Primary and metastatic hepatocellular carcinoma is a common malignant tumor of the liver in China, which has a poor prognosis due to its high malignancy. Surgery and transcatheter intervention have been widely used as effective treatments in clinical practice and have been accepted by physicians and patients. In recent years, percutaneous percutaneous radiofrequency ablation therapy, as an emerging new treatment technology, is gradually applied in clinical practice and gaining popularity.
Principle.
The main principle of radiofrequency ablation is that radiofrequency electrode head sends out medium-high frequency radiofrequency waves, which can excite tissue cells to produce plasma oscillation, and ions hit each other to produce heat, reaching 80~100℃, which can effectively and quickly kill local tumor cells, while high heat can make the vascular tissue around the tumor coagulate to form a reaction zone, so that it cannot supply blood to the tumor and is beneficial to prevent tumor metastasis.
Treatment method.
Under the guidance of CT, B-ultrasound, C-arm and other imaging equipment, the needle is punctured into the tumor and radiofrequency ablation treatment is carried out after accurate positioning and puncture in place.
Select the power of radiofrequency ablation, generally start from 20W small power, gradually increase the power by 10-20W every 1~2 minutes, when the tissue curing impedance increases, the energy decreases radiofrequency ablation will stop automatically, which can complete a treatment.
The advantages of radiofrequency ablation treatment.
1.Minimally invasive, no need for incision.
2, fast effect, short treatment time. For the diameter of <5cm disease, only 10-15 minutes a radiofrequency can achieve inactivation.
3.Safe and reliable. Killing tumor tissue is reliable, and the damage to surrounding normal tissue is small.
Intraoperative reaction and postoperative complications.
When receiving intraoperative treatment, there will be varying degrees of distension and heat; some patients will have decreased heart rate and can be given intramuscular atropine; occasionally there will be respiratory difficulty, which can be relieved by mask oxygen administration.
Postoperative complications include.
1. Pain in the liver area, especially obvious when the tumor is located at the liver edge, and generally no pain when the tumor is located in the deep tissue.
2.Fever: Patients start to have fever on the 2nd postoperative day, with body temperature fluctuating around 38℃, and the highest exceeds 39℃. Mostly, the body temperature turns to normal within 1 week after postoperative application of hormone plus antibiotics, and its original trapping is absorption fever caused by tumor necrosis absorption.
3.Jaundice and ascites: RF causes necrosis of normal liver cells around the tumor, and the effect on liver function is the main cause of jaundice and ascites.
4.Pneumothorax: correct selection of needle entry point to avoid the angle of rib diaphragm can prevent the occurrence of pneumothorax.
5.Gastrointestinal tract perforation: Patients with tumor near gastrointestinal tract or adhesion between tumor and gastrointestinal tract, resulting in heat damage to intestine during treatment, and electrode passing through gastrointestinal tract during needle opening are the causes of gastrointestinal tract perforation, which requires surgery.
6, bleeding: incidence 0.46%~1.6%, mostly due to cirrhosis coagulation dysfunction.
Radiofrequency therapy as a safe and effective treatment method for liver-occupying lesions has been recognized by the majority of physicians and patients in clinical practice at home and abroad. The combination of transcatheter embolization (TACE) treatment can achieve a synergistic effect. The promotion of this method will provide a new treatment method for liver tumor patients, especially those with lack of blood supply, greatly improve the survival quality of liver cancer patients, prolong the survival period, and provide conditions for radical tumor cure.