86 Tap chi GAN MAT V I £ T NAM s^ 29-2014
Danh gia Ut qua dieu tri ung thu gan Mng phumig phap nhiet cao tan To assess the results ofradiofrequency ablation of liver cancers
Hodng Trong Nhdt Phuang. Bang Ngpc Hung, Hd Vdn Linh, Le Lpc.
Tom t a t
M y c dich: Danh gia hieu qua ciia phuong phap di6u tri ung thu gan bSng nhiet cao tan.
PhtroBg p h a p : 197 benh nhan (75 b?nh nhan CO cit gan kem theo,23 benh nhan di can gan va 99 benh nhan RFA dan thuin) vdi 469 l i n dugc di6u tri bang nhiet cao tin, trong do co 62 lan dugc thuc hien qua phau thuat md, 95 benh nhan qua phlu thuat npi soi va 312 lan qua da dudi hudng dan cua sieu am.
K i t q u a : C 6 1 benh nhan t u vong sau khi d6t, 8 benh nhan suy gan tiSn tri^n trong thdi gian hau phau trong do co 4 benh nhan tu vong trong vong 3 thang. 17 benh nhan bdng thanh bung khi ddt dudi sieu am. Ty le b i i n chiing chimg la 8,5%.
K i t l u a n : D6t u gan bang nhiet cao tan c6 hieu qua tdt ddi vdi u gan kich thudc vira va nho khi khong cd chi dinh cat gan.
S u m m a r y :
Objective: To assess the therapeutic effects ofradiofrequency ablation of liver cancers.
Methods: 197 patients of liver cancers (75 patients with hepatectomy, 23 hepatic metastasis and 99 the only RFA) underwent 469 cures of the radiofrequency ablation: 62 patients RFA with an open surgical approach, 95 patients RFA with the laparoscopic approach and 312 patients
with the percutaneous under ultrasonographic or computed tomography guidance.
Results: There was 1 death, 8 patients with the increasing risk of postoperative liver failure, four of whom dead in three months; 17 patients bum of the abdominal parietal abdomen. The rate of the general complication were 8,5%.
Conclusion: Radiofrequency ablation is ef- fective for medium and small liver cancers.
1. Dat van de
Ung thu gan la loai ung thu kha pho b i i n d Viet Nam ciing nhu tren the gidi. Ung thu gan CO hai loai: nguyen phat va thu phat. Ung thu gan nguyen phat thudng gap d Viet nam va cac nudc chau A, trong khi d6 d chau Au va b i c My ung thu gan thii phat la chu ylu.
PhSu thuat cat bo khoi u gan cho din nay van la phucmg phap dieu tri hiiu hieu nhit d6i vdi ung thu gan. Nhung that khong may, phau thuat cat bo khoi u gan khong phai liic nao cung thuc hien duoc vi cac ly do han chi sau: kich thudc khoi u, u nam canh mach mau va dudng mat ldn, u tren nIn xa gan nang, nhilu k h i i u gan, t h i trang benh nhan khong cho phep thuc hien phau thuat ldn... Vi vay chi co 5-15% s6 benh nhan bi ung thu gan dugc dilu tn bing phiu thuat [1].
Ngoai phuong phap phiu thuat cit khii u gan.
* B?nh vi?n Trung uong Hue
Phan bi?n khoa hpc: GSTS Mai Hong Bang.
con CO nhung phuong phap khac dugc ap dung de dieu tri ung thu gan nhu tiem con vao khoi u gan, dot lanh, dot nhiSt khoi u, laser, vi song...
Trong do, dieu tri bang phuong phap nhi|t cao tan (RF) la phuong phap da va dang dugc ap dung rpng rai d nhieu n u d c fren t h i gidi.
