Lin Shi-Ming, Lin Chun-Jung, Chung Hock-Jean, Hsu Chao-Wei, Peng Cheng-Yuan
Liver Research Unit, Chang Gung Memorial Hospital, Chang Gung University, 199, Tung Hwa North Rd., Taipei, 105 Taiwan.
AJR Am J Roentgenol. 2003 Jan;180(1):151-7. doi: 10.2214/ajr.180.1.1800151.
The purpose of this study was to compare the efficacy between standard and interactive radiofrequency ablation for treatment of hepatocellular carcinoma.
Of 97 patients with 112 nodular hepatocellular carcinomas, 59 hepatocellular carcinomas were ablated using a standard algorithm and 53 hepatocellular carcinomas, using an interactive algorithm. For the procedure using the interactive algorithm, the electrode's array was partially retracted or fully deployed depending on the change of impedance. Complete tumor necrosis was defined as the lack of enhancement on single-detector helical CT at least 4 months after the last radiofrequency ablation.
Complete necrosis was achieved in 101 (90%) of 112 hepatocellular carcinomas, with complete necrosis being achieved more frequently in hepatocellular carcinomas undergoing interactive ablation (96%) than standard ablation (85%) (p = 0.034). Power rolloff (a clinical end point in which power decreases as impedance increases) occurred in all of the 53 hepatocellular carcinomas that underwent interactive ablation, whereas power rolloff occurred in 48 (81%) of the 59 hepatocellular carcinomas that underwent standard ablation (p = 0.00053). Complete necrosis occurred more frequently when rolloff was achieved (96%) than without rolloff (36%) (p < 0.0001). Multivariate analysis determined that power rolloff was an independent factor in achieving complete necrosis of hepatocellular carcinomas (p < 0.0001).
The use of interactive radiofrequency ablation increased the frequency of power rolloff and the rate of complete necrosis in the treatment of hepatocellular carcinoma. Power rolloff was a significant determinant of whether complete necrosis was achieved in hepatocellular carcinomas treated with radiofrequency ablation.
本研究旨在比较标准射频消融与交互式射频消融治疗肝细胞癌的疗效。
97例患者共112个结节性肝细胞癌，其中59个肝细胞癌采用标准算法进行消融，53个肝细胞癌采用交互式算法进行消融。对于采用交互式算法的操作，根据阻抗变化部分收回或完全展开电极阵列。完全肿瘤坏死定义为在最后一次射频消融后至少4个月单排螺旋CT上无强化。
112个肝细胞癌中有101个（90%）实现了完全坏死，交互式消融的肝细胞癌完全坏死发生率（96%）高于标准消融（85%）（p = 0.034）。53个接受交互式消融的肝细胞癌均出现功率衰减（功率随阻抗增加而降低的临床终点），而59个接受标准消融的肝细胞癌中有48个（81%）出现功率衰减（p = 0.00053）。实现功率衰减时完全坏死的发生率（96%）高于未实现功率衰减时（36%）（p < 0.0001）。多因素分析确定功率衰减是实现肝细胞癌完全坏死的独立因素（p < 0.0001）。
在肝细胞癌治疗中，使用交互式射频消融增加了功率衰减的频率和完全坏死率。功率衰减是射频消融治疗肝细胞癌能否实现完全坏死的重要决定因素。
