??? ??? (Radiofrequency ablation, RFA)

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Radiofrequency ablation of Liver tumor
? ? ?
2
??? ????
????? ?????? ? ??? ??? ??? ? ?? ?? ???? ?? ??. ?? ?? ??? ??? ????? ??,??? ?? ?? ??? ????? ??? ???? ??? ??. ?? ?? ??? 927? ??.
????? ?????? ??? ?? ??? ????? ? ??? ?? ??? ?? ???? ?? ??. ???? ?? ??? ???? ??? ???
????? ?????? ????? ???(TACE) ???? ?? ???? ????? ???? ???? ? ? ????? ?? ??? ??. ??? ????? ??? ??? ???? ?? ??.
????? ?????? ??? ???? ??????????(Radiofrequency ablation, RFA) ???? ???? ???? 500? ??? ???? ???? ???? ????? ?? ????? ??? ???? ????, ??? ??? ????? ?? ??? ???? ? ? ?? ???? ?? ????? ??? ??.
????? ?????? ??? ???? ???????????(Percutaneous ethanol injection therapy, PEIT) ?? ????? ?? ??? ???? 99.5 ?? ???? ????? ???? ?? ?? ????? ??. ?? 3? ??? ?? 3? ??? ??? ??? ?? ?? ??
????? ?????? ?? ???? ???? ?????? ???. ?? ?? ??? ????? ? ???, ???????? ?? ??? ???? ??? ??? ????.
????? ?????? ??? ?? ???????? ?? ??? ???? ???? ? ? ??? ??? ?? ????? ??, ????? ??? ?????????? ??? ???? ??? ??? ??? ??? ???? ??
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Radiofrequency ablation(RFA)

• RFA(??? ???)? ??? ?? ?? ???? ?? 3cm??? ?? ???
  ???? ?????? ???? ??? ??? ????? ???? 5cm? ????
  ???? 34? ??? ???? ?? ????. ?? 3cm?? ??? ??? ????
  ?? ??? ??? ????? ??? ??? ?? ???? ?????? ???? ??.
  ???? ?? ?? 3cm??? ?? ??? ?? RFA? ?? ?? ??????.

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Principle

• ?? 4550? ???? ????? ???? ??? ???? ???? ???? ????
  ??? ??? ??( Radiofrequency.460kHz)? ?? ??? ???
  ???? ??? ???? ????, ???? ???? 1?? 40??? 50???
  ????? ???? ??? ??? ????? ??? ??.

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RFA? ???
??? ? ??? ?? ?? 4cm?? ? ??? 3? ???? ?? 3cm??
??? ???? ? ??? 6?/mm,Transprothrobin times 60?? ? ?? 3cm??? ????,????? ??? ?? ? ??? ??, ?? ?? 5cm??,?? 5? ??
??? ???? ? ????? ???? ?? ? ??? ? ?? ?? ?? ? ???? ?? ??? ??? ?? ? ???? ?? ????? ????
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Approach

• Guidance
• 1) US
• 2) CT
• 3) MR
• 4) fluoro

• Method
• 1) Percutaneous
• 2) laparoscopic
• 3) intra-Op.

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RITA Medical System
Temperature based treatment Typical treatment
times 20 45min
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Boston Scientific

• Impedance based treatment
• Typical treatment times 20 45min
• Expandable needle ( ??? ?? )
• -15G? Needle? ???? 4?12??
• ??? ??? ??? ??? ????
• ?? ????? ??? ???? ????
• Needle? ?? ???
• ???? ????
• ??? ????.

50W?? ???? 30sec? 10W? ?????(????)

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Cool-tip system
TM

• Fully automatic operation
• Typical treatment times 12minutes
• -?? 1??? ?? 200W?? ????? ??? ???? ? ??? ??? ??
  ??? ???? ???? 12?? ???? ????.
• Cooled-tip needle(??? ???)
• - 17G. single type? cluster type
• - Needle ?? ???? ?? ??(??)
• Infusion of saline into tissue
• - Needle ??? ??? Saline? ???? ??
• ??? ???? ?? ??????.?? ??
• ? ??? ? ?? ?? ??? ??? ?? ?
• ?? ?? ?? ?? ??? ???? ?? ?
• ???? ?? ???? ??.

