Künzli Beat M, Abitabile Paolo, Maurer Christoph A
Beat M Künzli, Paolo Abitabile, Christoph A Maurer, Department of Surgery, Kantonsspital Liestal, Liestal, CH-4416, Switzerland.
World J Hepatol. 2011 Jan 27;3(1):8-14. doi: 10.4254/wjh.v3.i1.8.
Over the past decade, radiofrequency ablation (RFA) has evolved into an important therapeutical tool for the treatment of non resectable primary and secondary liver tumors. The clinical benefit of RFA is represented in several clinical studies. They underline the safety and feasibility of this new and modern concept in treating liver tumors. RFA has proven its clinical impact not only in hepatocellular carcinoma (HCC) but also in metastatic disease such as colorectal cancer (CRC). Due to the increasing number of HCC and CRC, RFA might play an even more important role in the future. Therefore, the refinement of RFA technology is as important as the evaluation of data of prospective randomized trials that will help define guidelines for good clinical practice in RFA application in the future. The combination of hepatic resection and RFA extends the feasibility of open surgical procedures in patients with extensive tumors. Adverse effects of RFA such as biliary tract damage, liver failure and local recurrence remain an important task today but overall the long term results of RFA application in treating liver tumors are promising. Incomplete ablation of liver tumors due to insufficient technology of ablation needles, tissue cooling by the neighbouring blood vessels, large tumor masses and ablation of tumors in close vicinity to heat sensitive organs remain difficult tasks for RFA. Future solutions to overcome these limitations of RFA will include refinement of ultrasonographic guidance (accuracy of probe placement), improvements in needle technology (e.g. needles preventing charring) and intraductal cooling techniques.
在过去十年中，射频消融术（RFA）已发展成为治疗不可切除的原发性和继发性肝肿瘤的重要治疗工具。多项临床研究表明了RFA的临床益处。这些研究强调了这种治疗肝肿瘤的新现代概念的安全性和可行性。RFA不仅在肝细胞癌（HCC）中，而且在转移性疾病如结直肠癌（CRC）中都证明了其临床影响。由于HCC和CRC的数量不断增加，RFA在未来可能会发挥更重要的作用。因此，完善RFA技术与评估前瞻性随机试验的数据同样重要，这些试验将有助于确定未来RFA应用的良好临床实践指南。肝切除术与RFA的联合应用扩大了广泛肿瘤患者开放手术的可行性。RFA的不良反应如胆道损伤、肝衰竭和局部复发仍是当今的一项重要任务，但总体而言，RFA治疗肝肿瘤的长期效果是有前景的。由于消融针技术不足、邻近血管导致的组织冷却、大肿瘤块以及靠近热敏感器官的肿瘤消融等原因，肝肿瘤的不完全消融仍然是RFA面临的难题。克服RFA这些局限性的未来解决方案将包括完善超声引导（探头放置的准确性）、改进针技术（如防止烧焦的针）和导管内冷却技术。
