RFA : HCC. percutaneous acetic acid injection therapy: PAIT 3 percutaneous hot water injection therapy: PHot 4 HCC HCV HCC

Transcript

1 89 Vol. 33, pp , 2005 radiofrequency ablation therapy RFA : HCC 3 HCC B HBV C HCV HCV HCC 8 HCC HCV 7 8 high risk group HCC HCC i ii iii HCC HCC radiofrequency ablation therapy: RFA percutaneous ethanol injection: PEI 1 2 percutaneous acetic acid injection therapy: PAIT 3 percutaneous hot water injection therapy: PHot PEI percutaneous microwave coagulation therapy: PMCT 5 PMCT 2 1 cm PEIT PEIT PMCT RFA RFA HCC PEIT RFA 1 RFA RFA RFA khz RFA RITA, RTC, Radionics 3 2 expandable type 2, 3 Radionics cool-tip RFA 1

2 RFA 8 PEIT: RFA: 1, 2 cool-tip expandable 3 RITA 9 RTC 30 Radionics 147 RITA RTC RFA Radionics RFA 3cm 3 5cm RFA A B 3cm 3 HCC 6 Child-Pugh grade A B HCC RFA ADL 3cm HCC PEIT 5mm 15 RFA 5mm safety margin safety margin 5 16 RFA HCC transarterial chemoembolization: TACE 1 RFA RFA 2

3 radiofrequency ablation therapy RFA 91 2 RITA 3 RTC 3

4 92 ῌῐ4 RADIONICS ῌCool-tip ῐ1 4

5 radiofrequency ablation therapy RFA ablation RFA safety margin MDCT safety margin 7 safety margin HCC : 40 mm 30 mm RFA safety margin 5mm5 mm 5 mm 8 5 mm mm 5 mm mm 29 5 mm 5 mm mm safety 5

6 94 6 stage liver damage 7 RFA TACE RFA safety margin margin RFA Child C 6

7 radiofrequency ablation therapy RFA 95 8 RFA safety margin a: 5mm5 mm b: 5mm 5 mm 9 5 mm HCC RFA Child-Pugh B 9 S4 2.5 cm HCC RFA 10 HCC RFA HCC cool -tip RFA 12.5 seeding RFA cool -tip 7

8 96 10 RFA a: S4 2.5 cm HCC b: RFA HCC QOL RFA real time 1 Shiina S, Imamura M, Omata M: Percutaneous ethanol injection therapy PEIT for malignant liver neoplasms. Semin Interv Radiol 1997; 14: Livraghi T: Percutaneous ethanol injection in the treatment of hepatocellular carcinoma in cirrhosis. Hepatogastroenterol 2001; 48: Ohnishi K, Nomura F, Ito S, et al: Prognosis of small hepatocellular carcinoma less than 3 cm after percutaneous acetic acid injection: Study of 91 cases. Hepatology 1996 ; 23: Honda N, Guo Q, Uchida H, et al: Percutaneous hot saline injection therapy for hepatic tumors: An alternative to percutaneous ethanol injection therapy. Radiology 1994; 190: Seki T, Wakabayashi M, Nakagawa T, et al: Ultrasonically guided percutaneous microwave coagulation therapy for small hepatocellular carcinoma. Cancer 1994;74: Curley SA, Izzo F, Ellis LM, et al: Radiofrequency ablation of hepatocellular cancer in 110 patients with cirrhosis. Ann Surg 2000; 232: Wood TF, Rose DM, Chung M, et al: Radiofrequency ablation of 231 unresectable hepatic tumors: indications, limitations, and complications. Ann Surg Oncol 2000; 7: Bowles BJ, Machi J, Limm WM, et al: Safety and e$cacy of radiofrequency thermal ablation in advanced liver tumors. Arch Surg 2001; 136: Wong SL, Edwards MJ, Chao C, et al: Radiofrequency ablation for unresectable hepatic tumors. Am J Surg 2001; 182:

9 radiofrequency ablation therapy RFA Livraghi T, Goldberg SN, Lazzaroni S, Meloni F, Solbiati L, Gazelle GS. Small hepatocellular carcinoma: treatment with radio-frequency ablation versus ethanol injection. Radiology 1999; 210: Cool tip RFA 2000: 41: : 42: Izumi N, Asahina Y, Noguchi O, et al: Risk factors for distant recurrence of hepatocelluar carcinoma in the liver after complete coagulation by microwave or radiofrequency ablation. Cancer 2001; 91: , Shiina S, Tagawa K, Unuma T, et al: Percutaneous ethanol injection therapy for hepatocellular carcinoma. Cancer 1991; 68: : 2005: 46: Mulier S, Mulier P, NiY, et al. Complications of radiofrequency coagulation of liver tumors Br J Surg 2002; 89: Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal liver tumors with percutaneous radiofrequency ablation: complications encountered in a multicenter study. Radiology 2003; 226: : 44: Curley SA, Marra P, Beaty K, et al : Early and late complication after radiofrequency ablation of malignant liver tumors in 608 patients. Ann Surg 2004; 239: Llovet JM, Vilana R, Bru C, et al: Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatology 2001; 33: Bolondi L, Gaiani S, Celli N, et al: Tumor dissemination after radiofrequency ablation of hapatocellular carcinoma. Hepatology 2001; 34: de Sio I, Castellano L, De Girolamo V, et al: Tumor dissemination after radiofrequency of hepatocellular carcinoma. Hepatology 2001; 34: Livraghi T: Tumor dissemination after radiofrequency ablation of hapatocellular carcinoma. Hepatology 2001; 34; Goldberg SN, Solbiati L: Tumor dissemination after radiofrequency ablation of hapatocellular carcinoma. Hepatology 2001; 34: