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Song KD, Lee MW, Rhim H, Kang TW. Hemostasis using re-radiofrequency ablation for hepatic tract bleeding after ultrasound-guided percutaneous radiofrequency ablation of hepatic tumors. Br J Radiol 2021; 94:20210353. [PMID: 34538063 DOI: 10.1259/bjr.20210353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the hemostatic efficacy of re-radiofrequency ablation (re-RFA) for hepatic tract bleeding after ultrasound-guided RFA of hepatic tumors. METHODS A total of 4679 percutaneous ultrasound-guided RFA procedures were performed for hepatic tumors at Samsung Medical Center between January 2012 and December 2020. We identified patients who had hepatic tract bleeding after RFA by reviewing radiologic reports and ultrasound images and investigated the measures taken to control the bleeding and their outcomes. We also identified patients who had a significant peritoneal hematoma on immediate post-RFA CT or underwent transarterial embolization to control hepatic bleeding after RFA of hepatic tumors. RESULTS In total, 91 patients with tract bleeding after RFA were identified. As initial measures to control the bleeding, external compression, re-RFA, and observation were performed in 71 (78%), 17 (19%), and 3 (3%) patients, respectively. Hemostasis using re-RFA was attempted to control tract bleeding in 40 patients as an initial measure or an additional measure after other initial efforts. In all 40 patients, the bleeding stopped after re-RFA on Doppler ultrasound, and there was no active bleeding on the immediate follow-up CT. During the study period, in the years when re-RFA was performed frequently, the number of transarterial embolizations to control tract bleeding and significant peritoneal hematoma formation tended to be low. CONCLUSION Hemostasis using re-RFA of the needle tract is effective in controlling tract bleeding after ultrasound-guided RFA of hepatic tumors. ADVANCES IN KNOWLEDGE Re-RFA is a simple, safe, and effective method to control tract bleeding.
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Affiliation(s)
- Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyunchul Rhim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Rodrigues BT, Mei SLCY, Fox A, Lubel JS, Nicoll AJ. A systematic review on the complications and management of hepatic adenomas: a call for a new approach. Eur J Gastroenterol Hepatol 2020; 32:923-930. [PMID: 32433418 DOI: 10.1097/meg.0000000000001766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Hepatic adenomas are benign hepatic lesions with heterogeneous characteristics. Awareness of complications, including haemorrhage and malignant transformation, has improved alongside a concurrent rise in their detection. Monitoring and management guidelines, however, remain inconsistent. This systematic review analyses the natural history of hepatic adenomas, and existing and novel risk factors associated with haemorrhage and malignant transformation. Results of this systematic review commonly identified male sex, and the beta-catenin histopathological hepatic adenoma subtype, as risk factors for malignant transformation, whilst those associated with haemorrhage included lesion size and number, exophytic nature, and recent hormone use. Overall, females demonstrated higher rates of haemorrhage, whilst males exhibited a higher risk of hepatocellular carcinoma development. This systematic review highlights that tumour size and subtype may not be as characteristically linked with complications as previously thought. We have additionally reported novel risk factors contributing to development of hepatic adenoma-related complications. We conclude by highlighting the risk of taking a conservative approach to seemingly low-risk lesions and suggest revised practice guidelines.
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Affiliation(s)
- Beverly T Rodrigues
- Department of Gastroenterology, Eastern Health.,School of Medicine, Monash University, Eastern Health Clinical School, Monash University
| | | | - Adrian Fox
- Department of Gastroenterology, Eastern Health
| | - John S Lubel
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria 3128, Australia
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Zhang L, Shi H, Li D, Ye H, Zhang W, Yin S. Radiofrequency Coblation-Assisted Resection of Skull Base Neoplasms Using an Endoscopic Endonasal Approach. ORL J Otorhinolaryngol Relat Spec 2019; 82:25-33. [PMID: 31739305 DOI: 10.1159/000503974] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 10/07/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We describe our early experiences with resecting skull base tumors using a radiofrequency ablation-assisted endoscopic endonasal approach. Ninety-seven patients with skull base tumors who were admitted to the Otorhinolaryngology department at Shanghai Jiaotong University Affiliated Shanghai Sixth People's Hospital between January 2014 and December 2016 were operated on using a radiofrequency ablation-assisted endoscopic endonasal approach. Complete resection was achieved in all patients. This paper describes the operative technique and presents the degree of resection, complications, and early clinical outcomes. METHODS We investigated the safety and feasibility of the technique and assessed preliminary treatment outcomes. RESULTS No patients experienced a new neurological deficit, cerebrospinal fluid leak, or meningitis after surgery. No deaths related to skull base tumors were observed during the follow-up period (14-50 months). The volume of intraoperative blood loss was 100-1,200 mL (median 350 mL), the duration of operation was 40-510 min (median 180 min), and the hospital stay was 6-65 days (median 18). CONCLUSIONS Our limited experience indicates that this technique is feasible and safe for complete resection of some skull base tumors in selected cases and in the future will have an increasing role to play in endoscopic sinonasal and skull base tumor dissection.