RFA (Radiofrequency Ablation) la ky thuat tieu diet tai cho khoi u gan b i n g nhiet. Khi te bao khdi u bi d i t nong d nhiet dp 45-50°C tren 3 phiit thi protein ben frong t l bao bi b i i n chat va iam tan chay mang lipid k6p ma hau qua la te bao bi tieu hiiy. Dudi tac di^ng cua dong dien xoay chilu, dien cue d d i u moi kim phat ra nhimg song dao dpng hinh sin vdi t i n s6 rit cao (400-500KHZ) di vao trong t l bao, lam di chuyen cac ion chua trong t l bao, chinh sir di chuyen h6n loan ciia cac ion nay iam cho chiing va cham, ma sat vao nhau, kich thich t l bio
Tap chi GAN MAT VIET NAM so 29-2014 87 nong din len, co thi dat din 80-110°C va kit
qua la lam dong vdn, hoai tCr tl bao gin vdi dien Ctfc[2],[3].
Tai khoa ngoai Tieu Hda - Benh vien Trung Ucmg Hue, chiing tdi da ap dimg phuang phap RFA de di§u tri cho benh nhan ung thu gan khdng con chi dinh phau thuat cit bo tir cudi nam 2002 cho den nay va da thu dugc nhirng kit qua nhat dinh. Cd 3 phuong thiic dl tilp can khoi u gan: phau thuat hd, phlu thuat ngi soi, qua da dudi su hudng din ciia sieu am. M6i phuang phap c6 nhung uu va nhugc diem nhat dinh.
Trong nghien ctm nay chiing toi muln danh gia hiSu qua ciia phuang phap ciing nhu dua ra mgt so chi dinh va phuong each tilp can khdi u ciia phuang phap nay.
2. Benh nhan va phu-ong phap B^nh nh^n
RFA dupc ap dung doi vdi nhiing khoi u gan khong con kha nang phau thuat hoac phau thuat khong dem lai nhimg kit qua rdiu mong muon, doi liic con dua den nhiJng ket qua ngugc lai.
Trong nghiSn ciiu nay, chiing toi chi ap dung RFA cho nhung trudng hgp nhilu khoi u lan toa ca 2 thuy gan, u gan ldn khong the cat bo dugc, u gan fren nen xo gan ma phan gan con lai sau khi cat se khong dam bao chiic nang, cac khoi u nSm canh cac mach man va dudng mat ldn ma vi?c cat bd co kha nang iam thuang ton den chiing, u gan da di can ngoai gan, u gan thii phat do di can tu noi khac den ma phan ldn tir dai
true trang, u gan tai phat sau cat gan, the trang benh nhan hoac cac benh canh phdi hgp khong the chiu dugc mgt cupc phlu thuat ldn....
Benh dugc chan doan ung thu gan dua fren cac dau hieu lam sang ggi y, chan doan hinh anh (Sieu am, CT Scanner) de xac dinh vi tri, kich thudc khoi u cung nhu tim kiem nhung hinh anh di can ngoai gan... va ket qua sinh thiet de chan doan xac dinh. Ngoai ra, chiing toi con thuc hien cac xet nghiem alpha foetoprotein, men gan dl theo doi benh nhan, cac xet nghiem ve albumin, billirubin... de danh gia tinh frang xo gan ma cy the la phan loai xo gan theo Child-Pugh, ciing nhu cac xet nghiem thong thudng khac ve tdng trang chung cua benh nhan.
Phirffng phap
- He thong may RF vdi dien cue dugc iam lanh.
- Phuong each tiep can khoi u: Md md, mo ngi soi va qua da dudi hudng din cua sieu am.
Danh gia sau dieu tri: Iam cac xet nghiem de danh gia chiic nang gan, men gan sau mo. Theo doi dien bien bing dinh lugng alpha Foetopro- tein, sieu am, CT scanner 1 thang, 3 thang, 6 thang va 1 nam sau mo.
3. Ket qua
Tir nam 2005 den nay, 197 benh nhan ung thu gan vdi 469 ISn dot u gan bang song cao tan, trong do CO 173 nam va 24 nii, tuoi trung binh 52 ± 3,2. Trong d6 c6 62 ian dot qua phau thuat md, 95 lan qua phau thuat npi soi va 312 qua da dudi hudng dan ciia sieu am.
