Radiofrequency Treatment
The number of deaths due to liver cancer in China reaches 130,000 every year. However, the size of the tumor, its relationship with large blood vessels and biliary tract, as well as the damage to liver function due to cirrhosis all limit the application of surgery. Radiofrequency ablation is an emerging international treatment tool with the features of safety, minimally invasive, wide indications and low complications.
Principle of radiofrequency ablation treatment
The mechanism is that after local anesthesia, under the guidance of ultrasound and CT, the multi-polar needle ablation electrode is accurately pierced into the tumor site, and the radiofrequency ablation instrument conducts the radiofrequency pulse energy to the tumor tissue through the multi-polar needle under the control of electronic computer, which causes the tumor tissue to produce local high temperature (70℃-95℃), so as to make the tumor and its neighboring tumor spread. The tumor tissue and its adjacent tissues that may be spread are coagulated and necrotic, and the necrotic tissues are mechanized or absorbed in situ.
For tumors smaller than 50 mm, the tumor can be successfully destroyed in one pass, and for larger tumors, the treatment can be achieved through multiple passes. The laparoscopic and intraoperative application of radiofrequency treatment can detect and treat tumors that are not detected before surgery due to the guidance of intraoperative ultrasound, and the positioning is more accurate.
Indications for radiofrequency ablation
Radiofrequency ablation can be used for benign and malignant solid tumors of human organs, and is currently used more often in clinical applications: liver cancer, lung cancer, breast cancer. Patients with primary tumors, metastatic tumors, advanced tumors that cannot be removed surgically, tumors that cannot be completely removed by exploration during surgery, and tumors that cannot tolerate radiotherapy and chemotherapy can all receive radiofrequency ablation treatment.
The 5-year survival rate of ablation for small hepatocellular carcinoma has actually reached a level comparable to that of surgical resection, and surgical resection, liver transplantation and local ablation are considered as the first-line curative options for hepatocellular carcinoma. Early stage hepatocellular carcinoma can be treated by ablation instead of surgical resection.
Indications
①Size: single tumor, diameter Q5cm; tumor diameter Q3, number Q3 pcs.
②Site: better results in the liver parenchyma. Caution should be exercised when located near the gallbladder, stomach, colonic hepatic flexure and the 1st, 2nd and 3rd hepatic hilum.
③In recent years, it is also used for the treatment of large hepatocellular carcinoma at home and abroad (combined with TAE).
④When liver cancer is awaiting liver transplantation.
Contraindications
①Prothrombin time > 40% of the upper limit of normal value (18sec).
② Platelets < 40,000/mm3.
③Child C liver function.
④Multiple and diffuse lesions and extrahepatic metastases.
⑤ Acute stage of severe cardiopulmonary disorders, pregnant women, cardiac pacemaker.
Pre-treatment preparation.
①Three major routine, liver and kidney function, three coagulation, AFP, EKG, chest X-ray, etc.
②Imaging data: ultrasonography or CT-enhanced scan or MRI, etc.
③ Biopsy to clarify the diagnosis.
④Pay attention to comorbidities: such as the management of hypertension, etc.
Fasting for 6 hours before treatment; infusion of fluids to the left upper limb.
Anesthesia: local anesthesia, local anesthesia + intensification, holding rigid, general anesthesia.
Modality: percutaneous, laparoscopic, open.
Puncture: ultrasound normal probe, puncture probe localization, CT/MRI localization.
Post-treatment management.
①Pressure ice pack at the puncture site and fasting from food and water for 12 hours.
② Observe changes in vital signs (1 time/2-4h).
③ Use hemostatic, anti-infective, hepatoprotective drugs, hormones, and symptomatic treatment in case of fever.
Other: pay attention to the lung condition, etc.
Review after treatment
①Time: 1 day to 1 month.
②Ultrasound imaging or CT-enhanced scan.
③Find residual lesions and intensify treatment once more.