Low Shoen C S, Lo Richard H G, Lau Te-Neng, Ooi London Lucien P J, Ho Chee-Keong, Tan Bien-Soo, Chung Alexander Y F, Koo Wen-Hsin, Chow Pierce K H
Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
Ann Acad Med Singap. 2006 Dec;35(12):851-7.
The aim of this paper was to study the efficacy, side effects and complications of radiofrequency (RF) ablation of primary and metastatic liver malignancies.
We retrospectively reviewed 57 patients (39 men, 18 women; mean age, 63 years; age range, 44 to 83 years) who underwent RF ablation for liver malignancies from January 2002 to December 2004. A total of 87 tumours were ablated - 71 (81.6%) hepatocellular carcinomas and 16 (18.4%) metastases (from primaries in the colon, stomach and pancreas). RF ablation was performed either percutaneously (n = 71) under conscious sedation or intraoperatively (n = 16) under general anaesthesia. Follow-up ranged from 1 month to 41 months (mean, 15.2) and included computed tomography (CT) 1 day, 1 month and 3 months after ablation, and half-yearly thereafter. Patients were observed for local tumour progression and for the emergence of new tumours.
Four patients with a total of 5 tumours were lost to follow-up. Of the remaining 82 tumours treated, complete ablation was attained in 66 tumours after a single procedure, giving a primary effectiveness rate of 80.5%. Seven (8.5%) required 2 procedures to achieve complete ablation, giving a secondary effectiveness rate of 89% after 2 ablations. One tumour (1.2%) required 3 procedures to achieve complete ablation. One tumour required 4 procedures to date, with the latest follow-up CT still demonstrating incomplete ablation. Two tumours (2.4%) had an initial RF ablation and subsequent transarterial chemoembolisation (TACE). One tumour had an initial RF ablation followed by 32Phosphorus-biosilicon (BrachySil) injection, the latter as part of a Phase IIA trial. One tumour required 2 RF ablations and a subsequent TACE. Lastly, 3 tumours received initial RF ablation but subsequent local tumour progression was not treated as the patients were deemed unfit for repeat ablation. No procedure-related deaths or major complications were encountered. Minor complications were reported in 2 patients (3.8%) - subcapsular haematoma and thermal injury to the adjacent gastric antrum, both not necessitating surgical intervention.
RF ablation is an effective, safe and relatively simple procedure for the treatment of unresectable liver malignancies.
本文旨在研究射频（RF）消融治疗原发性和转移性肝脏恶性肿瘤的疗效、副作用及并发症。
我们回顾性分析了2002年1月至2004年12月期间接受肝脏恶性肿瘤射频消融治疗的57例患者（39例男性，18例女性；平均年龄63岁；年龄范围44至83岁）。共消融了87个肿瘤——71个（81.6%）肝细胞癌和16个（18.4%）转移瘤（来自结肠、胃和胰腺的原发性肿瘤）。射频消融在清醒镇静下经皮进行（n = 71）或在全身麻醉下术中进行（n = 16）。随访时间为1个月至41个月（平均15.2个月），包括消融后1天、1个月和3个月以及此后每半年的计算机断层扫描（CT）。观察患者局部肿瘤进展及新肿瘤的出现情况。
4例患者共5个肿瘤失访。在其余接受治疗的82个肿瘤中，单次手术后66个肿瘤实现了完全消融，初次有效率为80.5%。7个（8.5%）肿瘤需要2次手术才能实现完全消融，2次消融后的二次有效率为89%。1个肿瘤（1.2%）需要3次手术才能实现完全消融。1个肿瘤至今需要4次手术，最新的随访CT仍显示消融不完全。2个肿瘤（2.4%）先进行了射频消融，随后进行了经动脉化疗栓塞（TACE）。1个肿瘤先进行了射频消融，随后注射了32磷生物硅（BrachySil），后者是IIA期试验的一部分。第1个肿瘤需要2次射频消融及随后的TACE。最后，3个肿瘤接受了初次射频消融，但随后局部肿瘤进展未予治疗，因为患者被认为不适合再次消融。未发生与手术相关的死亡或重大并发症。2例患者（3.8%）报告了轻微并发症——包膜下血肿和邻近胃窦的热损伤，均无需手术干预。
射频消融是治疗不可切除肝脏恶性肿瘤的一种有效、安全且相对简单的方法。