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Affiliation(s)
- Ling Zhang
- Department of Otorhinolaryngology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Haibo Shi
- Department of Otorhinolaryngology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Dawei Li
- Department of Otorhinolaryngology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Haibo Ye
- Department of Otorhinolaryngology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China,
| | - Weitian Zhang
- Department of Otorhinolaryngology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Shankai Yin
- Department of Otorhinolaryngology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai, China
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Abstract
Introduction Hemorrhage is a serious complication following percutaneous biopsy requiring detecting and immediate treatment of active bleeding. This study aimed to explore the potential benefits of ultrasound (US)-guided microwave ablation (MWA) to treat acute hemorrhage in risky locations. Materials and methods We present seven patients (four males and three females) aged 19–69 years with solid-organ arterial hemorrhage treated by US-guided MWA and followed up with contrast-enhanced US (CEUS). Results All seven cases successfully underwent MWA for hemostasis, and their vital signs subsequently stabilized. During the follow-up from 13 to 36 days, the ablation area decreased slowly in five patients and was still stable in two cases. There were no complications observed in this study after MWA treatment. We also reviewed a total of 12 publications in the past 10 years. Conclusion This study suggested that US-guided MWA may be an effective and safe strategy for acute hemorrhage in the emergency setting. To confirm this method and benefit more patients, more prospective studies with larger samples and longer follow-ups are recommended.
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Affiliation(s)
- Jiabao Guo
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guo Tian
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China
| | - Qiyu Zhao
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tian'an Jiang
- Department of Ultrasound Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, China
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Huang Q, Xu E, Tan L, Zeng Q, Zheng R, Li K. Thermal ablation of hepatocellular carcinoma in patients with abnormal coagulation function. Int J Hyperthermia 2017; 34:1038-1043. [PMID: 29082796 DOI: 10.1080/02656736.2017.1390787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To evaluate the safety of thermal ablation for hepatocellular carcinoma (HCC) in patients with abnormal coagulation function. METHODS Fifty-seven HCC tumours in 50 patients were treated with thermal ablation. All patients had a meted platelet count <50 × 109/L or international normalised ratio (INR) ≥ 1.7. Gastroscopy before ablation, platelet concentrate or fresh frozen plasma transfusion during ablation and contrast enhanced ultrasoundgraphy (CEUS)-guided ablation to cease needle tract bleeding were performed to reduce haemorrhage. The incidences of haemorrhage and other major complications were recorded and patients were followed up to observe the local tumour progression (LTP), intrahepatic distant recurrence (IDR), overall survival (OS) and recurrence-free survival (RFS) rates. RESULTS Two incidences of needle tract bleeding and one needle tract bleeding together with bleeding at the suture of the spleen fossa were found. Three needle tract bleeding events were detected by CEUS and ceased after CEUS-guided complementary ablation. CEUS failed to detect bleeding at the suture of the spleen fossa. Therefore, a laparotomy was conducted for haemostasis. No other major complications were found after ablation. The median follow-up periods were 18.7 ± 12.0 months (range 1 ∼ 42 months) and 1 LTP and 15 IDRs occurred. The 1-, 2- and 3-year OS rates were 84.8%, 82.7% and 82.7%, and RFS rates were 67.9%, 64.0% and 64.0%, respectively. CONCLUSION With gastroscopy before ablation, platelet concentrate or fresh frozen plasma transfusion during ablation and CEUS-guided ablation to cease needle tract bleeding, thermal ablation is a safe treatment for HCC in patients with abnormal coagulation function.