Bdng 1: Liin quan giiia hgi ung thu vd phuang each tiip can khoi u
Tiep can u Loaiu
N
%
T6ng
PTmo Nguyen
phdt 55 11,7
Thii phat 7 1.5 62* (13,2%)
PTNS Nguyen
phat 87 18,6
Thu phat 8 1,7 95 (20,3%)
Qua da Nguyen
phat 285 60,8
Thii phat 27 5,7 312(66,5%)
Tong
469 100
88 Tap cM GAN MAT VlfiT NAM 8^29-2014 Ung thu gan thii phat chu ySu di can hi ung thu dai hue hang, 15 benh nhan duoc phau thuat cit u nguyen phat kem RFA u di can gan, 8 benh nhan u di can gan sau phlu thuat u nguyen phat
*28 benh cat u gan ph6i hop RFA nhan ve tinh phin gan con lai, 30 benh m6 mo, khong cat duoc u nen lam RFA, 4 benh ngi soi khong xac dinh dugc u nen m6 md dS xac dinh vi tri u.
Bdng 2: Phdn loai muc do xa gan theo Child-Pugh
Da s6 gan con a giai doan A.
Giai doan C chi d6t khi u nho.
Bdng 3: Lien quan giUa ung thu gan vd viem gan virus
Loai virus N
%
B 129 65,5
C 14 7,1
B v a C 7 3,6
Khong 47 23,8
Child-Pugh N
%
A 378 80,6
B 83 17,7
C 8 1,7
Viem gan virus B chiem da so trong cac truong hgp ung thu gan nguyen phat.
Khong nhilm vims thucmg gap b cac benh nhan ung thu gan thir phat.
Bang 4: Lien quan giUa kich thuac khoi u vd phuang each tiep can u
^ ^ ^ P h u o n g each Kich thucfc u ^ ^ ^
< 3cm 3 - 5 c m 5 - 10cm
> 10cm T6ng
P T m o 19(4,1%) 23(4,9%) 12(2,6%) 8(1,7%) 62(13,2%)
PTNS 5(1,1%) 21(4,5%) 63(13,4%)
6(1,3%) 95(20,3%)
Qua da 168(35,8%) 113(24,1%) 29(6,2%)
2(0,4%) 312(66,5%)
T6ng 192(40,9%) 157(33,5%) 104(22,2%) 16(3,4%) 469(100%) Kich thudc u chu ylu nho han 5 cm. Dli vdi u ldn hon 5cm, lan dau thudng dugc dot dudi npi soi.
Bdng 5: So ldn dot tren moi benh nhdn So lan dot
N
%
1 87 344,2
2 - 3 58 29,4
4 - 5 28 14,2
>5»
24 12,2 C6 4 benh nhan dot fren 10 lan.
Bdng 6: Bien chung
^ " ^ " ^ . ^ ^ Phircmg each Bien chung ^~"~-^-^.^^
Chay mau trong phiic mac Mau tu trong gan Ty mau dual bao gan Ap-xe Trong gan
FT md (n - 62) N
0 0 0
^
%
0 0 0 0,4
P T N S ( n N
0 0 0 2
= 95)
%
0 0 0 0,4
Qua da ( N
0 0 0 1
n = 312)
%
0 0,2 0 0,2
J I
Tap clii GAN MAT VIET NAM so 29-2014 89 Ton thucmg duong mit
Tran khi,tran dich mang phoi Ton thuong mach mdu gan Suy gan
Suy than
B6ng da vi tri dat plaque Bong thanh bung T&n thuong tang lan can Tii vong
1 0 0 5 1 2 0 0 0
0,2 0 0 1,1 0,2 0,4 0 0 0
0 0 0 2 1 1 0 0 0
0 0 0 0,4 0,2 0,2 0 0 0
0 0 0 1 0 2 17 0 1
0 0 0 0,2
0 0,4 3,6 0 0,2 Ty 1§ bien chung thap. 1 trudng hgp tir vong do chay mau dudng mat.
