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ORIGINAL ARTICLE
Year : 2019  |  Volume : 22  |  Issue : 10  |  Page : 1408-1411

Treatment of primary hepatic carcinoma through ultrasound-guided microwave ablation


1 Department of Ultrasonic, Xi'an Children's Hospital, Xi'an, Shaanxi, China
2 Department of Ultrasonic, Xijing Hospital of Air Force Medical University, Xi'an, Shaanxi, China

Date of Acceptance31-May-2019
Date of Web Publication14-Oct-2019

Correspondence Address:
Dr. X D Zhou
Department of Ultrasonic, Xijing Hospital of Air Force Medical University, Xi'an, Shaanxi
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_368_18

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   Abstract 


Objective: To study the clinical effect of ultrasound-guided microwave ablation on primary hepatic carcinoma. Method: The subjects comprised 94 patients with primary hepatic carcinoma who were admitted to our hospital between August 2014 and November 2016. They were divided into two groups in accordance with a random-number table. The control (n = 47) and study (n = 47) groups received conventional surgical excision and ultrasound-guided microwave ablation, respectively. The operation duration, clinical effect, complication occurrence rates, and hepatic functions of the two groups were compared. Results: The control group exhibited longer duration of operation and length of stay but significantly lower quantities of intraoperative bleeding and blood transfusion (P < 0.05) than the study group. The study group demonstrated significantly higher (P < 0.05) effective rate of treatment but significantly lower (P < 0.05) occurrence rate of complications than the control group. The study group exhibited significantly higher (P < 0.05) albumin and total bilirubin levels but significantly lower alanine aminotransferase and aspartate transaminase levels than the control group. No difference was observed in prothrombin time between the two groups (P > 0.05). Conclusion: Ultrasound-guided microwave ablation treatment offers the advantages of minor injury and low complication occurrence rates. Moreover, it is associated with faster postoperative recovery and improved hepatic function. Thus, it is worthy as a clinical option and must be promoted and applied.

Keywords: Microwave ablation, primary hepatic carcinoma, ultrasound guidance


How to cite this article:
Fang L, Meng X, Luo W, Zhou X D. Treatment of primary hepatic carcinoma through ultrasound-guided microwave ablation. Niger J Clin Pract 2019;22:1408-11

How to cite this URL:
Fang L, Meng X, Luo W, Zhou X D. Treatment of primary hepatic carcinoma through ultrasound-guided microwave ablation. Niger J Clin Pract [serial online] 2019 [cited 2019 Nov 15];22:1408-11. Available from: http://www.njcponline.com/text.asp?2019/22/10/1408/269016




   Introduction Top


Primary hepatic carcinoma is a common malignancy that originates from the liver mesenchyme or epithelial tissues. It is associated with high morbidity rates and malignancy grades.[1] Its main clinical manifestations include emaciation, jaundice, abdominal edema, poor appetite, and fatigue. The pathogenesis of primary hepatic carcinoma has not been completely defined but is believed to be directly related to external environmental factors, such as chemical substances and ethyl alcohol, and internal factors, such as sex hormones.[2],[3] In addition, viral hepatitis is associated with the pathogenesis of this malignancy.

Surgical excision is the preferred method for the treatment of primary hepatic carcinoma. However, most patients are diagnosed with moderate- or advanced-stage primary hepatic carcinoma upon initial consultation.[4] At these stages, the window for obtaining the optimal therapeutic effect through surgical excision has been missed. The continuous perfection and development of medical technology have improved the therapeutic effects of radio frequency and microwave ablation.[5] Thus, these two methods have been extensively applied to treat primary hepatic carcinoma. The effectiveness of these methods is widely recognized by physicians and many patients. These methods exhibit superior therapeutic effect, limited trauma, and favorable repeatability. These techniques can be promoted as nonsurgical options for the treatment of primary hepatic carcinoma. In this study, we recruited 94 participants from patients with primary hepatic carcinoma who had been admitted to our hospital. We present the study details below.


   Subjects and Methods Top


A total of 94 patients with primary hepatic carcinoma who had been admitted to our hospital between August 2014 to November 2016 were selected as subjects on the basis of the following inclusion criteria: completely conformed to the relevant diagnostic criteria for primary hepatic carcinoma formulated by the hepatic surgery scientific group from the Chinese Medical Association; accepted treatment for the first time and without liver, kidney, heart, and brain diseases; with Child-Pugh grades of A or B for hepatic function; with complete clinical data and could accept follow-up visit after treatment; and approved by the medical ethics committee and provided a signed written informed consent form.