???? ?? ??
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Preparation

• ?? ? CT ?? MRI? ??? ?? ?? ? ??? ??? ??? ???? ??
  ??? ???? ???? ?? ???? ????? ?? ???? ??? ????. ??
  ?? ?? ??? ?, ?? ?? ??? ??? ?? 6?? ??? ???
  ????.(?????)
• ?? ??? Demerol, lidocaine, saline(2)

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Sono guide?? RF probe ? ??? ? ??
?? ??? ???? ??? ?? ??? ?? ??? ???? ??? ?? ?? ??
???? ?? ??? ?? Demerol? ???? ??? ?????. ?? 3cm???
??? ?? 20? ??? ??? ???? size? ??? ?? ?? ??? ?? ?
??? ??? ?? ??? ??.
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Needle tip
Tumor
2. Needle ???.
1. Needle insert
??? ????? ??? ?? ??? ?? ???
3. ???
4. ??? ??
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Post-RFA

• ????? ?? ????? sand bag?? ??? ??? 4?? ?? ??.
• ??? ???? ??? ?? enhance-CT? ????, ??? CT??? ???
  ????? ???? ?? ?? ??? ??? ? ?? ??. ?? ??? CT???
  ??? ?? 1?? f/u? ???? ? ? 3???? CT f/u? ????.

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Post-RFA
Pre-RFA
RFA??? ????? ?? ???? F/U CT
HCC
HCC ??? abdomen ECT?? artery phase? enhacement
?? portal phase? washout ? lesion ????. ?? ?
artery phase? enhace??? lesion? ?? ? enhace ?? ??
????? ???? ? ??? ??? ?? ??? ???? ?? ?? ??
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Residual Unablated Tomer
????(Residual Tomer) ?? ? 6?? ??? ???? ?? ???
????? ???? ?? ?????? ???? ??.
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Pre-RFA
(M/71)
Artery
Portal
Low density nodule with peripheral enhancement in
left lateral segament(1.9cm) Tip ??
??? abdomen ECT? artery phase? ???? ??
portal phase? ???? ?? ??? ????.
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US Guide RFA??
Cool-tip electrode 3cm single Left lat
segament 2.4cm
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Post-RFA
Ablative Margin
Index tomer
Immediate
3 month
Saft Margin ???? ???? ???? ???? ???? ????? ???
?? ???? 0.51cm ??? ??? ??( ?? ??)
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Pre-RFA(M/73)
HCC(2008.2.15 Biopsy)? TACE(2008.12.10)??
recure(?2.3cm) Left lateral segament? partial
lipiodol uptaken nodule(seg4)? ???? enhancing
lesion? ???, delayed washout???.
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Post-RFA
Segment 4? partial lipiodol uptaken nodule?
???? ? 3.5cm? RFA? ?? lower density lesion? ??
?? enhancing lesion? ???? ??? ?? CT? ???? ?????
enhan cing lesion? ?? ??? ??? ?? ? ??? ???
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CT guide

• USG? lesion? ?? ????,???? ?? CT guide?? RFA? ????
  ?? ?? ???? ??? ??? ???? Route ??? ????.

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Pre-RFA
(M/71)
HCC? TACE?? recure. .(?2cm) Slight enlargement of
TACE treaded nodule in the posteromedial
aspect.(segament 6)
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US Guide RFA??
Sonic window?? ??? fail
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CT Guide RFA??
Cool-tip electrode 3cm single segament 6
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Post-RFA (art)
segament 6? 3.7cm? RFA? ?? lower density lesion?
?? ?? CT? ???? ????? enhancing lesion? ?? ??? ???
?? ? ??? ???
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Complication

• RFA??? ??? ??? ??? ??? ?? ???, 17G? ?? Needle?
  ???? ???? ??? ??? ??? ?? ??? ???, ??, ??, ??, ?
  ?? ?? ?? ??? ?? ? ??? ?? ?? ??,??, ??, ??, ?? ??
  ???? ??? ? ??

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Burn

• ??
• -pad? ??? ???? ?? ?? ?? ?? ?? ?? ??? ?? ????? ??
  ? ???? ??? ?? ??.??? ?? ??? ?? ???? ? ??? pad?
  ??? ?? ???? ??? ??? ???? ???? ?? ????.

Peel off coating

• ??? ??? Impedance??
• 50 ??? ???? ?? pad? ?? ??? ??? ? ???,
• ??? ??? ped? ??? ??? ped? ???? ?? check

ped
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Abscess
Immediately
1 Mo. F/U
Cool-tip system? ?? ??? ??? saline? ?? ????
cooling? perfusion?? ??? ??? ??? ?? ??
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Bowel injury
Pre-RFA
Post-RFA
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Diaphragm injury-hemopericardium
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Hemothorax
Pneumothorax