Although surgical resection is still the optimal treatment option for early-stage hepatocellular carcinoma(HCC) in patients with well compensated cirrhosis,thermal ablation techniques provide a valid nonsurgical treat...Although surgical resection is still the optimal treatment option for early-stage hepatocellular carcinoma(HCC) in patients with well compensated cirrhosis,thermal ablation techniques provide a valid nonsurgical treatment alternative,thanks to their minimal invasiveness,excellent tolerability and safety profile,proven efficacy in local disease control,virtually unlimited repeatability and cost-effectiveness.Different energy sources are currently employed in clinics as physical agents for percutaneous or intra-surgical thermal ablation of HCC nodules.Among them,radiofrequency(RF) currents are the most used,while microwave ablations(MWA) are becoming increasingly popular.Starting from the 90s',RF ablation(RFA) rapidly became the standard of care in ablation,especially in the treatment of small HCC nodules;however,RFA exhibits substantial performance limitations in the treatment of large lesions and/or tumors located near major heat sinks.MWA,first introduced in the Far Eastern clinical practice in the 80s',showing promising results but also severe limitations in the controllability of the emitted field and in the high amount of power employed for the ablation of large tumors,resulting in a poor coagulative performance and a relatively high complication rate,nowadays shows better results both in terms of treatment controllability and of overall coagulative performance,thanks to the improvement of technology.In this review we provide an extensive and detailed overview of the key physical and technical aspects of MWA and of the currently available systems,and we want to discuss the most relevant published data on MWA treatments of HCC nodules in regard to clinical results and to the type and rate of complications,both in absolute terms and in comparison with RFA.展开更多
We describe the case of a hepatic injury after the insertion of a PEG. In a cirrhotic woman affected by a locally advanced cancer of the pharynx, the PEG tube was inserted through the edge of the left lobe of the live...We describe the case of a hepatic injury after the insertion of a PEG. In a cirrhotic woman affected by a locally advanced cancer of the pharynx, the PEG tube was inserted through the edge of the left lobe of the liver. The patient was treated with a conservative approach by managing abdominal pain and the PEG was removed after 4 months without complication. Hepatic injury is a rare complication of PEG placement;in order to avoid it, PEG tube should be inserted to the left of the abdominal midline and the lower edge of the liver should be defined by palpation;in cirrhotic patients, where left hepatic lobe hyper-trophy is common, ultrasound guidance could have been appropriate.展开更多
文摘Although surgical resection is still the optimal treatment option for early-stage hepatocellular carcinoma(HCC) in patients with well compensated cirrhosis,thermal ablation techniques provide a valid nonsurgical treatment alternative,thanks to their minimal invasiveness,excellent tolerability and safety profile,proven efficacy in local disease control,virtually unlimited repeatability and cost-effectiveness.Different energy sources are currently employed in clinics as physical agents for percutaneous or intra-surgical thermal ablation of HCC nodules.Among them,radiofrequency(RF) currents are the most used,while microwave ablations(MWA) are becoming increasingly popular.Starting from the 90s',RF ablation(RFA) rapidly became the standard of care in ablation,especially in the treatment of small HCC nodules;however,RFA exhibits substantial performance limitations in the treatment of large lesions and/or tumors located near major heat sinks.MWA,first introduced in the Far Eastern clinical practice in the 80s',showing promising results but also severe limitations in the controllability of the emitted field and in the high amount of power employed for the ablation of large tumors,resulting in a poor coagulative performance and a relatively high complication rate,nowadays shows better results both in terms of treatment controllability and of overall coagulative performance,thanks to the improvement of technology.In this review we provide an extensive and detailed overview of the key physical and technical aspects of MWA and of the currently available systems,and we want to discuss the most relevant published data on MWA treatments of HCC nodules in regard to clinical results and to the type and rate of complications,both in absolute terms and in comparison with RFA.
文摘We describe the case of a hepatic injury after the insertion of a PEG. In a cirrhotic woman affected by a locally advanced cancer of the pharynx, the PEG tube was inserted through the edge of the left lobe of the liver. The patient was treated with a conservative approach by managing abdominal pain and the PEG was removed after 4 months without complication. Hepatic injury is a rare complication of PEG placement;in order to avoid it, PEG tube should be inserted to the left of the abdominal midline and the lower edge of the liver should be defined by palpation;in cirrhotic patients, where left hepatic lobe hyper-trophy is common, ultrasound guidance could have been appropriate.