Patients were excluded on the basis of the following criteria: pregnant or lactating; with serious disease immune or circulatory system diseases; and incomplete follow-up visit data or impossible follow-up visit after treatment. The patients were divided into control and study groups in accordance with a random-number table. The control group comprised 47 patients, of whom 27 were males and 20 were females. The patients in this group had an age range of 40–76 years (mean: 58.2 ± 1.5 years). In this group, 29 and 18 patients had Child-Pugh grades of A and B, respectively, for hepatic function. The study group consisted of 47 patients, of whom 26 were males and 21 were females. The patients in this group had an age range of 41–75 years (mean: 56.5 ± 1.4 years). In this group, 30 and 17 patients had Child–Pugh grades of A and B, respectively, for hepatic function. The demographic data of the two groups were not significantly (P > 0.05) different. Thus, these two groups could be compared.


   Methods Top


The control group underwent conventional surgical excision under general anesthesia. Conventional laparotomy was implemented for tumor excision. The excision region encompassed 2.0 cm of tissue outside of the tumor edge, and laparotomy was performed for left liver lobe excision, hepatic segment excision, or half-liver excision in accordance with the concrete conditions of each patient. The study group received ultrasound-guided microwave ablation with a SIEMENS ACUSON X300, color diasonograph (Acuson, USA). A convex-array variable-frequency probe with 2–6 MHz frequency was selected, and disposable sterile rubber gloves were wrapped on the probe to assist the movement of the diasonograph to the corresponding puncture site. A KY-2200 multifunctional microwave therapy apparatus operating at 60–100 W was used. Disposable microwave ablation needles carrying a cold circulation system were utilized as microwave ablation needles, and frozen 0.9% sodium chloride was used as the cold circulation liquid. The patient received general or local anesthesia. The patient was maintained in a supine position, and microwave power was adjusted in accordance with the patient's tolerance level. A single microwave was allowed to penetrate the target site through electrode needles that were inserted at a suitable angle under ultrasound guidance. Focuses were ablated per point, and ablation duration, which was usually at 3–8 min, was adjusted on the basis of tumor size. In situ heating was implemented until a strong echo covered the ultrasonic echo of the tumor body, and the puncture channel was adjusted under heat treatment during needle removal. Pressure bandaging was implemented during surgery, and drug therapy for liver protection, hemostasis, and infection was provided.

Observational indexes

The operation duration, intraoperative bleeding quantity, intraoperative blood transfusion quantity, and length of stay (LOS) of the two groups were calculated and recorded. Hepatic function indexes, such as alanine aminotransferase (ALT), aspartate transaminase (AST), albumin (ALB), and total bilirubin (TBIL), were tested and evaluated one week after treatment to assess the recovery of hepatic function. To assess the occurrence rates of complications, the occurrence of complications, such as incision infection, biliary fistula, pneumonia, and pleural effusion, was followed up.

Evaluation criteria for curative effect

The short-term curative effects of patients in the two groups were evaluated three months after treatment completion. Complete remission was defined as the disappearance of clinical symptoms and foci and the improvement of clinical symptoms. Partial remission was defined as focal shrinkage by ≥50%. Stable remission was defined as slight improvement in clinical symptoms and focal shrinkage by 25–50%. Disease progression was defined as the lack of change in clinical symptoms or focal size or the appearance of new foci. The total effective rate of treatment was calculated as follows: Total effective rate of treatment = complete remission rate + partial remission rate.

Statistical analysis

Data were analyzed and processed using SPSS 21.0 software. Data for operation conditions and relevant hepatic function indexes were expressed as (χ–± s), and t test was performed. The total effective rate of treatment and the occurrence rate of complications were expressed in (%), and χ2 test was conducted. P < 0.05 indicated that the intragroup difference was significant.


