Treatment of recurrent hepatocellular carcinoma by radiofrequency thermal ablation.
Treatment of recurrent hepatocellular carcinoma by radiofrequency thermal ablation.
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射频热消融治疗复发性肝细胞癌。
DOI：
10.1007/s005340100003
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发表时间：
2001
期刊：
影响因子：
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通讯作者：
A. Hasheminia
中科院分区：
文献类型：
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作者：
N. Nicòli;A. Casaril;L. Marchiori;G. Mangiante;A. Hasheminia
摘要背景和目的肝细胞癌的首选治疗方法是手术切除。大多数患者会出现复发。积极治疗肝脏复发可提高患者的生存率，但最常见的是，这些患者不适合手术。本研究的目的是分析射频热消融（RFTA）治疗肝细胞癌手术切除后或 RFTA 后肝内复发的适应症和结果。 患者和方法 79 例 HCC 患者接受 RFTA 治疗（17 例在剖腹手术期间，1 例在电视腹腔镜手术中，61 例经皮手术）。其中 5 例 (5/79) 患者在手术切除后出现复发，1 例患者在经皮 RFTA 后出现复发（新病灶）。 79 名患者中有 15 名在经动脉化疗栓塞 (TACE) 后接受了复发治疗，而对于其余 58 名患者，RFTA 是首选治疗方法。我们使用了带有可扩展针的射频发生器，其末端有四个、七个或九个钩子。我们在 RFTA 后 1 个月对所有患者进行增强计算机断层扫描 (CT) 扫描和甲胎蛋白采样，然后每 4 个月进行一次随访。 结果 肝切除后平均 43 个月后，所有 5 名因切除后复发而接受治疗的患者均存活。 1 名患者无病，1 名患者疾病得到控制，3 名患者病情进展。 RFTA 后复发的患者在 4 个月后痊愈。结论我们采用多模式方法治疗了所有手术切除后肝内复发的患者。我们将 RFTA 视为治疗肝内复发的首选治疗方法。对于浅表肿瘤，手术切除仍然是最好的治疗方法。对于多灶性复发，需要 TACE。 RFTA 可作为 TACE 未完全治疗的病变的补充技术。
AbstractBackground and aimsThe treatment of choice for hepatocellular carcinoma is surgical resection. Recurrence occurs in most patients. Aggressive treatment of liver recurrence increases patients' survival, but most frequently, these patients are not suitable for surgery. The aim of this study was to analyze the indications for and results of radiofrequency thermal ablation (RFTA) in the treatment of intrahepatic recurrences of hepatocellular carcinoma after surgical resection or after RFTA.Patients and methodsSeventy-nine patients with HCC were treated by RFTA (17 during laparotomy, 1 in video-laparoscopic surgery, and 61 percutaneously). Five (5/79) of these patients had recurrences after surgical resection and 1 patient had a recurrence (new lesion) after percutaneous RFTA. Fifteen of the 79 patients were treated for recurrence after transarterial chemoembolization (TACE) and, for the remaining 58 patients, RFTA was the first treatment. We used a radiofrequency generator with an expandable needle with four, seven, or nine hooks at its end. We followed up all patients with enhanced computed tomography (CT) scans and α-fetoprotein sampling 1 month after RFTA, and then every 4 months.ResultsAll 5 patients treated for recurrence after resection are alive, after a mean period of 43 months from liver resection. One patient is disease-free, 1 patient has controlled disease, and 3 patients are in progression. The patient treated for recurrence after RFTA is disease-free after 4 months.ConclusionsWe treated all our patients with intrahepatic recurrence after surgical resection by a multimodal approach. We regard RFTA as the treatment of first choice in the management of intrahepatic recurrence. For superficial tumors, surgical resection is still the best treatment. For multifocal recurrence, TACE is needed. RFTA can be useful as a complementary technique for lesions not completely treated by TACE.