提升肝细胞癌射频消融疗效的技术性措施：外科视角

Technical measures to promote the efficacy of radiofrequency ablation for hepatocellular carcinoma： from the surgeon＇s per-spective

近十多年来，射频消融（RFA）治疗肝细胞癌（HCC）的疗效不断提升，已成为早期HCC常用的治愈性手段。但是RFA在我国的开展尚不普遍，疗效也有待提高。本文从外科视角，对提升HCCRFA疗效的技术性措施进行了较系统的阐述，包括明确癌灶部位和范围、把握适应证和禁忌证、科学应用预治疗、合理选择RFA路径和经皮穿刺路径的引导方式、选择合适的射频电极、充分镇痛、保证充分的消融边界、优化消融策略、积极预防和诊治并发症、准确判定完全消融、规范随访、重复应用RFA治疗局部肿瘤进展和肝内复发病灶共13项，旨在为在我国进一步推广该技术提供规范和参考。

Radiofrequency ablation （RFA） has been recognized as a curative therapeutic modality for hepatocellu- lar carcinoma （HCC） for its increasing efficacy in the recent more than ten years. However, RFA has not been generally carried out in our country and the efficacy still waits for im- provement. This paper presents a systemic discussion on the technical measures to promote the efficacy of RFA for HCC from the surgeonrs perspective, aiming to provide technical standard and reference for the further popularization and ap- plication of RFA in China. The 13 measures include clarifi cation of the tumor location and extent, following the indica- tions and contraindications of RFA, scientific application of pretreatments, selection of the best approach of RFA and of the reasonble guiding method for pereutaneous RFA, selec-tion of suitable RFA probe, adequate analgesia, sufficient ablative margin to guarantee pathological complete ablation, optimization of ablaiton strategy, active prevention, diagnosis and treatment of complications, correct evaluation of complete ablation, standadized follow-up and selection of RFA to treat the local tumor progression and intrahepatic occurrence.