经皮冷冻消融治疗肝脏肿瘤：印度一家三级医疗中心的初步经验。
Percutaneous Cryoablation of Liver Tumors: Initial Experience from a Tertiary Care Center in India.
作者信息
Kalra Naveen, Gupta Pankaj, Jugpal Tejeshwar, Naik Shailendra S, Gorsi Ujjwal, Chaluvashetty Sreedhara B, Bhujade Harish, Duseja Ajay, Singh Virendra, Dhiman Radha K, Sandhu Manavjit S
机构信息
Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Department of Hepatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
出版信息
J Clin Exp Hepatol. 2021 May-Jun;11(3):305-311. doi: 10.1016/j.jceh.2020.10.005. Epub 2020 Oct 19.
BACKGROUND
Percutaneous ablation is an important part of management strategy for liver tumors. While radiofrequency ablation and microwave ablation are the most widely used ablative techniques, cryoablation (CA) has several technical advantages but has been underused till recently. In this study, we report the initial experience with percutaneous CA of liver tumors.
METHODS
This was a retrospective evaluation of consecutive patients with liver tumors who underwent percutaneous CA between October 2018 and August 2019. The ablation procedures were performed under combined ultrasound and computed tomography guidance using argon-helium-based CA systems. The baseline tumor characteristics (including size and location), Barcelona Clinic Liver Cancer stage, and Child-Pugh score were recorded. Each patient underwent a follow-up after 1 month and at 3 months subsequently. Technical success, complete response, local tumor progression, and overall survival were evaluated.
RESULTS
Nine patients (mean age, 62.4 years, median age, 66 years, five men and four women) with 10 liver tumors (mean size, 2.22 cm) underwent CA. Seven (77.8%) patients had hepatocellular carcinoma (HCC), and 2 patients had solitary liver metastasis. One patient with HCC had two lesions, while the rest had only one lesion. Of the two metastatic lesions, one was from carcinoma of the cervix and the other was from jejunal neuroendocrine tumor. Five tumors were located adjacent to the gallbladder, two lesions were adjacent to the right portal vein, two lesions were subcapsular, and one lesion was adjacent to the stomach. Technical success was achieved in all the patients. Complete response was achieved in 7 (77.8%) patients. The median follow-up period was 7 months (range, 3-12 months). There was no local tumor progression and no death during the follow-up period. No procedure-related complication was seen.
CONCLUSION
Percutaneous CA of hepatic tumors is technically feasible and is a safe and effective ablative technique.
背景
经皮消融是肝肿瘤治疗策略的重要组成部分。虽然射频消融和微波消融是最广泛应用的消融技术，但冷冻消融（CA）具有多项技术优势，不过直到最近其应用仍不广泛。在本研究中，我们报告了经皮冷冻消融肝肿瘤的初步经验。
方法
这是一项对2018年10月至2019年8月期间接受经皮冷冻消融的连续性肝肿瘤患者的回顾性评估。消融操作在超声和计算机断层扫描联合引导下，使用基于氩氦的冷冻消融系统进行。记录基线肿瘤特征（包括大小和位置）、巴塞罗那临床肝癌分期及Child-Pugh评分。每位患者在术后1个月及随后的3个月进行随访。评估技术成功率、完全缓解率、局部肿瘤进展情况及总生存率。
结果
9例患者（平均年龄62.4岁，中位年龄66岁，5例男性和4例女性）共10个肝肿瘤（平均大小2.22 cm）接受了冷冻消融。7例（77.8%）患者为肝细胞癌（HCC），2例患者为孤立性肝转移瘤。1例HCC患者有2个病灶，其余患者仅有1个病灶。在2个转移瘤中，1个来自宫颈癌，另1个来自空肠神经内分泌肿瘤。5个肿瘤位于胆囊附近，2个病灶邻近右门静脉，2个病灶位于包膜下，1个病灶邻近胃。所有患者均获得技术成功。7例（77.8%）患者实现完全缓解。中位随访期为7个月（范围3 - 12个月）。随访期间无局部肿瘤进展，无死亡病例。未观察到与操作相关的并发症。
结论
经皮冷冻消融肝肿瘤在技术上是可行的，是一种安全有效的消融技术。
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