Contrast Enhanced Intraoperative Ultrasonography-Guided Percutaneous Radiofrequnecy Ablation with Artificial Hydrothorax for Hepatocellular Carcinoma in Hepatic Dome_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Jiaxin ¹ , WU Hong ¹ , HUANG Jiwei ¹ , LU Qiang ² , JIANG Hui ¹ , XU Yinglong ¹ , WANG Jingzhou ¹ , ZENG Yong ¹

1.Department of Hepatobiliopancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;;
2.Department of Ultrasonography, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding author：

Keywords：

Artificial hydrothorax; Contrast enhanced intraoperative ultrasonography; Radiofrequency ablation; Hepatoma; Hepatic dome

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ObjectiveTo explore the safety and feasibility of contrast enhanced intraoperative ultrasonographyguided percutaneous radiofrequency ablation with artificial hydrothorax to hepatocellular carcinoma in the hepatic dome. MethodsThe clinical data of nine patients with hepatocellular carcinoma in the hepatic dome underwent ultrasonographyguided percutaneous radiofrequnecy ablation with artificial hydrothorax from January 2008 to June 2009 at Department of Hepatobiliopancreatic Surgery of West China Hospital were retrospectively analyzed. The perioperative results and recurrence of tumor were also analyzed. ResultsAll of nine patients with twelve tumors received successfully radiofrequency ablation with artificial hydrothorax of (2 444±464) ml (2 000-3 000 ml). The ablation time was 12-24 min (median 12 min), with an average of (15±5) min for each tumor. No hemothorax, pneumothorax, and death occurred during operation. One patient had ascites of 2 000 ml after ablation due to hypoalbuminenia, and ascites disappeared by infusion of abumin on 4 d after operation. The total volume of pleural drainage was 250-1 420 ml, with an average of (717±372) ml for each patient, and the drainage tube was withdrawn on 3-5 d after operation. The followup time was 7-23 months (mean 15 months). Tumor recurrence was found in three patients on 5, 6, and 7 months after operation, respectively. Of them, two patients were in stable disease stage after interventional and conservative therapy, respectively, and one case recurred at six months after operation and died of hypertensive heart disease and hepatic function deterioration at sixteen months after operation. The rest patients survived and no recurrence and metastasis was observed during the follow-up period.ConclusionThe technique of percutaneous radiofrequency ablation with artificial hydrothorax increases the feasibility of the minimal invasive treatment for hepatoma, which can be applied to hepatocellular carcinoma in the hepatic dome with high safety and clinical application value.

Citation： LI Jiaxin ,WU Hong,HUANG Jiwei,LU Qiang,JIANG Hui,XU Yinglong,WANG Jingzhou,ZENG Yong. Contrast Enhanced Intraoperative Ultrasonography-Guided Percutaneous Radiofrequnecy Ablation with Artificial Hydrothorax for Hepatocellular Carcinoma in Hepatic Dome. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(2): 172-176. doi: Copy

