Kato Takeharu, Yamagami Takuji, Hirota Tatsuya, Matsumoto Tomohiro, Yoshimatsu Rika, Nishimura Tsunehiko
Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo, Kyoto 602-8566, Japan.
Hepatogastroenterology. 2008 Jul-Aug;55(85):1450-3.
BACKGROUND/AIMS: Radiofrequency ablation has been accepted as a safe treatment for unresectable malignant hepatic tumors. Tumors beneath the diaphragmatic dome may be difficult to visualize with ultrasonography. The aim of this study was to assess the use of transpulmonary radiofrequency ablation under real-time computed tomography-fluoroscopic guidance for hepatocellular carcinoma.
Twenty-four radiofrequency ablation treatments by means of a transpulmonary approach were performed in 22 patients under computed tomography-fluoroscopic guidance between December 2002 and April 2006. Every patient had a hepatocellular carcinoma less than 3cm in size beneath the diaphragmatic dome.
Transpulmonary radiofrequency ablation under real-time computed tomography-fluoroscopic guidance was successfully performed in every procedure. There was no local tumor recurrence in 22 cases (92%) on follow-up dynamic computed tomography performed an average of 8 months after radiofrequency ablation. The major complication was pneumothorax after 9 procedures (38%): pneumothorax in 6 patients had completely resolved on follow-up chest radiographs, and was treated with manual aspiration immediately after radiofrequency ablation in 3 patients, and no patients required chest-tube placement.
Transpulmonary radiofrequency ablation under computed tomography-fluoroscopic guidance is a useful method for the accurate and safe ablation of hepatocellular carcinoma that is not detectable with ultrasonography.
背景/目的：射频消融已被公认为是不可切除的恶性肝肿瘤的一种安全治疗方法。膈顶下的肿瘤可能难以通过超声检查可视化。本研究的目的是评估在实时计算机断层扫描-透视引导下经皮肺射频消融治疗肝细胞癌的应用。
2002年12月至2006年4月期间，在22例患者中，在计算机断层扫描-透视引导下通过经皮肺途径进行了24次射频消融治疗。每位患者膈顶下均有一个直径小于3cm的肝细胞癌。
在实时计算机断层扫描-透视引导下经皮肺射频消融在每次手术中均成功完成。在平均射频消融后8个月进行的随访动态计算机断层扫描中，22例（92%）无局部肿瘤复发。主要并发症为9例（38%）出现气胸：6例患者的气胸在随访胸部X线片上已完全缓解，3例患者在射频消融后立即进行手动抽吸治疗，无患者需要放置胸管。
在计算机断层扫描-透视引导下经皮肺射频消融是一种用于准确、安全地消融超声检查无法检测到的肝细胞癌的有用方法。
