tailieunhanh - Hepatobiliary Surgery - part 5

mái vòm cao trong gan, và Những Ngay lập tức tiếp giáp với các cơ quan khác intraabdominal năm đòi hỏi cách tiếp cận mở (nội soi hoặc Có thể). Curley và các đồng nghiệp tại Trung tâm Ung thư MD Anderson trình bày Hiện nay có một loạt lớn của RFA (thực hiện thông qua mở bụng) trong điều trị khối ung thư gan khác nhau. Điều trị này Xuất hiện an toàn, | 108 Heptobiliary Surgery high in the dome of the liver and those immediately adjacent to other intraabdominal organs require an open approach or possibly laparoscopic . Curley and colleagues at MD Anderson Cancer Center have presently presented a large series of RFA done via laparotomy in the treatment of various hepatic neoplasms. This treatment appears safe yet the long term results are not known at this time. Thermal ablation with microwave and laser technology have also been described with similar safety profiles in comparison to RFA. Although the three methods of thermal ablation appear effective in patients with small tumors they are generally not appropriate for larger tumors or those adjacent to the major vessels and bile ducts. We currently utilize this form of therapy percutaneous in Childs B and C patients with small lesions situated in anatomically accessible sites. We are beginning to explore the use of this modality intraoperatively as an alternative to cryotherapy. 7 Arterial Interruption HCC are known to be very vascular tumors as evidenced by their appearance on imaging studies and the abundant vascular structures on histologic examination. Hepatic arterial ligation was at one time the treatment of choice for HCC when lesions were found to be unresectable at the time of laparotomy. In patients with portal hypertension nonselective ligation of the main hepatic arteries carries a significant risk of hepatic ischemia and liver failure. Mortality following these nonse-lective ligations was as high as 13 in some series. With current angiographic techniques selective blockade of the hepatic artery branches supplying the tumors can be performed through embolization. Selective embolization is safe and widely reported in the literature. In many centers embolization is conducted with the concomitant intra-arterial infusion of chemotherapeutic agents chemoembolization . Complications following embolization or chemoembolization can occur and the reported .