Curley S A, Izzo F
M.D. Anderson Cancer Center, University of Texas, Houston, Texas, USA.
Minerva Chir. 2002 Apr;57(2):165-76.
The majority of patients with primary or metastatic hepatic tumors are not candidates for resection because of tumor size, location near major intrahepatic blood vessels precluding a margin-negative resection, multifocality, or inadequate hepatic function related to coexistent cirrhosis. Radiofrequency ablation (RFA) is an evolving technology being used to treat patients with unresectable primary and metastatic hepatic cancers. RFA produces coagulative necrosis of tumor through local tissue heating. Liver tumors are treated percutaneously, laparoscopically, or during laparotomy using ultrasonography to identify tumors and to guide placement of the RFA needle electrode. For tumors smaller than 2.0 cm in diameter, one or two deployments of the monopolar multiple array needle electrode is sufficient to produce complete coagulative necrosis of the tumor. However, with increasing size of the tumor, there is a concomitant increase in the number of deployments of the needle electrode and the overall time necessary to produce complete coagulative necrosis of the tumor. In general, RFA is a safe, well-tolerated, effective treatment for unresectable hepatic malignancies less than 6.0 cm in diameter. Effective treatment of larger tumors awaits the development of more powerful, larger array monopolar and bipolar RFA technologies.
由于肿瘤大小、位于主要肝内血管附近无法进行切缘阴性切除、多灶性或与并存肝硬化相关的肝功能不全，大多数原发性或转移性肝肿瘤患者不适合进行手术切除。射频消融（RFA）是一种正在发展的技术，用于治疗无法切除的原发性和转移性肝癌患者。RFA通过局部组织加热使肿瘤产生凝固性坏死。肝肿瘤可通过经皮、腹腔镜或开腹手术进行治疗，使用超声来识别肿瘤并引导RFA针电极的放置。对于直径小于2.0 cm的肿瘤，单极多阵列针电极进行一到两次部署就足以使肿瘤产生完全凝固性坏死。然而，随着肿瘤尺寸的增加，针电极的部署次数以及使肿瘤产生完全凝固性坏死所需的总时间也随之增加。一般来说，RFA对于直径小于6.0 cm的无法切除的肝恶性肿瘤是一种安全、耐受性良好且有效的治疗方法。对于更大肿瘤的有效治疗有待更强大、更大阵列的单极和双极RFA技术的发展。
