Dunne Ruth M, Shyn Paul B, Sung Jeffrey C, Tatli Servet, Morrison Paul R, Catalano Paul J, Silverman Stuart G
Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States.
Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States.
Eur J Radiol. 2014 Apr;83(4):632-8. doi: 10.1016/j.ejrad.2014.01.007. Epub 2014 Jan 18.
To compare the safety of image-guided percutaneous cryoablation and radiofrequency ablation in the treatment of hepatocellular carcinoma in patients with cirrhosis.
This retrospective HIPAA-compliant study received institutional review board approval. Forty-two adult patients with cirrhosis underwent image-guided percutaneous ablation of hepatocellular carcinoma from 2003 to 2011. Twenty-five patients underwent 33 cryoablation procedures to treat 39 tumors, and 22 underwent 30 radiofrequency ablation procedures to treat 39 tumors. Five patients underwent both cryoablation and radiofrequency ablation procedures. Complication rates and severity per procedure were compared between the ablation groups. Potential confounding patient, procedure, and tumor-related variables were also compared. Statistical analyses included Kruskal-Wallis, Wilcoxon rank sum, and Fisher's exact tests. Two-sided P-values <0.05 were considered significant.
The overall complication rates, 13 (39.4%) of 33 cryoablation procedures versus eight (26.7%) of 30 radiofrequency ablation procedures and severe/fatal complication rates, two (6.1%) of 33 cryoablation procedures versus one (3.3%) of 30 radiofrequency ablation procedures, were not significantly different between the ablation groups (both P=0.26). Severe complications included pneumothoraces requiring chest tube insertion during two cryoablation procedures. One death occurred within 90 days of a radiofrequency ablation procedure; all other complications were managed successfully.
No significant difference was seen in the overall safety of image-guided percutaneous cryoablation and radiofrequency ablation in the treatment of hepatocellular carcinoma in patients with cirrhosis.
比较影像引导下经皮冷冻消融术与射频消融术治疗肝硬化患者肝细胞癌的安全性。
本回顾性研究符合HIPAA法规，获得了机构审查委员会的批准。2003年至2011年期间，42例成年肝硬化患者接受了影像引导下经皮肝细胞癌消融术。25例患者接受了33次冷冻消融术以治疗39个肿瘤，22例患者接受了30次射频消融术以治疗39个肿瘤。5例患者同时接受了冷冻消融术和射频消融术。比较了消融组之间每个手术的并发症发生率和严重程度。还比较了潜在的混杂患者、手术和肿瘤相关变量。统计分析包括Kruskal-Wallis检验、Wilcoxon秩和检验和Fisher精确检验。双侧P值<0.05被认为具有统计学意义。
消融组之间的总体并发症发生率无显著差异，33次冷冻消融术中13次（39.4%），30次射频消融术中8次（26.7%）；严重/致命并发症发生率也无显著差异，33次冷冻消融术中2次（6.1%），30次射频消融术中1次（3.3%）（P均=0.26）。严重并发症包括2次冷冻消融术中需要插入胸管的气胸。1例患者在射频消融术后90天内死亡；所有其他并发症均成功处理。
影像引导下经皮冷冻消融术与射频消融术治疗肝硬化患者肝细胞癌的总体安全性无显著差异。