1.	Machi J, Uchida S, Sumida K, et al. Ultrasoundguided radiofrequency thermal ablation of liver tumors: percutaneous, laparoscopic, and open surgical approaches [J]. J Gastrointest Surg, 2001, 5(5): 477489.
2.	Bruix J, Sherman M, Llovet JM, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona2000 EASL conference. European Association for the Study of the Liver [J]. J Hepatol, 2001, 35(3): 421430.
3.	Rossi S, Di Stasi M, Buscarini E, et al. Percutaneous RF interstitial thermal ablation in the treatment of hepatic cancer [J]. AJR Am J Roentgenol, 1996, 167(3): 759768.
4.	Livraghi T, Goldberg SN, Lazzaroni S, et al. Small hepatocellular carcinoma: treatment with radiofrequency ablation versus ethanol injection [J]. Radiology, 1999, 210(3): 655661.
5.	Podnos YD, Henry G, Ortiz JA, et al. Laparoscopic ultrasound with radiofrequency ablation in cirrhotic patients with hepatocellular carcinoma: technique and technical considerations [J]. Am Surg, 2001, 67(12): 11811184.
6.	Ohmoto K, Tsuzuki M, Yamamoto S. Percutaneous microwave coagulation therapy with intraperitoneal saline infusion for hepatocellular carcinoma in the hepatic dome [J]. AJR Am J Roentgenol, 1999, 172(1): 6566.
7.	Shibata T, Shibata T, Maetani Y, et al. Transthoracic percutaneous radiofrequency ablation for liver tumors in the hepatic dome [J]. J Vasc Interv Radiol, 2004, 15(11): 13231327.
8.	Ishikawa T, Kohno T, Shibayama T, et al. Thoracoscopic thermal ablation therapy for hepatocellular carcinoma located beneath the diaphragm [J]. Endoscopy， 2001, 33(8): 697702.
9.	Minami Y, Kudo M, Kawasak T, et al. Percutaneous ultrasoundguided radiofrequency ablation with artificial pleural effusion for hepatocellular carcinoma in the hepatic dome [J]. J Gastroenterol, 2003, 38(11): 10661070.
10.	Koda M, Ueki M, Maeda Y, et al. Percutaneous sonographically guided radiofrequency ablation with artificial pleural effusion for hepatocellular carcinoma located under the diaphragm [J]. AJR Am J Roentgenol, 2004, 183(3): 583588.
11.	郑云, 张亚奇, 邹如海, 等. 人工胸水协助超声引导肝穹窿部肿瘤治疗 [J]. 中山大学学报(医学科学版), 2005, 26(6): 696699.
12.	周铁, 仇毓东, 张炜炜, 等. 人工胸腔积液超声引导经皮射频消融治疗膈顶部肝癌 [J]. 临床肿瘤学杂志, 2007, 12(3): 188190.
13.	Shimada S, Hirota M, Beppu T, et al. A new procedure of percutaneous microwave coagulation therapy under artificial hydrothorax for patients with liver tumors in the hepatic dome [J]. Surg Today, 2001, 31(1): 4044.
14.	Kume A, Nimura Y, Kamiya J, et al. Percutaneous ethanol injection via an artificially induced right hydrothorax for hepatocellular carcinoma in the hepatic dome [J]. Cardiovasc Intervent Radiol, 2003, 26(6): 543549.
15.	Wu H, Lu Q, Luo Y, et al. Application of contrastenhanced intraoperative ultrasonography in the decisionmaking about hepatocellular carcinoma operation [J]. World J Gastroenterol, 2010, 16(4): 508512.
16.	任正刚. 原发性肝癌的射频毁损治疗进展 [J]. 中国普外基础与临床杂志, 2007, 14(1): 57.
17.	林玲, 桂永忠, 梁郑, 等. 超声造影对高强度聚焦超声治疗肝细胞癌的疗效评价 [J]. 世界华人消化杂志, 2009, 17(18): 18791882.
18.	廖锦堂, 潘瑞喆, 刘艳, 等. 超声造影评价肝癌射频消融治疗近期疗效 [J]. 中国普外基础与临床杂志, 2009, 16(4): 265268.
19.	王文平, 魏瑞雪, 丁红, 等. 肝肿瘤实时超声造影的血流动力学分析 [J]. 中华超声影像学杂志, 2004, 13(5): 359362.
20.	罗葆明, 文艳玲, 智慧, 等. 实时谐波超声造影在肝肿瘤消融治疗中的应用 [J]. 中国超声医学杂志, 2005, 21(7): 522524.
21.	孙海, 马宽生, 张丰深, 等. 超声引导下犬肝注射醋酸高渗氯化钠混合液对射频消融毁损体积的影响 [J]. 中国普外基础与临床杂志, 2007, 14(5): 547550.
22.	Ding H, Kudo M, Onda H, et al. Hepatocellular carcinoma: depiction of tumor parenchymal flow with intermittent harmonic power Doppler US during the early arterial phase in dualdisplay mode [J]. Radiology, 2001, 220(2): 349356.
23.	Ding H, Kudo M, Onda H, et al. Evaluation of posttreatment response of hepatocellular carcinoma with contrastenhanced coded phaseinversion harmonic US: comparison with dynamic CT [J]. Radiology, 2001, 221(3): 721730.
24.	Ding H, Kudo M, Onda H, et al. Contrastenhanced subtraction harmonic sonography for evaluating treatment response in patients with hepatocellular carcinoma [J]. AJR Am J Roentgenol, 2001, 176(3): 661666.
25.	Kudo M. Contrast harmonic ultrasound is a breakthrough technology in the diagnosis and treatment of hepatocellular carcinoma [J]. J Med Ultrasonics, 2001, 28(3): 7981.

