Radiofrequency Ablation Combined With Percutaneous Ethanol Injection And Surgical Resection Of Colorectal Liver Metastases

Objective:To compare percutaneous ethanol injection and radiofrequency ablationcombined with operation for colorectal liver metastases, clinical application of twokinds of treatment methods.Methods:Review from January2008to January2010in our hospital ultrasounddepartment using radiofrequency ablation combined with tumor of anhydrous ethanolinjection treatment in patients with liver metastases from colorectal cancer andsurgery treatment of the clinical data of patients with liver metastases from colorectalcancer, a total of43cases, surgical removal of the22cases, joint radiofrequencyablation tumor injection of anhydrous alcohol in21cases.43patients were performedultrasound, CT/MRI, CEA, hepatic function and blood coagulation function testing,found in the same period or postoperative liver metastases, a clear diagnosis ofcolorectal cancer liver metastases.23cases of men, women,20cases. Success of22patients under general anesthesia laparotomy hepatic resection, of which3cases withcombined liver segment resection, liver resection in5cases,14cases had partial liverresection. Line21cases of patients with radiofrequency ablation combined withanhydrous alcohol injection therapy in tumor. By looking at hospitalized cases,follow-up visits, telephone and in the form of reporting and follow-up.Meet the following criteria:(1) patients were confirmed by surgery or liver biopsy pathology diagnosed withcolorectal cancer liver metastases.(2) the primary lesion of colorectal cancer can be removed and have been radicalresection.(3) the same or a different period (1year) occurred in colorectal liver metastases. (4) colorectal liver metastases receiving radiofrequency ablation combined withintratumoral ethanol injection therapy or surgical excision before treatment byimaging examination: the number of liver metastases surgical treatment group as asingle, radiofrequency ablation without intratumoral aqueous ethanol injection groupthe number of liver metastases as a single or two metastases integration. Two sets ofmaximum tumor diameter <4cm (exploratory surgery actual situation is not listed);(5) radiofrequency ablation combined with intratumoral ethanol injection or undergosurgical resection after FOLFOX or FOLFIRI Scenario4-6courses of systemicchemotherapy.(6) imaging revealed no main door meridians, hepatic vein thrombosis and theformation of large vascular invasion, and no extrahepatic metastasis (such as lung,bone, brain);(7) radiofrequency ablation combined with intratumoral ethanol injection selectedcases were complete remission, requiring periodic CDFI and enhanced helical CTexamination, all of the tumor necrosis or disappear completely, and maintain morethan4weeks;(8) No major organ failure, without cachexia.(9) Pugh Child-pughA or Child-pugh B;(10) with complete data, returning at least3years.Result.1the recurrence rate:Surgical resection of colorectal liver metastases treated with radiofrequencyablation combined with intratumoral ethanol and2-year recurrence rate of thetreatment group showed no statistically significant difference,3-year recurrence ratewas statistically significant (P <0.05).2survival:Surgical resection of colorectal liver metastases treated with radiofrequencyablation combined with intratumoral ethanol treatment group and3-year survival ratesshowed no significant difference (P>0.05).3Operation time: Operation time: colorectal cancer liver metastases resection treatment group averageoperation time was140.8+/-45.7minutes, percutaneous microwave ablationtreatment group average operation time was40.5+/-14.4minutes, statisticaldifferences between two groups.4Intraoperative bleeding:Liver metastasis in colorectal cancer hemorrhage operation excision in thetreatment group showed different degree, bleeding volume was375ml(150ml-1100ml), radiofrequency ablation combined with anhydrous alcohol treatmentgroup intraoperatie bleeding or bleeding, blood loss about10ml, largest haemorrhageamount is far less than the surgical treatment group.5Postoperative liver function changes:We have two groups of treatment statistics show that the change of liver functionbefore and after preoperative no significantly statistical differences between the twogroups. Postoperative alanine aminotransferase (ALT), aspertate aminotransferase(AST) and serum albumin (propagated) and cholinesterase (CHE) compared withpreoperative change obviously.3and7days after surgery, two groups of ALT andAST was also increased to different extent, degree of surgical removal of thetreatment group increased more obviously. Two groups of postoperative in3days and7days of the change of ALT statistically differences; AST3days change between thetwo groups was statistically significant, the postoperative day7AST change has noobvious difference between groups. Two groups of postoperative propagated and CHEwere reduced to some extent. Two groups of3and7days after CHE changestatistically significant; Postoperative day3propagated to change between the twogroups was statistically significant, the postoperative day7propagated to change, nosignificant differences between groups.6Complications, and postoperative length of hospital stay:Postoperative complications: two groups of patients were no perioperative deathsoccurred. Anaemia needs a blood transfusion after surgical removal of the treatmentgroup,8cases of abdominal effusion in5cases, and right pleural effusion in3cases.Radio frequency melting joint tumor in anhydrous alcohol treatment group after treatment without serious complications, most of the patients had the puncture pointor pain, liver area on the right side pleural effusion in1case,4cases were fever, aftersymptomatic treatment can alleviate. The complications were disappeared afterconservative treatment.Postoperative hospital stay, postoperative surgical resection group hospitalization time14.8+/-4.5d, radiofrequency ablation combined with tumor in anhydrous alcoholtreatment group7.3+/-2.3d, postoperative length of hospital stay after test, P <0.01,with statistical significance.Conclusion:(1) on the premise of removed, by surgical removal of colorectal cancer livermetastases as the best treatment.(2) joint radiofrequency ablation tumor within theapplication of anhydrous ethanol injection therapy for colorectal cancer livermetastases provides a new treatment option, for diameter <4cm, single or twomutual confluence of colorectal cancer liver metastases, radiofrequency ablationcombined with tumor in anhydrous alcohol injection can obtain similar to surgicalresection treatment effect.(3) for surgery is difficult to reach the purpose of, in thedeep liver tumor tissues, radiofrequency ablation combined with tumor in anhydrousalcohol injection instead of surgical resection, partly to become some of the treatmentof choice for colorectal cancer liver metastases.(4) joint radiofrequency ablationtumor in anhydrous alcohol injection is surgical removal of the operation is simple, insitu inactivated completely, small trauma, less impact on the liver function and lowincidence of serious complications, good repeatability, and can be applied to older,general state is bad, not suitable for surgery or refuse surgery patients.