Crucitti A, Danza F M, Antinori A, Vincenzo Antonacci, Pirulli P G V, Bock E, Magistrelli P
Department of Surgery, Catholic University of the Sacred Heart, Rome, Italy.
J Exp Clin Cancer Res. 2003 Dec;22(4 Suppl):191-5.
Radiofrequency Thermal Ablation (RFA) of liver tumors is done by percutaneous, laparoscopic and open surgical approach. Selection criteria for percutaneous or open surgical ablation of 65 hepatic lesions are here evaluated in 45 patients treated in a two-years period. Twenty-five patients were males and 20 females, ages ranged from 35 to 80 years (mean 63 years). RFA was performed in 57 procedures, ablating 14 hepatomas and 51 liver metastases. In 10 cases the treatment was repeated twice. Tumor size ranged from 0.5 cm to 8 cm, with a mean of 2.4 cm. Open surgical approach was performed in 14 cases (24.6%), seven of which were simultaneously treated for associated diseases. Percutaneous treatment was adopted in 43 cases (75.4%). A laparoscopic approach was not tempted in any case. Morbidity was 8.8%, mostly in open surgery (4 cases or 28.6%) but in one patient (2.3%) with percutaneous approach. Difference in between the two groups was statistically significant (p=0.013). Overall mortality was 2.2%: one patients deceased for myocardial infarction. The mean length of hospital stay was of 4.1 days for the percutaneous treatment group and 7.6 days for the open surgery approach. Number of the lesions did not interfere with surgical approach. Postoperative CT control showed no differences, in terms of complete ablation of the tumor, between the two groups of patients. Advantages of percutaneous approach include less invasiveness, reduced postoperative pain, shorter hospitalization, reduced costs and lower discomfort in repeating the procedure. In addition, open surgical RFA allows better cancer staging, avoidance of adjacent organ injury, accessibility to all liver areas and gives the chance to performe simultaneous organ resection. These results are encouraging in making the percutaneous approach of RFA the method of choice in these patients.
肝脏肿瘤的射频热消融（RFA）可通过经皮、腹腔镜及开放手术途径进行。本文评估了45例在两年内接受治疗的患者中65个肝脏病变采用经皮或开放手术消融的选择标准。25例为男性，20例为女性，年龄在35至80岁之间（平均63岁）。共进行了57次RFA手术，消融了14个肝癌和51个肝转移瘤。10例患者进行了两次治疗。肿瘤大小从0.5厘米至8厘米不等，平均为2.4厘米。14例（24.6%）采用开放手术途径，其中7例同时治疗相关疾病。43例（75.4%）采用经皮治疗。未尝试腹腔镜途径。发病率为8.8%，主要发生在开放手术中（4例，占28.6%），但经皮途径有1例患者（2.3%）发病。两组之间的差异具有统计学意义（p = 0.013）。总体死亡率为2.2%：1例患者死于心肌梗死。经皮治疗组的平均住院时间为4.1天，开放手术组为7.6天。病变数量不影响手术途径。术后CT检查显示，两组患者在肿瘤完全消融方面无差异。经皮途径的优点包括侵入性较小、术后疼痛减轻、住院时间缩短、成本降低以及重复操作时不适感较低。此外，开放手术RFA能更好地进行癌症分期、避免邻近器官损伤、可到达肝脏所有区域并能同时进行器官切除。这些结果令人鼓舞，使经皮RFA途径成为这些患者的首选治疗方法。