   Results Top


Operation conditions

The study group exhibited significantly shorter operation duration and LOS and significantly lower intraoperative bleeding and blood transfusion quantities than the control group [P < 0.05, [Table 1].
Table 1: Comparison of operation conditions (X̄ ± s) between groups

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Curative effect

The total effective rate of treatment in the study group was significantly lower than that in the control group (P < 0.05) as shown in [Table 2].
Table 2: Comparison of curative effect between groups [n (%)]

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Postoperative hepatic function indexes

The ALT and AST of the control group were significantly (P < 0.05) higher than those of the study group, whereas the ALB and TBIL of the study group were significantly (P < 0.05) lower than those of the control group. However, the two groups did not have significantly different prothrombin time (PT) (P > 0.05), as shown in [Table 3].
Table 3: Comparison of change in postoperative hepatic function indexes (X̄ ± s) between groups

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Complication occurrence rates

The occurrence rate of complications of the control group was significantly higher than that of the study group (P < 0.05) as shown in [Table 4].
Table 4: Comparison of occurrence rate of complications [n (%)] between groups

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   Discussion Top


Primary hepatic carcinoma is a common and highly malignant tumor type. It is associated with high morbidity and fatality rates and its development is attributed to complex etiological factors.[6] Its prevalence exhibits regional disparity. For example, the total global morbidity of hepatic carcinoma has declined annually in recent years. However, the incidence and mortality rates of hepatic carcinoma remain high and continue to increase in China.[7] Thus, this malignancy seriously threatens the physical and mental health and life safety of the Chinese population.

A favorable therapeutic effect can be obtained through early discovery, diagnosis, and treatment of hepatic carcinoma. Therapeutic strategies for primary hepatic carcinoma have diversified with the development and innovation of medical technology.[8] Surgery and local ablation remain the most commonly used methods for the treatment of this malignancy. The traditional excision treatment method can prolong patient survival to a certain degree. However, it is only applicable to patients with early-stage but not mid- or advanced-stage primary hepatic carcinoma.[9] Moreover, excision treatment is associated with high postoperative complication and recurrence rates, as well as poor patient recovery and prognosis.

Ultrasound-guided microwave ablation is a novel and radical treatment method. Its high usage rate can be attributed to its effectiveness, accuracy, convenience, safety, and minimal invasiveness. It can effectively shrink trauma areas and decrease complication occurrence rates. The basic principles of microwave ablation treatment are as follows [10]: Water molecules in tissues generate high temperature under microwave effect. High temperature kills tumor cells and facilitates tumor necrosis. This treatment method can be used for the local and radical treatment of tumors and prevent the infiltration and metastasis of tumor cells. Compared with traditional surgical excision, ultrasound-guided microwave ablation exerts superior therapeutic effect and minimal injury. Moreover, it can decrease and relieve complications and promote rapid hepatic function recovery. When used to treat early-stage hepatic carcinoma, the curative effect of microwave ablation was not different from that obtained through surgical excision. This study found that the control and study groups exhibited significantly different operation durations, intraoperative bleeding quantity, intraoperative blood transfusion quantity, LOS, and relevant hepatic function indexes. In addition, compared with the control group, the study group had a significantly higher total effective rate of treatment and the lower occurrence rate of complications (P < 0.05).


   Conclusion Top


In summary, compared with surgical excision, ultrasound-guided microwave ablation offers the advantages of minor injury and low complication occurrence rates. Moreover, it promotes rapid postoperative recovery and hepatic function recovery. Thus, it must be promoted and applied.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Cheng Q, Li X, Wang Y, Dong M, Zhan FH, Liu J. The ceramide pathway is involved in the survival, apoptosis and exosome functions of human multiple myeloma cells in vitro. Acta Pharmacol Sin 2018;39:561-8.  Back to cited text no. 2
    
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Cicalese L, Raun L, Shirafkan A, Campos L, Zorzi D, Montalbano M, et al. An ecological study of the association between air pollution and hepatocellular carcinoma incidence in Texas. Liver Cancer 2017;6:287-96.  Back to cited text no. 6
    
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Zeng ZC, Seong J, Yoon SM, Cheng JC, Lam KO, Lee AS, et al. Consensus on stereotactic body radiation therapy for small-sized hepatocellular carcinoma at the 7th Asia-pacific primary liver cancer expert meeting. Liver Cancer 2017;6:264-74.  Back to cited text no. 7
    
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Mitra S, Gupta S, Dahiya D, Saikia UN. A rare case of primary sarcomatous hepatocellular carcinoma without previous anticancer therapy. J Clin Exp Hepatol 2017;7:378-84.  Back to cited text no. 8
    
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Yu J, Chen BH, Zhang J, Han ZY, Wu H, Huang Y, et al. Ultrasound guided percutaneous microwave ablation of benign breast lesions. Oncotarget 2017;8:79376-86.  Back to cited text no. 9
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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