Department of Diagnostic and Therapeutic Radiology, Kawasaki Medical School, 2-6-1, Nakasange, Kita-ku, Okayama, 700-8505, Japan.
Department of Radiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki, Kanagawa, 216-8511, Japan.
Jpn J Radiol. 2021 Nov;39(11):1119-1126. doi: 10.1007/s11604-021-01148-y. Epub 2021 Jun 5.
To retrospectively assess the feasibility, safety, and efficacy of artificial carbon dioxide (CO) pneumothorax for computed tomography (CT) fluoroscopy-guided percutaneous radiofrequency (RF) ablation of hepatocellular carcinoma (HCC).
This study included 26 sessions of 24 patients in whom the creation of artificial CO pneumothorax was attempted to avoid the transpulmonary route during CT fluoroscopy-guided percutaneous RF ablation of HCC between April 2011 and December 2017. In these 26 sessions, 29 HCCs (mean tumor diameter: 12 mm, range: 6-22 mm) were treated.
Adequate lung displacement after induction of artificial CO pneumothorax was achieved in 23 of the 26 sessions (88.5%). In the remaining three sessions, transpulmonary RF ablation, transthoracic extrapulmonary RF ablation after switching to an artificial pleural effusion procedure, or RF ablation with electrode insertion in the caudal-cranial oblique direction was performed. No major complications were found. Among the 29 treated tumors, one (3.4%) showed local progression, and the other 28 (96.6%) were completely ablated at the last follow-up (mean follow-up period: 39.3 months, range: 7-78 months).
Artificial CO pneumothorax for CT fluoroscopy-guided percutaneous RF ablation appeared to be a feasible, safe, and useful therapeutic option for HCC.
回顾性评估人工二氧化碳（CO）气胸在 CT 透视引导下经皮射频（RF）消融治疗肝细胞癌（HCC）中的可行性、安全性和疗效。
本研究纳入 2011 年 4 月至 2017 年 12 月期间 24 例患者共 26 次尝试通过 CT 透视引导下经皮 RF 消融治疗 HCC 时，采用人工 CO 气胸来避免经肺途径。在这 26 次治疗中，共治疗 29 个 HCC（平均肿瘤直径：12mm，范围：6-22mm）。
26 次治疗中有 23 次（88.5%）成功诱导人工 CO 气胸后实现了充分的肺移位。在其余 3 次治疗中，分别进行了经肺 RF 消融、转换为人工胸腔积液后经胸外肺 RF 消融、或电极沿头尾斜向插入进行 RF 消融。未发现严重并发症。在 29 个治疗的肿瘤中，1 个（3.4%）出现局部进展，其余 28 个（96.6%）在最后一次随访时完全消融（平均随访时间：39.3 个月，范围：7-78 个月）。
CT 透视引导下经皮 RF 消融采用人工 CO 气胸似乎是一种可行、安全且有效的 HCC 治疗选择。