Bdng 7: Theo doi thoi gian song thim chi thuc hien duac tren 72 benh nhdn
l . O -
OJB-
"So*
o o -
' ^—1
^^n
^—u_
Thdi gian sing trung binh 37 ± 1,8 thang D6i vdi u kich thudc ldn thi kha nang dot khong hit khii u rit cao va ty le tai phat, phat trien u mdi cung nhu ty le tir vong cao. Trudng hgp u tai phat tai cho hoac phat trien u mdi, chimg toi tilp tuc RFA thudng dugc thuc hien qua da dudi sieu am.
4. Ban luan
Cho din nay, phiu thuat cit bo khoi u gan van la phuang phap huu hieu nhit de dilu tri ung thu gan. Tuy nhien, phiu thuat cat bo khii u gan khong phai liic nao cimg thuc hien dugc vi ung thu gan thudng xuit hien tren nen gan xo, nhu mo gan edn lai sau cit gan khong du dam bao chiic nSng ho|ic nhilu khoi u gan lan tda ca gan phai va gan trai hoac kich thudc khii u qua ldn hoac the tr^ng b?nh nhan khdng cho phep thuc hi|n phau thu^t ldn...Vi vay, tren thuc te kha nang phlu thuat cit bo khii u gan chi thi^c hien dugc tir 10-15%
T H oioiAM(thang)
tnrdng hap[l]. Ngoai ra, con co nhieu phucmg phap khac dl dilu tri tai cho khoi u gan da dugc ap dung tren the gidi ciing nhu d Viet Nam trong thdi gian qua nhu [3]:
-Tiem c6n true tiep vao khoi u gan: Chi thuc hien c6 hieu qua doi vdi nhiing khoi u gan co kich thudc nho (2-3cm) va phai thuc hien nhieu lan tren mpt khoi u, vi vay de xay ra cac bien chiing chay mau, suy gan, hoai tir hay do dudng mat...
-D6t khii u bang vi song hoac bang tia laser:
Ciing chi dugc ap dung doi vdi nhimg khoi u kich thudc nho (l-2cm).
-Ghep gan; La phuong phap thuc su co hi^u qua dli vdi benh nhan u gan tren gan xo, nhung phuong phap nay khong dugc kha thi vi s^r tiln triln nhanh chong ciia HCC. trong khi do gan de ghep lai hiem.
90 Tap chi GAN MAT VIET NAM so 29-2014 Tir thap nien 1990 da cd nhilu cdng trinh nghien ciiu fren thi ^di da bao cao ket qua cua jjhuong phap diet khdi ung thu gan bin^ nhiet cao tin (Radiofrequency Ablation) vdi nhieu mi diem vupt frgi so vdi cac phuong phap trudc day, dac biet vl kich thudc khii u.
v l mat chi dinh, thong thudng RFA dugc chi dinh dli vdi nhung benh nhan khdng the cat bd khii u gan vi nhilu khdi u iai rac d gan, chiic nang gan kem va u nim gan cac mach mau ldn d frong gan ma khi cit gan khong bao dam dugc bd an toan. v l kich thudc khoi u, nhieu tac gia thdng nhit ring chi dinh RFA tdt nhit doi vdi khdi u kich thudc nho han 5 cm. Doi vdi nhiing khdi u ldn hon 5 cm la trd ngai ldn doi vdi RFA vi kich thudc huy hoai tl bao gan ciia RF co gidi ban. Tuy nhiSn, vai nghien cim da chi ra rang c6 the thuc hien nhilu vi tri RF tren cimg mgt khoi u ldn cho den khi dat ket qua mong muon. Livraghi et al.
