Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
AJR Am J Roentgenol. 2010 Feb;194(2):W227-31. doi: 10.2214/AJR.09.2979.
This study was designed to assess whether artificial ascites has a heat-sink effect on the ablation zone for percutaneous radiofrequency ablation (RFA) of hepatic tumors abutting the diaphragm.
We retrospectively assessed 28 patients who underwent percutaneous RFA for the treatment of a single nodular hepatic tumor that abutted the diaphragm from July 2000 to December 2006. All patients underwent ultrasound-guided RFA using internally cooled electrodes. A single ablation for 12 minutes was applied using 3-cm active-tip electrodes. We divided patients into two groups on the basis of whether artificial ascites was introduced before RFA: Group A consisted of patients who received artificial ascites with a mean of 760 mL of a 5% dextrose in water solution (n = 15) and group B consisted of patients who did not receive artificial ascites (n = 13). The volume of the ablation zone was measured on CT images obtained immediately after the ablation procedure, and imaging findings were compared for both groups using the Student's t test. We also compared the local tumor progression rate between both groups using the chi-square test (mean follow-up, 37.4 months).
There was no significant difference between the two patient groups with regard to age, sex, Child-Pugh class, or tumor location (p > 0.05). The tumors were significantly smaller in group A patients (mean +/- SD, 1.6 +/- 0.5 cm) than in group B patients (2.1 +/- 0.7 cm) (p = 0.019). The mean volume of the RFA zone was 31.6 +/- 11.9 cm(3) in group A patients and 30.9 +/- 11.0 cm(3) in group B patients. There was no significant difference between the groups in the ablation volume (p = 0.871). Local tumor progression was noted in four patients (26.7%) in group A and in three patients (23.1%) in group B. There was no significant difference in the local tumor progression rate between the two groups (p = 0.83).
Artificial ascites did not show a heat-sink effect on the volume of the ablation zone after percutaneous RFA for the treatment of a hepatic tumor abutting the diaphragm.
本研究旨在评估人工腹水是否对经皮射频消融（RFA）治疗毗邻膈肌的肝肿瘤的消融区具有热沉效应。
我们回顾性评估了 2000 年 7 月至 2006 年 12 月期间接受经皮 RFA 治疗的 28 例单一结节性肝肿瘤毗邻膈肌的患者。所有患者均采用内置冷却电极进行超声引导下 RFA。使用 3cm 活性尖端电极进行 12 分钟的单次消融。我们根据 RFA 前是否引入人工腹水将患者分为两组：A 组接受平均 760ml 5%葡萄糖水溶液的人工腹水（n=15），B 组未接受人工腹水（n=13）。在消融手术后立即获得 CT 图像测量消融区体积，并使用学生 t 检验比较两组的影像学发现。我们还使用卡方检验（平均随访 37.4 个月）比较两组的局部肿瘤进展率。
两组患者的年龄、性别、Child-Pugh 分级或肿瘤位置无显著差异（p＞0.05）。A 组患者的肿瘤明显小于 B 组（平均 +/- SD，1.6 +/- 0.5cm）（p=0.019）。A 组患者的 RFA 区平均体积为 31.6 +/- 11.9cm³，B 组为 30.9 +/- 11.0cm³。两组间消融体积无显著差异（p=0.871）。A 组有 4 例（26.7%）患者和 B 组有 3 例（23.1%）患者出现局部肿瘤进展。两组局部肿瘤进展率无显著差异（p=0.83）。
人工腹水在经皮 RFA 治疗毗邻膈肌的肝肿瘤后，对消融区的体积没有表现出热沉效应。
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