Park Sung Il, Kim Il Jung, Lee Shin Jae, Shin Min Woo, Shin Won Sun, Chung Yong Eun, Kim Gyoung Min, Kim Man Deuk, Won Jong Yun, Lee Do Yun, Choi Jin Sub, Han Kwang-Hyub
Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea.
Department of Radiology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon 14647, Korea.
Korean J Radiol. 2016 Sep-Oct;17(5):742-9. doi: 10.3348/kjr.2016.17.5.742. Epub 2016 Aug 23.
To evaluate the feasibility of angled cool-tip electrode for radiofrequency ablation of small superficial subcapsular liver tumors abutting abdominal wall, in order to traverse normal liver parenchyma, and thereby, obtain favorable configuration of ablation margin.
In this study, we retrospectively analyzed 15 small superficial subcapsular liver tumors abutting abdominal wall in 15 patients, treated with radiofrequency ablation from March 2013 to June 2015 using a cool-tip electrode manually modified to create 25-35° angle at the junction between exposed and insulated segments. The tumors were hepatocellular carcinoma (n = 13) and metastases (n = 2: cholangiocellular carcinoma and rectosigmoid cancer), with maximum diameter of 10-26 mm (mean, 15.68 ± 5.29 mm). Under ultrasonographic guidance, the electrode tip was advanced to the depth of the tumors' epicenter about 1 cm from the margin. The tip was re-directed to penetrate the tumor for radiofrequency ablation. Minimal ablation margin was measured at immediate post-treatment CT. Radiological images and medical records were evaluated for success rate, length of minimal ablation margin and complications.
Technical success rate of obtaining complete necrosis of the tumors was 100%, with no procedure-related complication. Minimal ablation margin ranged from 3-12 mm (mean, 7.07 ± 2.23 mm). CT/MRI follow-up at 21-1022 days (mean, 519.47 ± 304.51 days) revealed no local recurrence, but distant recurrence in 9 patients.
Using an angled cool-tip electrode for radiofrequency ablation of small superficial subcapsular tumors abutting abdominal wall may be a feasible technique for obtaining adequate ablation margin and lower complication rate.
评估成角冷极电极用于紧邻腹壁的小的浅表性肝包膜下肿瘤射频消融的可行性，以便穿过正常肝实质，从而获得良好的消融边缘形态。
在本研究中，我们回顾性分析了2013年3月至2015年6月期间15例患者的15个紧邻腹壁的小的浅表性肝包膜下肿瘤，这些肿瘤采用手动改良的冷极电极进行射频消融，该电极在裸露段与绝缘段的交界处形成25 - 35°角。肿瘤包括肝细胞癌（n = 13）和转移瘤（n = 2：胆管细胞癌和直肠乙状结肠癌），最大直径为10 - 26 mm（平均15.68 ± 5.29 mm）。在超声引导下，将电极尖端推进至距肿瘤边缘约1 cm的肿瘤中心深度。将尖端重新定向以穿透肿瘤进行射频消融。在治疗后即刻的CT上测量最小消融边缘。评估放射学图像和病历以确定成功率、最小消融边缘长度和并发症。
肿瘤获得完全坏死的技术成功率为100%，无手术相关并发症。最小消融边缘范围为3 - 12 mm（平均7.07 ± 2.23 mm）。在21 - 1022天（平均519.47 ± 304.51天）进行的CT/MRI随访显示无局部复发，但9例患者出现远处复发。
使用成角冷极电极对紧邻腹壁的小的浅表性肝包膜下肿瘤进行射频消融可能是一种获得足够消融边缘且并发症发生率较低的可行技术。
