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单击此处编辑母版标题样式,单击此处编辑母版文本样,*,Treatment Strategies for 3 cm HCC,with US guided RF Ablation,(Long term outcome from 302 cases,),Chen Min Hua,Yang Wei,Yan Kun,Peking University,School of Oncology,HCC incident account for 54,in the world,with mortality of 200,000 cases every year,Advanced or large HCC common at first diagnosis,Associated with liver cirrhosis and,poor liver function,Candidates for surgery 3 cm HCC:24,4,With the size increase,local recurrence higher,tumor diameter,2.5 cm:11.6(18/155,cases),2.5 cm:20.5(17/83 cases),1,、,Livraghi T.Radiology 2000;214:761-768.,2,、,Solbiati L.Radiology 1997;205:367-373.,3,、,Marco V.Annals of Surgery 2004;240,4,、,Lam VWT.J Am Coll Surg 2008;207:20-29.,Purpose,Investigate the treatment strategies and,outcome of ultrasound guided RF,ablation of 3cm HCC,Patients(1),2000 to 2010 year,520 patients with HCC underwent percutaneous RFA,Among them 3cm HCC 302 cases,Male 244,Female 58,Average age,60.4 years(range,24-87 years),Tumor size,3.1-7.0cm average,4.21.0cm,3.1-5.0cm 248,lesions,5.1-7.5cm 80,lesions,Patients(2),Solitary tumor 212 cases,multiple 90,cases,(29.8),Liver function Child-A 196,cases,B 94,cases C 12 cases,58 cases,were recurrent after surgery,(19.2),Treatment strategies,Plan ablation protocol based on invasive range of tumor on Contrast Enhanced Ultrasound(CEUS),Perform multiple overlapping ablations based on mathematical model,Optimal ablation with 2-3 bipolar electrodes,Color US guided ablation of feeding artery(or TACE)before RF ablation,1,、,Identify invasive range based on CEUS,Obtain samples from border area,which became,bigger or more irregular,on CEUS,Cancer cell was found in 88 of these specimens,and alternately grew with normal liver,CD34 immuhistochemistry staining showed,strong positive staining in vessel endothelium cell of this area,MVD was significantly higher than that in central area,US:,A,3.6 cm,nodule,with unclear border,CEUS:,the tumor enlarged,(5cm),Central necrosis,M/54 10 ys of hepatitis B,Surgery sample:,tumor with poor border,HE staining,malignant cell alternatively grows,with normal liver cell without clear border,between them,CD34 staining:,High density of micro-vessels,in the margin area of the HCC,Set up mathematical model for large tumors,Plan overlapping ablations protocol,Least,ablation number,Proper,ablation overlapping mode,Optimal,electrode placement design,2.Multiple ablations based on mathematical model,M.H.Chen,W,Yang,et al.Radiology.2004;232:260-271,3.New technique for RF ablation,Recently,RF machine and equipment developed fast,Cool water circulation used in all kinds of machines,Umbrella or Cool-tip increased the coagulation area,by one ablation,(5-6cm),2-3 bipolar electrode simultaneously,achieve 6.5 cm,coagulation area(40,mins),It is good time for RFA treatment of 5-6cm liver tumor,2 bipolar electrodes 2 for 6.2x6x5 cm,3,(22 min x2),1,2,1,2,3,1,3 bipolar electrodes for 6.5x6x6,cm,3,(40 Min),2,Male,77 years,6 cm HCC under diaphragm,16,Percutaneous place tube under diaphragm and inj water to separate tumor and diaphragm(),17,3 bipolar electrodes simultaneously 2 times(80mins),One month CT:no enhancement,4.Individual protocol for rich,supply and large tumor,Cool effect of flow during RF ablation would limit,coagulation area and result in recurrence,it is a challenge for RF ablation,Need effective treatment principle and new methods,Control feeding artery for tumor with rich blood supply,Chen MH,W,Yang,et al.,JVIR,2006;17:671-683.,Chen MH,W,Yang,et al.,Abdominal Imaging,2007;17:567-595.,It has been confirmed combination of,TACE,RFA,can decrease tumor supply and increase coagulation area improve efficiency,In our center,we use,1-2 courses of TACE,followed by RFA for these cases,1.Yang W,Chen MH.Hepatology research 2009,2.Shen SQ,et al.Hepatogastroenterology.2005.,3.Gasparini D,et al.Radiol Med.2002.,Traditional strategy,Male,64 years,hepatitis B and liver cirrhosis,for more than 10 years,HCC was in right lobe and after 2 times of TACE,CEUS Pre-RF:(left)CEUS:Lesion enhanced with size of,5.8x4.7cm,irregular close to right branch of PV,(right)US:Heterogeneous lesion with unclear border,PV,(Left),T40 3 bipolar electrodes with 3 cm space (Middle)T40 2 bipolar electrodes with 2.1cm space,(Right)post-RFA lesion present hyperechoic,During RFA,1 Mon post-RFA,:(Left)US:lesion size about 6.0 x4.5cm,(Middle),CT-AP:no enhancement,(Right)CT-PP:well defined margin,Percutaneous ablation of feeding artery,Large HCC,not suitable for TACE or,still have viability after TACE,Percutaneous Artery Ablation,(PAA),Chen MH,Yang W,et al.,JVIR,2006;17:671-83.,Chen MH,Yang W,et al.,Abdominal Imaging,2007;17:587-95,.,Color US guided Percutaneous Ablationblocking feeding Artery,(PAA),Additional 2-3 small ablations to ablate the entrance area of feeding artery to enhance the coagulation effect,Case.Wang XX,male,58 years.Hepatitis B for 10 years HCC was found 2 mons ago and size 5.5 x 4.8 cm,Tumor in right lobe and the size was 6x5 cmhad 2 big feeding arteriesfir
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