Scattered and rapid intrahepatic recurrences after radio frequency ablation for hepatocellular carcinoma
Scattered and rapid intrahepatic recurrences after radio frequency ablation for hepatocellular carcinoma
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DOI：
10.3748/wjg.v11.i43.6828
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发表时间：
2005-11-21
影响因子：
4.3
通讯作者：
Nakamuta, Makoto
中科院分区：
文献类型：
--
作者：
Kotoh, Kazuhiro;Enjoji, Munechika;Nakamuta, Makoto
目的：评价一系列采用不同方案和器械治疗的肝细胞癌（HCC）患者。方法：我们治疗了138例[慢性肝炎/肝硬化（Child-Pugh A/B/C），3/135（107/25/3）]，使用两种不同的设备和协议：冷尖针[60 W初始消融（标准方法）（n = 37）或40 W（改良方法）（n = 28）]或;使用标准单步完全扩张的LeVeen针进行消融结果：11例患者在消融后1 ~ 7 mo出现快速、散在复发。9例患者采用冷头端原始方案（60 W）治疗（9/37 = 24%），另外2例采用LeVeen单步方法治疗（2/39 = 5%）。复发部位3例局限于消融节段周围，8例累及一侧或双侧小叶。有没有复发的患者治疗与改良的cool-tip改良方法（40 W）或LeVeen多步骤method.CONCLUSION：有风险的快速和分散复发后，RFA，特别是当标准的cool-tip程序是使用。由于这种复发会恶化预后，我们建议在临床实践中应使用冷尖和LeVeen针方法的修改方案。(C)2005年WJG出版社和Elsevier Inc. All rights reserved.
AIM: To evaluate a series of patients with hepatocellular carcinoma (HCC) treated with several different protocols and devices.METHODS: We treated 138 patients [chronic hepatitis/liver cirrhosis (Child-Pugh A/B/C), 3/135 (107/25/3)] with two different devices and protocols: cool-tip needle [initial ablation at 60 W (standard method) (n = 37) or at 40 W (modified method) (n = 28)] or; ablation with a LeVeen needle using a standard single-step, full expansion (single-step) method (n = 39) or a multi-step, incremental expansion (multi-step) method.RESULTS: Eleven patients experienced rapid and scattered recurrences 1 to 7 mo after the ablation. Nine patients were treated by the cool-tip original protocol (60 W) (9/37 = 24%) and the other two by the LeVeen single-step method (2/39 = 5%). The location of the recurrence was surrounding and limited to the site of ablation segment in three cases, and spread over one lobule or both lobules in the other eight cases. There was no recurrence in the patients treated with the modified cool-tip modified method (40 W) or the LeVeen multi-step method.CONCLUSION: There is a risk of rapid and scattered recurrence after RFA, especially when the standard cool-tip procedure is used. Because such recurrence would worsen the prognosis, we recommend that modified protocols for the cool-tip and LeVeen needle methods should be used in clinical practice. (C) 2005 The WJG Press and Elsevier Inc. All rights reserved.