超声引导下肝脏射频消融的非手术室麻醉（NORA）

Non-Operating Room Anesthesia (NORA) for Ultrasound-Guided Liver Radiofrequency Ablation.

作者信息

Jung Carlo Felix Maria, Liverani Elisa, Binda Cecilia, Cristofaro Ludovica, Gori Alberto, Alemanni Luigina Vanessa, Sartini Alessandro, Coluccio Chiara, Gibiino Giulia, Petraroli Chiara, Serra Carla, Fabbri Carlo

机构信息

Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena Hospitals, AUSL Romagna, 47121 Forlì, Italy.

Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum-University of Bologna, 40138 Bologna, Italy.

出版信息

Diagnostics (Basel). 2024 Aug 15;14(16):1783. doi: 10.3390/diagnostics14161783.

DOI:10.3390/diagnostics14161783

PMID:39202272

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11353362/

Abstract

INTRODUCTION

Percutaneous ultrasound-guided radiofrequency ablation (RFA) is a well-studied treatment option for locally non-advanced hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLMs). Sedation is of crucial interest as it enables safe and pain-free procedures. Whether the type of sedation has an impact on procedural outcome is still not well investigated.

METHODS

We retrospectively collected data on patients undergoing liver RFA for various oncological conditions. Procedures were conducted in a non-operating room anesthesia (NORA) setting. Procedural-related complications and short-term oncological outcomes were analyzed.

RESULTS

Thirty-five patients (mean age 71.5 y, 80% male) were treated for HCC (26), CRLM (6) and gastric cancer metastases (3). Mean lesion size was 21 mm (SD ± 10.1 mm), and the most common tumor localization was the right hepatic lobe. RFA was performed in a step-up sedation approach, with subcutaneous lidocaine injection prior to needle placement and subsequent deep sedation during ablation. No anesthesia-related early or late complications occurred. One patient presented with pleural effusion due to a large ablation zone and was treated conservatively. Local tumor-free survival after 1 and 6 months was 100% in all cases where a curative RFA approach was intended.

CONCLUSIONS

NORA for liver RFA comes with high patient acceptance and tolerance, and optimal postoperative outcomes and oncologic results.

摘要

引言

经皮超声引导下射频消融术（RFA）是一种针对局部非进展期肝细胞癌（HCC）和结直肠癌肝转移瘤（CRLM）进行了充分研究的治疗选择。镇静至关重要，因为它能使手术安全且无痛。镇静类型是否会对手术结果产生影响仍未得到充分研究。

方法

我们回顾性收集了因各种肿瘤疾病接受肝脏RFA治疗的患者数据。手术在非手术室麻醉（NORA）环境下进行。分析了与手术相关的并发症和短期肿瘤学结果。

结果

35例患者（平均年龄71.5岁，80%为男性）接受了HCC（26例）、CRLM（6例）和胃癌转移瘤（3例）的治疗。平均病灶大小为21毫米（标准差±10.1毫米），最常见的肿瘤部位是右肝叶。RFA采用逐步镇静方法进行，在穿刺针放置前皮下注射利多卡因，在消融过程中随后进行深度镇静。未发生与麻醉相关的早期或晚期并发症。1例患者因消融区域较大出现胸腔积液，接受了保守治疗。在所有旨在采用根治性RFA方法的病例中，1个月和6个月后的局部无瘤生存率均为100%。