[211 da nghien ciiu hieu qua RFA qua doi vdi cac khoi u kich thudc vira va ldn (trung binh 5,4cm) d 114 benh nhan da cho ket qua dot hoan toan khii u la 78%. Chen et al.[22] da bao cao ty le ddt hoan toan khoi u la 87,6% doi vdi cac khoi u ^an ldn d 110 benh nhan. Vi tri giai phlu cua khoi u ciing anh hudng den hieu qua cua RF. Vi tri kho ciia khoi u doi vdi RFA bao gom u nam dudi bao, u nam quanh mach mau va trung tam u nam giira cac dudng mat ldn. Llovet et al [14] da chi ra ring c6 den 12,5% benh nhan bi gieo ric tl bao ung thu tren dudngdi cua kim khi thuc hien RFA qua da lien quan den khoi u nim vi tri dudi bao. D6i vdi u nam quanh mach mau ldn d trong gan (>3mm) thi kha nang dot khong hoan toan khoi u vi nhung te bao u nam quanh mach mau se dugc lam mat bdi dong chay ciia mau nen se khong bi hiiy bdi nhiet. Nghien ctm so sanh giiia hai nhom u nam canh va khong nam canh mach mau cho thiy ty le dit hoan toan khii u la 86,2% so vdi 95,1%, va ty le tai phat t^i chi la 10% so vdi 7%
[6]. Con doi vdi vi tri khoi u nim giua cac dudng mat thi kha nang ton thuong dudng mat rit cao khi thuc hien RFA [23],[24]. Mpt chi dinh khac nua cua RFA la ap dung cho nhiing khoi u gan tai phat sau khi cat gan. Mac diu chi dinh tot nhit cho u gan tai phat ciing la cit gan nhung thudng t>; 1? cat dupc u rat thip nen c6 thi thay thi dupc bang RFA. Trong nghien ciiu nay, chimg tdi ciing dat ra nhiing tieu chuan chpn benh nim trong cac gidi ban nhu cac tac gia khac da neu. Ngoai ra,
chung tdi cd 25 benh nhan chiem 21,37% cac trudng hpp RFA vdi khdi u gan ldn hem 5 cm, co thi dot mpt lin nhilu vi tri cua u hoac ddt lap lai nhilu lin dudi hirdng din cua sieu am va cho ket qua dang khich le.
v l phuang phap tilp can khdi u, da cd nhilu quan dilm khac nhau dupc tranh lu^n giiia cac iihdm n ^ e n cihi. Cd 3 phuong phap tiep c ^ khdi u gan gdm: Phiu thuat hd, phlu thu|lt npi soi va dudng qua da. Mdi each cd nhimg uu va nhugc dilm nhat dinh. Su chgn lua phuong each tilp can khdi u phu thugc vao kich thudc, vi tri cua Idioi u Cling nhu co dia cua benh nhan.
- Tilp can khdi u qua da la phuong each tham nhap tdi thieu nhit. Benh nhan cd tii 1 - 3 khii u vdi dudng kinh mdi Mioi u nhd han hoac bang 3 cm va nam nong d nhu md gan la nhung ti6u chuin tdt nhat de thuc hien RFA qua da dudi hudng din ciia sieu am hoac CT Scan[6] . iTu diem cua phuang phap nay la didi gian nam vi$n ngin va ty le tai biin, bien chimg thap. Livraghi va cgng su da nghien ciiu 2320 benh nhan RFA qua da vdi 3554 khoi u gan cho ket qua ty le bien chiing 2,2% va tix vong 0,3% do thimg ru^t, nhiem triing, suy gan, chay mau. Trong 312 trudng hgp RFA qua da ciia chiing toi cd t^ le bien chimg thap, co the chap nhan dugc. Mpt so tac gia so sanh giiia RFA qua da va tiem con qua da doi vdi u nhd hon hoac bang 3 cm, da dua din ket luan RFA cd kha nang tieu huy hoan toan khoi u cao hon, can it lan dieu tri hon va ty IS biin chiing thap hem so vdi tiem cdn[18].
