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The understanding of Radio frequency Ablation on the primary HCC &the metastatic HCC.

The understanding of Radio frequency Ablation on the primary HCC &the metastatic HCC. Moon-kyu Kwon, il-kwon Han, Ji-sang Jung, Soo-jung Yoon, Je-hoon Yoo, * Ha-jung Joo. RFA(Radiofrequency Ablation) Of Understanding. RFA is ?

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The understanding of Radio frequency Ablation on the primary HCC &the metastatic HCC.

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  1. The understanding of Radio frequency Ablation on the primary HCC &the metastatic HCC. Moon-kyu Kwon, il-kwon Han, Ji-sang Jung, Soo-jung Yoon, Je-hoon Yoo, *Ha-jung Joo.

  2. RFA(Radiofrequency Ablation) Of Understanding • RFA is ? • The co-relationships of the size and the number of tumor on the therapy. • The comparison of percutaneous RFA & RFA after an open surgery.

  3. RF(Radiofrequency )is? • Radiofrequency • 라디오 송신 주파수 300-1200Khz • RFA • 400 -500kHZ 교류전류

  4. Principles Of RFA Ionic agitation Alternating Electrical Current Coagulation Necrosis

  5. RF Mechanism Electric circuit

  6. RF Electrode Mechanism Roll-off

  7. Co-relation of Power & Impedance

  8. Depolyment ofRF Electroid

  9. US monitoring of Ablation

  10. Percutaneous RFA of liver metastases • Radiofrequency ablation of the liver: current status • American Journal of Roentgenology. 176:3-16, 2001 Jan

  11. Major Complication of RF Ablation • The Korean Study Group of Radiofrequency Ablation • 51 of 1154 patients (3.3%) • hepatic abscess (n=13, 0.8%) peritoneal hemorrhage (n=7, 0.5%) ground pad burn (n=6, 0.4%) pneumothorax or hemothorax (n=6, 0.4%) biloma (n=3, 0.2%) sepsis, hepatic infarction, hepatic failure, bile duct injury, vasovagal reflex, massive AV shunt, diaphragmatic injury, renal infarct, gastric ulcer, pseudoaneursym of abdominal wall, transient ischemic attack, colonic perforation

  12. Pre-Procesure MRI After Intra-op RF Ablation

  13. Contraindication of RFA • Prothrombin time: < 50%. • Platelet count: <50.000/ℓ. • Ascites Patient. • Severe lung dysfunction • Acute Infection Symptom. • Metastasis to another organ except liver. • Portal vein tumor thrombosis • Hepatic encephalopathy • Immunocompromised patient • Pregnant patient

  14. Indication of RFA • Primary or Metastatic hepatic tumors • 5cm or smaller • Four fewer number • cf) Severance:5cm(single),3cm(3 ea) • 1cm or more deep to liver capsule • 2cm or away from large vessels(Heat sink Effect) Dodd et al radiographic2000

  15. Percutaneous RFA Pre CT Tx Sono F/U 48 Hrs F/U 3M M/50 HCC Primary HCC M/59

  16. Pre Intra-op RFA CT M/62 Rectal ca

  17. Intra-op RFA (2 weeks f/u) M/62 Rectal ca

  18. Intra-op RFA (1 Year f/u) M/62 Rectal cancer

  19. M/60 Rectal cancer with multiple liver metastasis

  20. Intraoperative RF Ablation After Mile’s op.

  21. RFA(Radiofrequency Ablation) Of Understanding • RFA is ? • The co-relationships of the size and the number of tumor on the therapy. • The comparison of percutaneous RFA & RFA after an open surgery.

  22. Object • Duration: 2002, 3. ~ 2003, 5. • Pt: Total : 73 (m/52 , f/21) • Average year: 57 • 5cm < , 4ea <= : A group • 5cm >= , 3ea >= : B group • RFA after an open surgery : C group • Percutaneous RFA : D group

  23. Material • Leveen needle : 2.0cm, 3.0cm, 3.5cm, 4.0cm • Generator: RF3000 (Power 200W) • Ground pad : 4ea

  24. Evaluation of Therapy • High echogenecity on US after RFA. • Difficult to Differential diagnosis remaining tumor. • 48Hrs & 3M F/Uㅡ sequential Liver CT • Initial CT Comparison. • DDx by Contrast Media enhancement.

  25. Procedure of RFA 1 • After Open surgery : • Grounding pad contact to each on two thigh. • Under general anesthesia. • Sono guiding puncture. • Percutaneous RFA : • Demerol 50mg Im injection(pre 30min). • Grounding pad contact to each on two thigh. • Fentanyl citrat 100ug Iv inj(start time). • Sono guiding puncture.

  26. Procedure of RFA 2 • RF generation : • Needle 100c • 10 min ~ 15 min • Due to size and number of tumor • Move & Repeat ablation. • Fully high Echo check • F/u: 48Hrs ,3Months (Sequential Liver CT exam).

  27. Result 1 42 19 8.3% 7 5

  28. Conclusion 1 • The sizes and the numbers of the lesion were contributing a signicant effect on the therapy. Size & number ↓ : Therapy effect ↑ Primary HCC> Metastasis HCC

  29. Result 2 N=37 N=36

  30. Result 2-1

  31. Conclusion 2 • RFA after an open surgery,father than the percutaneous RFA ,had better result in perfection. • Easy Approaching to lesion. • Hemostatic during hemorrhagic situation • Patient’ control. • The same time,metastastic hematoma in surgical method.

  32. Perspective of RFA • Reducing blood flow during ablation therapy. • Total portal inflow occlusion. • Angiographic balloon occlusion. • Embolization prior to ablation. • Combining thermal ablation with chemotherapy. • Co-access needle use. • (Biopsy,One puncture site channel use RFA) • Lung ca, bone ca, breast, renal…(Primary ca).

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