Siperstein A E, Rogers S J, Hansen P D, Gitomirsky A
Department of Surgery, UCSF/Mount Zion Medical Center 94143-1674, USA.
Surgery. 1997 Dec;122(6):1147-54; discussion 1154-5. doi: 10.1016/s0039-6060(97)90221-x.
Neuroendocrine tumor metastases to the liver are generally slow growing, but patients suffer from hormone hypersecretion despite aggressive multimodality therapy. A minimally invasive method of tumor ablation affords symptomatic improvement with minimal morbidity.
Radiofrequency electrical energy is delivered to tissues via a 4-prong catheter resulting in tissue heating to 60 to 70 degrees C and cell death. Porcine studies were conducted to define appropriate parameters for energy delivery and then applied to patients using laparoscopic techniques.
In the porcine model 3.5 to 4 cm lesions were reproducibly created in 15 minutes using 30 to 50 W of power. The ablation process was monitored via temperature feedback from thermocouples in the catheter tips and by a hyperechoic blush noted on ultrasonography. Laparoscopic thermal ablation of 13 tumors in six patients with carcinoid (two patients), gastrinoma, insulinoma, nonsecreting islet cell cancer, or medullary thyroid cancer was performed. There were no intraoperative complications, and all patients were discharged the next day. Successful ablation was confirmed by spiral-computed tomography and by symptomatic improvement in patients with secreting tumors.
Laparoscopic thermal ablation of hepatic tumors is a novel, minimally invasive method of providing effective cytoreduction of neuroendocrine tumors metastatic to the liver.
神经内分泌肿瘤肝转移通常生长缓慢，但尽管采用了积极的多模式治疗，患者仍遭受激素分泌过多之苦。一种微创的肿瘤消融方法能在发病率极低的情况下改善症状。
通过四叉导管将射频电能传递至组织，使组织温度升至60至70摄氏度并导致细胞死亡。进行了猪实验以确定能量传递的合适参数，然后使用腹腔镜技术应用于患者。
在猪模型中，使用30至50瓦功率，15分钟内可重复制造出3.5至4厘米的病灶。通过导管尖端热电偶的温度反馈以及超声检查发现的高回声红晕来监测消融过程。对6例患有类癌（2例患者）、胃泌素瘤、胰岛素瘤、无分泌功能的胰岛细胞癌或甲状腺髓样癌的患者的13个肿瘤进行了腹腔镜热消融。术中无并发症，所有患者于次日出院。螺旋计算机断层扫描及分泌性肿瘤患者症状改善证实了消融成功。
腹腔镜热消融肝肿瘤是一种新型的微创方法，可有效减少肝转移神经内分泌肿瘤的细胞数量。