- Tiep can khoi u qua ngi soi d bimg la phuang phap that su co hieu qua khi phoi hpp vdi sieu am qua npi soi, no giiip phat hien chinh xac cac khoi di can frong gan tit hon khi sieu am qua da, ngoai ra no con giiip phat hien di can ngoai gan. RFA qua ngi soi se it dau vet thuong hon so vdi mo md va kiem soat dugc cac tang lan can nen hiem khi gay tin thuong cac tang lan can lihu khi RFA qua da. Montorsi va cgng su da th\rc hien RFA qua npi soi tren 29 benh nhin HCC da cho thiy tmh hieu qua va an toan ciia phuong phap. Trong 95 trudng hgp chimg tdi thuc hien RFA qua npi soi thi ty le dot khdng hit hoan toan u kha ldn (7/32) va ty le tai phat tai chd cao do chiing t6i chua cd sieu am trong ml va kich thudc u khd ldn, u tren nen xo gan.
- Tiep can u qua phiu thuat md dugc chi dinh ddi vdi nhiing u kich thudc ldn, tiiudng tren 5cin,
Tap chi GAN MAT VIET NAM so 29-2014 91 nhieu khoi u, u nam gan cac ca quan lan can va
cd tien sir md bung nen khong diyc hien ngi soi byng dugc. Ngoai ra Rf A qua phiu thuat md con dugc thuc hi?n khi phdi hgp vdi cit gan hoac cit dai true trang co di can gan.
Biin chiing RFA tuong ddi thip va thudng gap mpt sd bien chung sau:
- Chay mau vao o phiic mac thudng xay ra trong vong 24 gid sau khi RFA va dd la mot frong nhimg n^y6n nhan gay tir vong. Chay mau co the do ddt khong hoan toan khdi u, cd thi chay tir nhu m6 gan fren dudng di cua dien cue [7], co dil vd khdi mau hi trong gan [8] hoac co thi do v5 gia phmh dgng mach gan [9]. D I du phong bign chiing nay, sau khi dot xong cin gia cl them tren dudng di ciia dien cue bing each ngung he thing lam lanh dien cue (ddi vdi he thing RF dugc lam lanh) va tilp tuc dit trong khi nit dien cyc ra khdi gan [ 10],[ 11]. Mgt si nghien ciiu cho thiy ty le chay mau chilm khoang 0,7%
[12],[13],[14]. May man thay trong nghien cim nay chiing toi chi gap Itrudng hop nao chay mau dudng mat din din tii vong.
- Mdu ty trong gan, mau ty dudi bao gan la mot trong nhung biin chumg fliudng gap, co thi la do di?n cue di xuySn qua mach mau ldn. Dy phong bang each chpn dudng vao cua dien cyc hgp ly, trdnh cac mach mau ldn. Trong nghien cim nay co 1 tnrdng hgp mau tu trong gan khi thyc hien RFA qua da, khoi mdu ty nhd, khdng cin can thiep gi.
- Ap-xe gan thudng do frong qua dinh thuc hi$n RFA gay tin thuang dudng mat hoac xo hep dudng mat gay nen hipn tugng nhilm tning ngupc ddng, bpi nhiem vi khuan la nguyen nhan gay ap- xe gan[]5]. Trong nghien ciiu nay, cd 2 tnrdng hpp ap-xe gan vd ra thanh bung.
- Ton thuang dudng mat: Cac nghien ciiu chi ra ring nhiing dudng mat ldn dugc bao ve khoi sy pha huy ciia nhi?t bdi sy lam lanh ciia tinh m^ch ciia va dgng mach gan chay dgc theo chung.