1. Machi J, Uchida S, Sumida K, et al. Ultrasoundguided radiofrequency thermal ablation of liver tumors: percutaneous, laparoscopic, and open surgical approaches [J]. J Gastrointest Surg, 2001, 5(5): 477489.
2. Bruix J, Sherman M, Llovet JM, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona2000 EASL conference. European Association for the Study of the Liver [J]. J Hepatol, 2001, 35(3): 421430.
3. Rossi S, Di Stasi M, Buscarini E, et al. Percutaneous RF interstitial thermal ablation in the treatment of hepatic cancer [J]. AJR Am J Roentgenol, 1996, 167(3): 759768.
4. Livraghi T, Goldberg SN, Lazzaroni S, et al. Small hepatocellular carcinoma: treatment with radiofrequency ablation versus ethanol injection [J]. Radiology, 1999, 210(3): 655661.
5. Podnos YD, Henry G, Ortiz JA, et al. Laparoscopic ultrasound with radiofrequency ablation in cirrhotic patients with hepatocellular carcinoma: technique and technical considerations [J]. Am Surg, 2001, 67(12): 11811184.
6. Ohmoto K, Tsuzuki M, Yamamoto S. Percutaneous microwave coagulation therapy with intraperitoneal saline infusion for hepatocellular carcinoma in the hepatic dome [J]. AJR Am J Roentgenol, 1999, 172(1): 6566.
7. Shibata T, Shibata T, Maetani Y, et al. Transthoracic percutaneous radiofrequency ablation for liver tumors in the hepatic dome [J]. J Vasc Interv Radiol, 2004, 15(11): 13231327.
8. Ishikawa T, Kohno T, Shibayama T, et al. Thoracoscopic thermal ablation therapy for hepatocellular carcinoma located beneath the diaphragm [J]. Endoscopy， 2001, 33(8): 697702.
9. Minami Y, Kudo M, Kawasak T, et al. Percutaneous ultrasoundguided radiofrequency ablation with artificial pleural effusion for hepatocellular carcinoma in the hepatic dome [J]. J Gastroenterol, 2003, 38(11): 10661070.
10. Koda M, Ueki M, Maeda Y, et al. Percutaneous sonographically guided radiofrequency ablation with artificial pleural effusion for hepatocellular carcinoma located under the diaphragm [J]. AJR Am J Roentgenol, 2004, 183(3): 583588.
11. 郑云, 张亚奇, 邹如海, 等. 人工胸水协助超声引导肝穹窿部肿瘤治疗 [J]. 中山大学学报(医学科学版), 2005, 26(6): 696699.
12. 周铁, 仇毓东, 张炜炜, 等. 人工胸腔积液超声引导经皮射频消融治疗膈顶部肝癌 [J]. 临床肿瘤学杂志, 2007, 12(3): 188190.
13. Shimada S, Hirota M, Beppu T, et al. A new procedure of percutaneous microwave coagulation therapy under artificial hydrothorax for patients with liver tumors in the hepatic dome [J]. Surg Today, 2001, 31(1): 4044.
14. Kume A, Nimura Y, Kamiya J, et al. Percutaneous ethanol injection via an artificially induced right hydrothorax for hepatocellular carcinoma in the hepatic dome [J]. Cardiovasc Intervent Radiol, 2003, 26(6): 543549.
15. Wu H, Lu Q, Luo Y, et al. Application of contrastenhanced intraoperative ultrasonography in the decisionmaking about hepatocellular carcinoma operation [J]. World J Gastroenterol, 2010, 16(4): 508512.
16. 任正刚. 原发性肝癌的射频毁损治疗进展 [J]. 中国普外基础与临床杂志, 2007, 14(1): 57.
17. 林玲, 桂永忠, 梁郑, 等. 超声造影对高强度聚焦超声治疗肝细胞癌的疗效评价 [J]. 世界华人消化杂志, 2009, 17(18): 18791882.
18. 廖锦堂, 潘瑞喆, 刘艳, 等. 超声造影评价肝癌射频消融治疗近期疗效 [J]. 中国普外基础与临床杂志, 2009, 16(4): 265268.
19. 王文平, 魏瑞雪, 丁红, 等. 肝肿瘤实时超声造影的血流动力学分析 [J]. 中华超声影像学杂志, 2004, 13(5): 359362.
20. 罗葆明, 文艳玲, 智慧, 等. 实时谐波超声造影在肝肿瘤消融治疗中的应用 [J]. 中国超声医学杂志, 2005, 21(7): 522524.
21. 孙海, 马宽生, 张丰深, 等. 超声引导下犬肝注射醋酸高渗氯化钠混合液对射频消融毁损体积的影响 [J]. 中国普外基础与临床杂志, 2007, 14(5): 547550.
22. Ding H, Kudo M, Onda H, et al. Hepatocellular carcinoma: depiction of tumor parenchymal flow with intermittent harmonic power Doppler US during the early arterial phase in dualdisplay mode [J]. Radiology, 2001, 220(2): 349356.
23. Ding H, Kudo M, Onda H, et al. Evaluation of posttreatment response of hepatocellular carcinoma with contrastenhanced coded phaseinversion harmonic US: comparison with dynamic CT [J]. Radiology, 2001, 221(3): 721730.
24. Ding H, Kudo M, Onda H, et al. Contrastenhanced subtraction harmonic sonography for evaluating treatment response in patients with hepatocellular carcinoma [J]. AJR Am J Roentgenol, 2001, 176(3): 661666.
25. Kudo M. Contrast harmonic ultrasound is a breakthrough technology in the diagnosis and treatment of hepatocellular carcinoma [J]. J Med Ultrasonics, 2001, 28(3): 7981.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Contrast Enhanced Intraoperative Ultrasonography-Guided Percutaneous Radiofrequnecy Ablation with Artificial Hydrothorax for Hepatocellular Carcinoma in Hepatic Dome

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