Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
J Am Coll Surg. 2012 Sep;215(3):379-87. doi: 10.1016/j.jamcollsurg.2012.04.029. Epub 2012 Jun 16.
Ablation is increasingly used to treat primary and secondary liver cancer. Ablation near portal pedicles and hepatic veins is challenging. Irreversible electroporation (IRE) is a new ablation technique that does not rely on heat and, in animals, appears to be safe and effective when applied near hepatic veins and portal pedicles. This study evaluated the safety and short-term outcomes of IRE to ablate perivascular malignant liver tumors.
A retrospective review of patients treated with IRE between January 1, 2011 and November 2, 2011 was performed. Patients were selected for IRE when resection or thermal ablation was not indicated due to tumor location. Treatment outcomes were classified by local, regional, and systemic recurrence and complications. Local failure was defined as abnormal enhancement at the periphery of an ablation defect on post-procedure contrast imaging.
Twenty-eight patients had 65 tumors treated. Twenty-two patients (79%) were treated via an open approach and 6 (21%) were treated percutaneously. Median tumor size was 1 cm (range 0.5 to 5 cm). Twenty-five tumors were <1 cm from a major hepatic vein; 16 were <1 cm from a major portal pedicle. Complications included 1 intraoperative arrhythmia and 1 postoperative portal vein thrombosis. Overall morbidity was 3%. There were no treatment-associated mortalities. At median follow-up of 6 months, there was 1 tumor with persistent disease (1.9%) and 3 tumors recurred locally (5.7%).
This early analysis of IRE treatment of perivascular malignant hepatic tumors demonstrates safety for treating liver malignancies. Larger studies and longer follow-up are necessary to determine long-term efficacy.
消融术越来越多地用于治疗原发性和继发性肝癌。在门脉蒂和肝静脉附近进行消融术具有挑战性。不可逆电穿孔（IRE）是一种新的消融技术，它不依赖于热，并且在动物中，当应用于肝静脉和门脉蒂附近时，似乎是安全有效的。本研究评估了 IRE 消融血管周围恶性肝肿瘤的安全性和短期结果。
回顾性分析了 2011 年 1 月 1 日至 2011 年 11 月 2 日期间接受 IRE 治疗的患者。由于肿瘤位置，当不能进行切除或热消融时选择患者进行 IRE 治疗。根据局部、区域和全身复发及并发症对治疗结果进行分类。局部失败定义为消融缺陷周围的异常增强在术后对比成像上。
28 例患者共 65 个肿瘤接受治疗。22 例（79%）患者经开放性手术治疗，6 例（21%）患者经皮治疗。中位肿瘤大小为 1cm（范围 0.5-5cm）。25 个肿瘤距大肝静脉<1cm；16 个肿瘤距大门静脉蒂<1cm。并发症包括 1 例术中心律失常和 1 例术后门静脉血栓形成。总发病率为 3%。无治疗相关死亡。中位随访 6 个月时，有 1 例肿瘤持续存在（1.9%），3 例肿瘤局部复发（5.7%）。
这项关于血管周围恶性肝肿瘤 IRE 治疗的早期分析表明，IRE 治疗肝脏恶性肿瘤是安全的。需要更大的研究和更长的随访时间来确定长期疗效。