Bdi v^y khi co thuyen tic tinh mach cira thi nhirng dirdng m^t nho dudi 3mm mdi bi pha huy. Ton thuong dudng m^t ldn hon 3mm chua bao gid gap d cdc bao cao [16],[17]. Xo hep dudng mat ldn sau RFA thudng gap hem. Trong nghien ciiu cua chiing toi co mpt trudng hpp sau RFA 20 ngay xuat hi$n vang da, vang mat ngay cang tang, bilirubin tryc tiep tang troi hon so vdi gian tiep, dien tien ngay cang nang din, b^nh nghi ngd ton
thuang gay hpp dudng mat chinh, cd chi dinh dat stent dudng mat nhung benh khong hgp tac dilu tri va tu vong sau gan hai thang.
- Suy gan: trong bao cao cua chiing toi cd 8 hudng hgp suy gan sau RFA, xay ra ddi vdi cac benh nhan u gan ldn tren nIn xo gan, chiic nang gan d giai doan Child B, C. Sau RFA benh suy gan tmig din, va tii vong frong vong 3 thang.
- Tdn diuong tang ian can thudng gap la tdn thuang tui mat [20], tin thuong do bdng, co thi gay thung da day, rudt non, dai trang khi u nim ke can cac co quan nay, dac bi|t khi thyc hien qua da. May min thay trong nghien ciiu nay chiing toi khong gap trudng hgp nao thuang tin t ^ g ian canca.
Ngoai ra con mgt sd cac biin chiing khac ma nhieu nghien ciiu da chi ra nhu bien chiing phli, tin thucmg mach mdu, tin thuang co hoanh, biin chimg ve tim, than, hornion [19]...
Theo doi benh trong 12 thdng d nghien ciiu nay chung tdi nh|m thiy rang ty le dot khong hoan toan khoi u, ty le tai phat tai ch6, ty le phat triln u mdi kha cao la do u gan dugc chi dirih lam RFA ciia chiing toi cd kich thudc khd ldn, phan gan edn lai xo nhieu. Neu co dot hoan toan khii u thi khd nang suy gan rit Irni. D6i vdi khii u nho hon 5cm va dac biet khi khoi u nho hon 3cm thi kha nang dot hoan toan khoi u rat kha quan, kha nang tai phat tai cho thap, thdi gian song them tit hon va dac biet rat hiem gap cac hiln chiing.
5. Ket luan
Dieu tri ung thu gan tdt nhit vin la phau thuat cat gan tuy nhien so benh nhan dugc chi dinh phau thuat cat gan con han che vi nhieu ly do. Phuang phap phd hiiy tai cho khoi u gan bing nhiet cao tdn (RFA) da dem den nhung hieu qua thyc sy doi vdi nhirng trudng hgp ung thu gan khdng co chi dinh cat gan. Dua tren nghien cihi nay ciing nhu ket qua nghien ciiu ciia nhiing tdc gia khac, chiing toi nhan thay RFA co hieu qua doi vdi nhiing trudng hgp khoi u gan co kich thudc nho hoac vira, dac biet doi vdi nhirng khoi u gan co kich thudc nho hon 5cm. RFA khong c6 hi?u qud doi vdi nhiing trudng hgp ung thu gan vdi khoi u kich thudc qua ldn (> 10cm) va nhiing trudng hgp ung thu gan tren nen xo gan Child C. Vi$c chgn lya phuong phdp tiep c ^ khoi u gan phy thugc vj tri, kich thudc cung nhu sd lugng u gan.
92 Tap chi GAN MAT VIET NAM sS 29-2014 Tai lieu tham khao
1. Thierry De Baere, Dominique Elias, Michel Ducreux, Ablathermie ficrcutanee des metastases hepatiques par radio frequence. Gas- troenterol CUn Biol, 1999,23,1128-1133.
2. Rossi S, Fomari F, Paties C, Buscatini L.
Thermal lesions induced by 480-KHz localized current field in guinea pig and in pig livers. Tu- mori 1990; 76:54-57.
