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The Clinical Effects Evaluation of Microwave Coagulation in the Treatment of Hepatocellular Carcinoma

Author: QinYuGang
Tutor: ZhangXueWen
School: Jilin University
Course: Surgery
Keywords: Liver cancer Microwave coagulation therapy Guidence of B-type ultrasound
CLC: R735.7
Type: Master's thesis
Year: 2006
Downloads: 80
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Abstract


Objective:Nowadays,hepatectomy is still the first option and the mostsatisfactory ways for hepatocellular carcinoma (HCC). But HCC’s recurrenceis insidious, and most of patients with primary or secondary liver tumours areunsuitable for surgical resection because of extrahepatic disease or theanatomical distribution of their disease. In addition, the recurrence rate ofhepatectomy is high while the chance of the secondary resection is much lower.We have be known with many orthodox modalities of treatment such astranscatheter arterial embolization (TAE), percutaneous ethanol injection,cryotherapy, interstitial laser photocoagulation, focused high-intensityultrasound, hot saline injection, electrolysis and acetic acid injection, and so on.But all of their treatment results are unsatisfactory. Since its introduction in1979 by Tabuse, Microwave Coagulation Therapy (MCT) has been usedwidely in clinical treatment of the liver tumour and been performed atlaparotomy, laparoscopically, percutaneously and thorascopically. MCT is oneof hyperthermic technique relying on the conversion of energy to heat todestroy tumours. The ease of monitoring lesion size coupled with the rapidityof ablation is MCT’s two major advantages over other types of therapycurrently being developed. A lots of clinical informations have indicated thesatisfactory long-term results, and MCT is comparable to liver resection forsmall noduses (d≤3cm). Furthermoer, MCT has also been shown to becost-effective when compared with palliative treatments for both HCC andliver metastases. Because there are lots of above-mentioned advantages, MCThave accepted by more and more clinical doctors and patients in near years.The objective of our study was to research the changes of hepatic function andtheir influence factions and the clinical value.Methods:The 10 patients with liver cancer were treated throught theMicrowave Focused Hyperthermia System in China-Japan Union Hospitalfrom March 2004 to January 2006. They included 8 patients of solitary tumournodules, 2 patients (1 patient of 3 nodules, 1 patient of 4 nodules) of multipletumour nodules. There were 5 examples of d≤3cm and d > 3cm(dmix=1.5cm ,dmax =6.0cm), respectively. There are 5 cases of primary livercancers, 3 cases of secondary liver cancers and 2 cases of recurrent cancers.There are 2 representative examples, which one undergoes partial uterusresection, left adrenal capsule resection, rectal cancer radical cure, rightovaries tumour radical cure and TACE, another is colonal liver metastases.There were 5 patients who had undergone percutaneous microwavecoagulation therapy (PMCT) and 5 patients performed MCT at laparotomy orat the same time of performed others abdominal surgical operations, such ascolorectal resection, hepatectomy.PMCT was performed under local anaesthesia (total 5 numbers),Preoperative prepare is not difficult, only need abrosia for 8 hours, nodrinking for 4 hours and injecting Sauteralgyl 50mg before 30 preoperativeminutes. General anaesthesia is the same with normal operation.Before PMCT, We all obtained many biopsy piles which come from thedifferent parts (4 piles in margins and 3 piles in center). Following it, MCTprobe with a 1-1.5cm tip exposure is positioned into the lesion and spent on15-20 minutes in a 60-80 W generate. And it is very important for completeablation that the area of liver necrosis should be larger than the liver tumournodus.Preoperation and postoperation (3rd, 7th, 14th, 30th day) monitor nomalblood routine, liver function, serum albumen, serum alph-fetoprotein andstudy them. By sonography, CT, or MR imaging, we can decide whether thetumour nodus has been ablated completely. During treatment under ultrasoundcontrol, a gradually enlarging elliptical lesion can be seen with illdefinedmargins. These appearances persist up to several months after treatment. Ifhave observed local recurrence, we should perform the second times ablationaccording to his condition himself.All patients were followed up 1 to 23 months (mean time: 7.7±7.2),thechanges of liver function, the influence factions and local and long-termefficacy were analyzed.All data was signed by x ±s and used T test to statistically treatment.Results:Complications after PMCT are few. Only 1 example feveredafter postoperation and 1 example pained in the punct point. No pneumothorax,liver and lung abscesses, biliary fistula, bile fistula or leaking, portal veinthrombosis, hepatic failure, biloma, haemorrhage, tumour cell disseminationinto the peritoneal cavity and along the needle track, skin burns.Serum ALT of All patients is more and less increase after MCT, but P>0.05, have no statistically significant difference. While CHE and ALBdecrease. And serum CHE has singnificant changes, P < 0.05, in3rd,7th,14th,they have significant difference. In addition,Child B grade, large nodus, multiple nodus is more significant decreasethan Child A grade, small nodus, solitary nodus in the 3rd day of postoperation,they have significant statistically difference(P<0.05=.There are 2 positive serum alph-fetoprotein(AFP>40μg/L).After MCT,serum alph-fetoprotein level reduced in the 3rd day of postoperation and 1patient go down the normal level in 1 month of postoperation. While whowere negtive serum alph-fetoprotein have no significant changes. 1 patientoccur local tumour progress (LTP), no distant recurrence and metastases, nodeath.Conclusion : There were many advantages to live cancer usingmicrowave coagulation therapy, such as curative effect, minor damage to liverfunction, few complications, and so on. And it has well local and long-termefficacy, especially for those nodules less than 3cm in diameter. But thesample is extremely small, so the conclusions are circumscribe. In the future,large-scale randomised controlled trials are required before widespreadacceptance of these techniques can occur. We will also continue deeply tostudy.

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CLC: > Medicine, health > Oncology > Gastrointestinal Cancer > Liver tumors
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