Imai Yusuke, Hirooka Masashi, Ochi Hironori, Koizumi Yohei, Ohno Yoshinori, Watanabe Takao, Tokumoto Yoshio, Kumagi Teru, Abe Masanori, Hiasa Yoichi
Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
Center for Liver-Biliary-Pancreatic Diseases, Matsuyama Red Cross Hospital, 1 Bunkyocho, Matsuyama, 790-8524, Ehime, Japan.
Clin J Gastroenterol. 2015 Oct;8(5):318-22. doi: 10.1007/s12328-015-0599-2. Epub 2015 Aug 29.
Bile duct injury is a potential complication of radiofrequency ablation (RFA). Bipolar RFA devices have recently become available. Because visibility of the bipolar RFA electrodes is not good on ultrasonography, more careful usage of the electrodes to avoid bile ducts is needed. We present a case with hepatocellular carcinoma (HCC) located near the B5 intrahepatic bile duct. To view the bile duct, we used contrast medium for ultrasonography, administered through a biliary drainage catheter for endoscopic nasobiliary drainage (ENBD). Infusing the contrast medium allowed clear visualization of the HCC adjacent to the major bile duct during RFA. We also used a navigation system for bipolar RFA to confirm positions of the electrodes and HCC. We confirmed complete ablation of the HCC while avoiding bile duct injury and late bile duct stenosis. Administration of contrast medium for ultrasonography through an ENBD tube appears useful to avoid bile duct injury during RFA.
胆管损伤是射频消融（RFA）的一种潜在并发症。双极RFA设备最近已上市。由于双极RFA电极在超声检查中的可视性不佳，因此需要更谨慎地使用电极以避免损伤胆管。我们报告一例肝细胞癌（HCC）位于肝内B5胆管附近的病例。为了观察胆管，我们通过用于内镜鼻胆管引流（ENBD）的胆道引流导管注入超声造影剂。注入造影剂后，在RFA过程中可以清晰地看到与主要胆管相邻的HCC。我们还使用了双极RFA导航系统来确认电极和HCC的位置。我们确认HCC完全消融，同时避免了胆管损伤和晚期胆管狭窄。通过ENBD管进行超声造影剂注射似乎有助于在RFA期间避免胆管损伤。
