Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Department of General, Visceral and Vascular Surgery - Campus Benjamin Franklin, Berlin - Hindenburgdamm 30, 12203, Berlin, Germany.
Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Department of Radiology - Campus Benjamin Franklin, Berlin - Germany - Hindenburgdamm 30, 12203, Berlin, Germany.
Sci Rep. 2020 Oct 1;10(1):16210. doi: 10.1038/s41598-020-71512-x.
Radiofrequency ablation (RFA) is a curative treatment option for early stage hepatocellular carcinoma (HCC). Vascular inflow occlusion to the liver (Pringle manoeuvre) and multibipolar RFA (mbRFA) represent possibilities to generate large ablations. This study evaluated the impact of different interapplicator distances and a Pringle manoeuvre on ablation area and geometry of mbRFA. 24 mbRFA were planned in porcine livers in vivo. Test series with continuous blood flow had an interapplicator distance of 20 mm and 15 mm, respectively. For a Pringle manoeuvre, interapplicator distance was predefined at 20 mm. After liver dissection, ablation area and geometry were analysed macroscopically and histologically. Confluent and homogenous ablations could be achieved with a Pringle manoeuvre and an interapplicator distance of 15 mm with sustained hepatic blood flow. Ablation geometry was inhomogeneous with an applicator distance of 20 mm with physiological liver perfusion. A Pringle manoeuvre led to a fourfold increase in ablation area in comparison to sustained hepatic blood flow (p < 0.001). Interapplicator distance affects ablation geometry of mbRFA. Strict adherence to the planned applicator distance is advisable under continuous blood flow. The application of a Pringle manoeuvre should be considered when compliance with the interapplicator distance cannot be guaranteed.
射频消融（RFA）是治疗早期肝细胞癌（HCC）的一种有治愈可能的治疗选择。肝脏血管流入阻断（Pringle 手法）和多极射频消融（mbRFA）是产生大消融区的可能性。本研究评估了不同的间隔距离和 Pringle 手法对 mbRFA 的消融区和几何形状的影响。在体内猪肝脏中计划了 24 次 mbRFA。连续血流的测试系列的间隔距离分别为 20mm 和 15mm。对于 Pringle 手法，间隔距离预设为 20mm。肝解剖后，通过宏观和组织学分析评估消融区和几何形状。在维持肝血流的情况下，采用 Pringle 手法和 15mm 的间隔距离可实现融合且均匀的消融。在生理肝灌注下，间隔距离为 20mm 时，消融几何形状不均匀。与持续肝血流相比，Pringle 手法可使消融面积增加四倍（p<0.001）。间隔距离会影响 mbRFA 的消融几何形状。在持续血流下，严格遵守计划的间隔距离是明智的。如果无法保证间隔距离，则应考虑应用 Pringle 手法。
