Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Liver Int. 2019 Oct;39(10):1975-1985. doi: 10.1111/liv.14187. Epub 2019 Jul 28.
BACKGROUND & AIMS: Ablation plays an important role in the treatment of hepatocellular carcinoma. Because image-guided navigation technology has recently entered the clinical setting, we aimed to analyse its safety, therapeutic and procedural efficiency.
Retrospective analysis of patients treated with stereotactic image-guided microwave ablation (SMWA) between January 2015 and December 2017. Interventions were performed using computertomography-guidance with needle trajectory, ablation planning and automatic single-marker patient registration. Needle placement and ablation coverage was controlled by image fusion under general anaesthesia with jet-ventilation.
In total 174 ablations were performed in 88 patients during 119 interventions. Mean age was 66 (46-84) years, 74 (84.1%) were men and 74% were Child Pugh Class A. Median tumour size was 16 (4-45) mm, 62.2% were BCLC A. Median lateral and longitudinal error of needle placement were 3.2 (0.2-14.1) and 1.6 (0-15.8) mm. Median one tumour (1-4) was ablated per session. One patient developed a Dindo IIIb (0.8%) complication, six minor complications. After re-ablation of 12 lesions, an efficacy rate of 96.3% was achieved. Local tumour progression was 6.3% (11/174). Close proximity to major vessels was significantly correlated with local tumour progression (P < .05). Median overall follow-up was 17.5 months after intervention and 24 months after initial diagnosis. BCLC stage, child class and previous treatment were significantly correlated with overall survival (P < .05).
Stereotactic image-guided microwave ablation is a safe and efficient treatment for HCC offering a curative treatment approach in general and in particular for lesions not detectable on conventional imaging or untreatable because of difficult anatomic locations.
消融在肝细胞癌的治疗中起着重要作用。由于影像引导导航技术最近已进入临床应用，我们旨在分析其安全性、治疗效果和程序效率。
回顾性分析 2015 年 1 月至 2017 年 12 月期间接受立体定向图像引导微波消融（SMWA）治疗的患者。采用 CT 引导下的针道、消融计划和自动单标记患者注册。在全身麻醉下使用射流通气进行图像融合，控制针的放置和消融覆盖范围。
共对 88 例患者的 174 个病灶进行了 119 次介入治疗。平均年龄为 66（46-84）岁，74（84.1%）为男性，74%为 Child-Pugh 分级 A。肿瘤大小中位数为 16（4-45）mm，62.2%为 BCLC A 期。针放置的横向和纵向误差中位数分别为 3.2（0.2-14.1）mm 和 1.6（0-15.8）mm。每次治疗中位数消融 1 个（1-4 个）病灶。1 例患者发生 Dindo IIIb 级（0.8%）并发症，6 例发生轻微并发症。对 12 个病灶进行再次消融后，获得 96.3%的疗效。局部肿瘤进展率为 6.3%（11/174）。与局部肿瘤进展显著相关的是紧邻大血管（P<.05）。介入治疗后中位总随访时间为 17.5 个月，初始诊断后为 24 个月。BCLC 分期、Child 分级和既往治疗与总生存显著相关（P<.05）。
立体定向图像引导微波消融是一种安全有效的 HCC 治疗方法，可提供一般的根治性治疗方法，特别是对常规影像学检查无法发现或因解剖位置困难而无法治疗的病灶。