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Affiliation(s)
- Qiannan Huang
- a Department of Ultrasound , The Third Affiliated Hospital, Sun Yat-sen University , Guangzhou , China
| | - Erjiao Xu
- a Department of Ultrasound , The Third Affiliated Hospital, Sun Yat-sen University , Guangzhou , China
| | - Lei Tan
- a Department of Ultrasound , The Third Affiliated Hospital, Sun Yat-sen University , Guangzhou , China
| | - Qingjing Zeng
- a Department of Ultrasound , The Third Affiliated Hospital, Sun Yat-sen University , Guangzhou , China
| | - Rongqin Zheng
- a Department of Ultrasound , The Third Affiliated Hospital, Sun Yat-sen University , Guangzhou , China
| | - Kai Li
- a Department of Ultrasound , The Third Affiliated Hospital, Sun Yat-sen University , Guangzhou , China
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Zhao DW, Tian M, Zou JZ, Zheng YY, Li T. Effects of Non-Focused Microbubble-Enhanced and High-Intensity Focused Ultrasound on Hemostasis in a Rabbit Model of Liver Trauma. Ultrasound Med Biol 2017; 43:629-639. [PMID: 28062179 DOI: 10.1016/j.ultrasmedbio.2016.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 11/15/2016] [Accepted: 11/21/2016] [Indexed: 06/06/2023]
Abstract
Uncontrolled hemorrhage after trauma to the liver can lead to death. The present study compared the effects of non-focused microbubble-enhanced ultrasound and high-intensity focused ultrasound on hepatic hemostasis in the injured liver. Blood perfusion level, serum liver enzyme levels and the aspartate transaminase/alanine transaminase ratio differed between the two types of treatment (all p values < 0.05). Hepatic cells in the microbubble-enhanced ultrasound group exhibited edema and compressed the hepatic sinus and blood vessels in the portal area. Coagulation and necrosis, inflammatory cell infiltration, and fibrous tissue encapsulation were observed in the high-intensity focused ultrasound group at later stages. The groups also differed in degree of ultrastructural damage and recovery time. Thus, microbubble-enhanced ultrasound has less of an impact on blood reperfusion and surrounding normal tissue than high-intensity focused ultrasound and is a better choice for the treatment of liver trauma.
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Affiliation(s)
- Da-Wei Zhao
- Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing, China
| | - Meng Tian
- Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing, China
| | - Jian-Zhong Zou
- State Key Laboratory of Ultrasound Engineering in Medicine Co-Founded by Chongqing and the Ministry of Science and Technology, Chongqing Medical University, Chongqing, China
| | - Yuan-Yi Zheng
- Department of Ultrasound, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China; Institute of Ultrasound Imaging, Chongqing Medical University, Chongqing, China
| | - Tao Li
- Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing, China.
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Zhao DW, Tian M, Yang JZ, Du P, Bi J, Zhu X, Li T. Hemostatic mechanism underlying microbubble-enhanced non-focused ultrasound in the treatment of a rabbit liver trauma model. Exp Biol Med (Maywood) 2016; 242:231-240. [PMID: 27633577 DOI: 10.1177/1535370216669835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The aim of our study was to investigate the hemostatic mechanism underlying microbubble-enhanced non-focused ultrasound treatment of liver trauma. Thirty rabbits with liver trauma were randomly divided into three groups-the microbubble-enhanced ultrasound (MEUS; further subdivided based on exposure intensity into MEUS1 [0.11 W/cm2], MEUS2 [0.55 W/cm2], and MEUS3 [1.1 W/cm2]), ultrasound without microbubbles (US), and microbubbles without ultrasound (MB) groups. The pre- and post-treatment bleeding weight and visual bleeding scores were evaluated. The serum liver enzyme concentrations as well as the blood perfusion level represented by mean peak contrast intensity (PI) ratio in the treatment area were analyzed. The hemostatic mechanism was evaluated by histological and transmission electron microscopic examination of liver tissue samples. The MEUS subgroups 1-3 (grade 0-1, grade 0-2, and grade 1-2, respectively) exhibited significantly lower post-treatment visual bleeding scores than the US and MB groups (both, grade 3-4; all, P < 0.05). Subgroups MEUS1 (0.346 ± 0.345 g) and MEUS2 (2.232 ± 2.256 g) exhibited significantly lower post-treatment bleeding weight than the US and MB groups (5.698 ± 1.938 and 5.688 ± 2.317 g, respectively; all, P < 0.05). Additionally, MEUS subgroups 1-3 exhibited significantly lower post-treatment blood perfusion levels (PI ratios, 0.64 ± 0.085, 0.73 ± 0.045, and 0.84 ± 0.034, respectively) than the US and MB groups (PI ratios, 1.00 ± 0.005 and 0.99 ± 0.005, respectively; all, P < 0.05). In the MEUS group, hepatic cells became edematous and compressed the hepatic sinus and associated blood vessels. However, the serum liver enzyme levels were not significantly altered. Microbubble-enhanced non-focused ultrasound does not significantly affect blood perfusion and liver function and can be used to induce rapid hemostasis in case of liver trauma.
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Affiliation(s)
- Da-Wei Zhao
- 1 Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing 400042, P.R. China
| | - Meng Tian
- 1 Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing 400042, P.R. China
| | - Jian-Zheng Yang
- 1 Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing 400042, P.R. China
| | - Peng Du
- 1 Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing 400042, P.R. China
| | - Jie Bi
- 1 Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing 400042, P.R. China
| | - Xinjian Zhu
- 2 State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing 400042, P.R. China
| | - Tao Li
- 1 Department of Ultrasound, Daping Hospital & Institute of Surgery Research, Third Military Medical University, Chongqing 400042, P.R. China
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