Wood T F, Rose D M, Chung M, Allegra D P, Foshag L J, Bilchik A J
Department of Surgical Oncology, John Wayne Cancer Institute, Santa Monica, California 90404, USA.
Ann Surg Oncol. 2000 Sep;7(8):593-600. doi: 10.1007/BF02725339.
Radiofrequency ablation (RFA) is increasingly used for the local destruction of unresectable hepatic malignancies. There is little information on its optimal approach or potential complications.
Since late 1997, we have undertaken 91 RFA procedures to ablate 231 unresectable primary or metastatic liver tumors in 84 patients. RFA was performed via celiotomy (n = 39), laparoscopy (n = 27), or a percutaneous approach (n = 25). Patients were followed with spiral computed tomographic (CT) scans at 1 to 2 weeks postprocedure and then every 3 months for 2 years.
Intraoperative ultrasound (IOUS) detected intrahepatic disease not evident on the preoperative scans of 25 of 66 patients (38%) undergoing RFA via celiotomy or laparoscopy. In 38 of 84 patients (45%), RFA was combined with resection or cryosurgical ablation (CSA), or both. RFA was used to treat an average of 2.8 lesions per patient, and the median size of treated lesions was 2 cm (range, 0.3-9 cm). The average hospital stay was 3.6 days overall (1.8 days for percutaneous and laparoscopic cases). Ten patients underwent a second RFA procedure (sequential ablations) and, in one case, a third RFA procedure for large (one patient), progressive (seven patients), and/or recurrent (three patients) lesions. Seven (8%) patients had complications: one skin burn; one postoperative hemorrhage; two simple hepatic abscesses; one hepatic abscess associated with diaphragmatic heat necrosis following sequential percutaneous ablations of a large lesion; one postoperative myocardial infarction; and one liver failure. There were three deaths, one (1%) of which was directly related to the RFA procedure. Three of the complications, including one RFA-related death, occurred after percutaneous RFA. At a median follow-up of 9 months (range, 1-27 months), 15 patients (18%) had recurrences at an RFA site, and 36 patients (43%) remained clinically free of disease.
Celiotomy or laparoscopic approaches are preferred for RFA because they allow IOUS, which may demonstrate occult hepatic disease. Operative RFA also allows concomitant resection, CSA, or placement of a hepatic artery infusion pump, and isolation of the liver from adjacent organs. Percutaneous RFA should be reserved for patients at high risk for anesthesia, those with recurrent or progressive lesions, and those with smaller lesions sufficiently isolated from adjacent organs. Complications may be minimized when these approaches are applied selectively.
射频消融术（RFA）越来越多地用于不可切除肝脏恶性肿瘤的局部毁损。关于其最佳方法或潜在并发症的信息很少。
自1997年末以来，我们已进行了91例RFA手术，以消融84例患者的231个不可切除的原发性或转移性肝肿瘤。RFA通过剖腹术（n = 39）、腹腔镜检查（n = 27）或经皮途径（n = 25）进行。术后1至2周用螺旋计算机断层扫描（CT）对患者进行随访，然后每3个月随访1次，共2年。
术中超声（IOUS）在66例通过剖腹术或腹腔镜检查接受RFA的患者中的25例（38%）术前扫描未显示的肝内疾病。84例患者中的38例（45%），RFA与切除术或冷冻消融术（CSA）或两者联合应用。RFA平均用于治疗每位患者2.8个病灶，治疗病灶的中位大小为2 cm（范围0.3 - 9 cm）。总体平均住院时间为3.6天（经皮和腹腔镜病例为1.8天）。10例患者接受了第二次RFA手术（序贯消融），1例患者因病灶大（1例）、进展性（7例）和/或复发性（3例）接受了第三次RFA手术。7例（8%）患者出现并发症：1例皮肤烧伤；1例术后出血；2例单纯肝脓肿；1例在对大病灶进行序贯经皮消融后出现与膈热坏死相关的肝脓肿；1例术后心肌梗死；1例肝功能衰竭。有3例死亡，其中1例（1%）与RFA手术直接相关。3例并发症，包括1例与RFA相关的死亡，发生在经皮RFA后。中位随访9个月（范围1 - 27个月）时，15例患者（18%）在RFA部位复发，36例患者（43%）临床上无疾病。
RFA首选剖腹术或腹腔镜检查方法，因为它们允许使用IOUS，这可能显示隐匿性肝病。手术RFA还允许同时进行切除术、CSA或放置肝动脉灌注泵，并将肝脏与相邻器官隔离。经皮RFA应保留给麻醉风险高的患者、有复发或进展性病灶的患者以及病灶较小且与相邻器官充分隔离的患者。选择性应用这些方法可将并发症降至最低。
