The NCCN clinical practice guidelines for hepatocellular carcinoma state that patients with hepatic occupancies should first be evaluated surgically, and ablation can be performed for those who are inoperable, or for those who refuse surgery. The following issues are worth noting in the ablation process.
1. Which patients are suitable for radiofrequency ablation treatment?
The indications for radiofrequency ablation are
(1) Single lesion diameter Q5cm, multiple lesions Q3 cancer foci, the largest foci Q3cm.
(2) recurrent cancer after surgical resection, with the same tumor size characteristics as above.
(3) clear tumor boundary with sufficient safe range for tumor extirpation.
(4) liver function Child A or partial B grade.
(5) No extra-hepatic metastasis.
2. What are the contraindications of radiofrequency ablation?
(1) Hepatocellular carcinoma with extrahepatic metastasis.
(2) Severe cardiopulmonary and cerebral diseases that cannot tolerate radiofrequency treatment.
(3) Severe liver insufficiency, liver function Child C grade.
(4) Those with severe coagulation disorders
3. How to perform radiofrequency ablation treatment?
(1) Anesthesia It can be performed under intravenous anesthesia or local anesthesia combined with intravenous anesthesia, and sedative and analgesic drugs can be added when using local anesthesia.
(2) Guidance Guidance by B-ultrasound, or under CT guidance when the tumor is located at the top of the diaphragm and there is air dryness.
(3) Ablation route Percutaneous, laparoscopic and open.
(4) Ablation range After puncture and placement of radiofrequency electrode, the ablation process should be completed according to the instruction of radiofrequency transmitter, and the ablation range must completely cover the tumor range and exceed its boundary by 0.5-1cm.
4. What are the problems that need attention after radiofrequency ablation?
(1) Closely monitor the changes of vital signs and abdominal conditions after the operation to prevent complications; bleeding and biliary fistula are more serious complications, but the incidence is low.
(2) Local swelling and pain or fever are more common after ablation, and usually only symptomatic treatment is needed.
5. How to follow up after the implementation of radiofrequency ablation?
Regular follow-up with ultrasound or enhanced CT is performed after the operation to check the changes of AFP, blood routine and liver and kidney function, evaluate the efficacy and decide whether additional treatment is needed.