Laeseke Paul F, Frey Tina M, Brace Chris L, Sampson Lisa A, Winter Thomas C, Ketzler Jan R, Lee Fred T
Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA.
AJR Am J Roentgenol. 2007 Jun;188(6):1485-94. doi: 10.2214/AJR.06.1004.
The objective of our study was to retrospectively analyze our initial clinical experience with percutaneous multiple-electrode radiofrequency ablation and evaluate its safety and efficacy for treating hepatic malignancies.
Thirty-eight malignant hepatic tumors (mean diameter, 2.7 cm; range, 0.7-10.0 cm) in 23 patients (12 men and 11 women; mean age, 65 years; range, 40-84 years) were treated in 26 radiofrequency ablation sessions with an impedance-based multiple-electrode system. One, two, or three (mean, 2.4) 17-gauge electrodes were placed, and tumors were ablated using a combination of CT and sonography for guidance and monitoring. Electrodes were placed in close proximity (mean spacing: two electrodes, 1.0 cm; three electrodes, 1.4 cm) to treat large tumors or were used independently to treat several tumors simultaneously. Contrast-enhanced CT scans were obtained immediately after ablation to determine technical success and evaluate for complications. Follow-up CT scans at 1, 3, 6, 9, and 12 months (mean, 4 months) after ablation were obtained to assess for tumor progression and new metastases.
Local control was achieved in 37 of 38 tumors, 34 of which were treated in one session. Ablations created with closely spaced electrodes had a mean diameter of 4.9 cm. The total ablation time was reduced by approximately 54% compared with an equivalent number of ablations performed with a single-electrode system (1,014 vs 2,196 minutes). Three complications occurred: one death from a presumed postprocedure pulmonary embolus, one pneumothorax, and one asymptomatic perihepatic hemorrhage.
Multiple-electrode radiofrequency ablation appears to be a safe and effective means of achieving local control in large or multiple hepatic malignancies at short-term follow-up.
本研究的目的是回顾性分析我们在经皮多电极射频消融方面的初步临床经验，并评估其治疗肝脏恶性肿瘤的安全性和有效性。
23例患者（12例男性和11例女性；平均年龄65岁；范围40 - 84岁）的38个肝脏恶性肿瘤（平均直径2.7 cm；范围0.7 - 10.0 cm）接受了26次基于阻抗的多电极系统射频消融治疗。放置1根、2根或3根（平均2.4根）17号电极，使用CT和超声联合进行引导和监测来消融肿瘤。电极近距离放置（平均间距：两根电极，1.0 cm；三根电极，1.4 cm）以治疗较大肿瘤，或独立用于同时治疗多个肿瘤。消融后立即进行对比增强CT扫描以确定技术成功与否并评估并发症。在消融后1、3、6、9和12个月（平均4个月）进行随访CT扫描以评估肿瘤进展和新的转移灶。
38个肿瘤中的37个实现了局部控制，其中34个在一次治疗中完成。采用紧密间隔电极进行的消融平均直径为4.9 cm。与使用单电极系统进行相同数量的消融相比，总消融时间减少了约54%（1014分钟对2196分钟）。发生了3例并发症：1例因推测为术后肺栓塞死亡，1例气胸，1例无症状肝周出血。
在短期随访中，多电极射频消融似乎是实现对大的或多个肝脏恶性肿瘤局部控制的一种安全有效的方法。
