounding pad closer to the lesion on the back rather than the thigh resulted in more efficient energy delivery to the tumor. Lesions larger than 3 cm in diameter required overlapping ablations to achieve a 1-cm margin of normal liver. Most patients required overnight hospitalization, with no coagulopathy or electrolyte disturbances noted.
The LRFA procedure is a novel, minimally invasive technique for treatment of liver tumors that have failed conventional therapy. This study documents the technical aspects of targeting lesions and performing reproducible zones of ablation. Familiarity with these techniques should lead to more widespread application.
射频热消融是一种用于局部破坏肝脏肿瘤的新技术。自从我们首次描述腹腔镜射频消融术（LRFA）用于治疗肝脏肿瘤以来，在患者选择、腹腔镜超声（LU）引导下放置消融导管、监测消融过程以及患者随访等方面已经有了很多了解。
自1996年1月以来，我们对67例患者的250个肿瘤进行了LRFA，其中包括85例腺癌、107例神经内分泌肿瘤、34例肉瘤、1例黑色素瘤和11例肝癌。我们使用LU来引导消融导管的放置并监测消融过程。大多数患者有两个套管针（摄像头和腹腔镜超声），15号消融导管（美国加利福尼亚州山景城的RITA医疗系统公司生产）经皮放置。
所有患者的LRFA手术均成功完成，每位患者有1至14个病灶，直径范围为0.5至10厘米。通过右肋缘下端口，LU可以检查整个肝脏。成功消融的标准是在100摄氏度下消融5分钟，冷却1分钟，温度为60至70摄氏度。通过超声监测溶解氮的排气情况，有助于确认消融区域。消融前可见的病灶内彩色血流多普勒在消融后消失。将接地垫放置在背部靠近病灶处而非大腿上，可使能量更有效地传递到肿瘤。直径大于3厘米的病灶需要重叠消融以获得1厘米的正常肝边缘。大多数患者需要住院过夜，未发现凝血功能障碍或电解质紊乱。
LRFA手术是一种用于治疗传统治疗失败的肝脏肿瘤的新颖、微创技术。本研究记录了靶向病灶和进行可重复消融区域的技术方面。熟悉这些技术应会导致更广泛的应用。
