Kurokohchi Kazutaka, Masaki Tsutomu, Miyauchi Yoshiaki, Hosomi Naoki, Yoneyama Hirohito, Yoshida Shuhei, Himoto Takashi, Deguchi Akihiro, Nakai Seiji, Inoue Hideyuki, Watanabe Seishiro, Kuriyama Shigeki
Third Department of Internal Medicine, Kagawa University School of Medicine, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan.
Int J Oncol. 2004 Dec;25(6):1737-43. doi: 10.3892/ijo.25.6.1737.
Percutaneous radiofrequency ablation (RFA) is able to destroy hepatocellular carcinoma (HCC) in a few sessions without major complications. We have previously shown that not only the combined use of percutaneous ethanol injection and RFA (PEI-RFA) but also injection of mixture of ethanol and lipiodol (PELIT) was useful for the treatment of HCC. In the present study, we further developed the combined use of PELIT and RFA through percutaneous or laparoscopic approach (PELI-RFA or LELI-RFA) and evaluated its usefulness. Nineteen nodules in 18 cases were treated with PELI-RFA or LELI-RFA. In the cases treated with LELI-RFA, no bleeding and no spilling milky fluid containing tumor cells were observed from the surface of ablated tumors. In the cases sufficiently treated with PELI-RFA or LELI-RFA, the mixture of ethanol and lipiodol was accumulated in the entire region of the tumor and low-density area was observed around the lipiodol deposit by computed tomography (CT). These delineations of coagulated area were helpful to evaluate the precise area of safety margin around the tumor treated with PELI-RFA or LELI-RFA. Furthermore, the total volume of coagulated necrosis significantly and positively correlated with the product of energy requirement for ablation and the volume of ethanol injected by PELI-RFA or LELI-RFA. Among the cases treated with PELI-RFA or LELI-RFA, local recurrence emerged only in one case in whom enough safety margin could not be achieved by PELI-RFA. Therefore, it is critical to evaluate whether enough safety margin could be obtained with RFA therapy, and PELI-RFA and LELI-RFA are helpful in visualizing the safety margin area.
经皮射频消融（RFA）能够在几次治疗中破坏肝细胞癌（HCC），且无严重并发症。我们之前已经表明，不仅经皮乙醇注射与RFA联合使用（PEI-RFA），而且乙醇与碘油混合注射（PELIT）对HCC治疗均有效。在本研究中，我们通过经皮或腹腔镜途径进一步开发了PELIT与RFA联合使用（PELI-RFA或LELI-RFA）并评估了其有效性。18例患者的19个结节接受了PELI-RFA或LELI-RFA治疗。在接受LELI-RFA治疗的病例中，未观察到消融肿瘤表面有出血和含肿瘤细胞的乳状液溢出。在接受PELI-RFA或LELI-RFA充分治疗的病例中，乙醇与碘油的混合物积聚在肿瘤的整个区域，通过计算机断层扫描（CT）观察到碘油沉积周围有低密度区。这些凝固区域的描绘有助于评估接受PELI-RFA或LELI-RFA治疗的肿瘤周围精确的安全边缘区域。此外，凝固性坏死的总体积与PELI-RFA或LELI-RFA消融所需能量与注射乙醇体积的乘积显著正相关。在接受PELI-RFA或LELI-RFA治疗的病例中，仅1例出现局部复发，该病例中PELI-RFA未能获得足够的安全边缘。因此，评估RFA治疗是否能获得足够的安全边缘至关重要，而PELI-RFA和LELI-RFA有助于可视化安全边缘区域。