3. Steven A. Curley, Francesco Izzo, J.
Nicolas Vauthay, Paolo Vallone. Radiofre- quency Ablation of Hepatocellular Cancer in 110 patients with cirrhosis. Annals of surgery, vol 202. no. 3,381-391.
4. Anton J. Bilchiic, Thomas F. Wood and David P. AUegra. Radiofrequency Ablation of unresectable hepatic malignancies. The Oncolo- gist, Vol. 6, No. 1,24-33.
5. L& L6c, Phan Hai Thanh. Butyc ddu diiu tri ung thu gan nguyen phdt vd thir phdt bang ra- diofrequence. Tap chi Y hoc Viet Nam, tap 297, tt 19-23.
6. Kelvin K. Ng, Ronnie T. Poon. Radiofre- quency ablation for malignant livertumor Surgi- cal Oncology 14 (2005), 41-52.
7. Livraghi T et al. radiofrequency ablation in the treatment of hepatocellular carcinoma: experi- ence in 259patients. Radiology 1999; 213: 282-3.
8. Bowles BJ et al. Safety and efficacy ofra- diofrequency thermal ablation in advanced liver tumors. Arch Surg 2001; 136: 864-9.
9. Torres et al. Vascular complications after hepatic tumor radiofrequency. Eur Radiol 2001- ll(SupplA):410.
10. Risse O et al. Destruction de tumeurs he- patiques malignes par radiofrequence. Expe- rience preliminaire apropos de 25 cas. Ann Chir 2001;126:118-26.
11. De Baere T et al. Radiofrequency liver ab- lation: experimental comparative study of water- cooled versus expandable systems. AJR Am J Roentgenol 2001; 176: 187-92.
12. Lim HK et al. Complications after ra- diofrequency thermal ablation of hepatic ttimors:
a report of the Korean RF study group Radiolosv 2001; 221 (suppl): 248.
13. Blackman GE et al. Early experience with radiofrequency ablation of tumors of varying his-
tology with follow-up. J Vase Intervent Radiol 2000; ll(suppl): 238.
14. Llovet .IM et al. Increased risk oftomor seeding after percutaneous radiofrequency abla- tion for single hepatocellular carcinoma. Hepa- tology 2001; 33:1124-9.
15. Spies JB et al. Antibiotic prophylaxis in vascular and interventional radiology: a rational approach. Radiology 1988; 166: 381-7.
16. De Baere et al. Radiofrequency ablation of 100 hepatic metastases with a mean follow-up of more than 1 yean AJR Am 3 Roeatgeaol 2000;
175: 1619-25.
17. Hansen PD et al. Radiofrequency ablation lesions in a pig liver model. J Surg Res 1999;
87:114-21.
18. Ambrogio et al. Radiofrequency thermal ablation vs. percutaneous ethanoi injection for small hepatocellular carcinoma in cirrhosis:
Meta-analysis of randomized controlled trials.
Am J Gasttoenterol 2009; 104: 514-524.
19. Wen-Tao Kong et al. Major complications after radiofrequency ablation for liver tumors:
analysis of 255 patients. World J gasttoenterol 2009; 15: 2651-2656.
20. Sang Won Kim et al. Percutaneous ra- diofrequency ablation of hepatocellular carcino- mas adjacent to the gallbladder with internally cooled electrodes: Assessment of safety and ther- apeutic efficacy. Korean J ladiol 2009; 10:366-76.
21. Livraghi T. et al. Hepatocellular carci- noma: Radiofrequency ablation of medium and large lesions. Radiology 2000; 214; 761-8.
22. Chen IMH et al. Large liver tumors: pro- tocol for radiofrequency ablation and its clinical application in 110patients. Radiology 2004; 232:
260-71.
23. Wood TF. Et al. Radiofrequency ablation of 231 unresectable hepatic tiimors: indications, limitations and complications. Annals of surgical oncology 2000; 7: 593-600.
24. MuUer S. et al. complication ofradiofre- quency coagulation of liver titmors. British joumal of surgery 2002; 89: 1206-22.
