Authors: CS Ho JR Kachura S Gallinger D Grant P Greig I McGilvray J Knox M Sherman F Wong D Wong
Publish Date: 2007/01/02
Volume: 30, Issue: 2, Pages: 241-247
Abstract
Fine needles with an end hole or multiple side holes have traditionally been used for percutaneous ethanol injection PEI of hepatomas This study retrospectively evaluates the safety and efficacy of PEI of unresectable mediumtolarge 35–9 cm hepatomas using a multipronged needle and with conscious sedation Twelve patients eight men and four women age 51–77 years mean 69 received PEI for hepatomas mostly subcapsular or exophytic in location with average tumor size of 56 cm range 35–90 cm Patients were consciously sedated and an 18G retractable multipronged needle Quadrafuse needle Rex Medical Philadelphia PA was used for injection under realtime ultrasound guidance By varying the length of the prongs and rotating the needle the alcohol was widely distributed within the tumor The progress of ablation was monitored by contrastenhanced ultrasound computed tomography CT or magnetic resonance imaging MRI after each weekly injection and within a month after the final third injection and 3 months thereafter An average total of 63 mL range 20–154 ml of alcohol was injected per patient in an average of 23 sessions Contrastenhanced CT ultrasound or MRI was used to determine the degree of necrosis Complete necrosis was noted in eight patients 67 nearcomplete necrosis 90–99 in two 167 and partial success 50–89 in two 167 Followup in the first 9 months showed local recurrence in two patients and new lesions in another There was no mortality One patient developed renal failure liver failure and localized perforation of the stomach He responded to medical treatment and surgery was not required for the perforation One patient had severe postprocedural abdominal pain and fever and another had transient hyperbilirubinemia both recovered with conservative treatment PEI with a multipronged needle is a new safe and efficacious method in treating mediumtolargesized hepatocellular carcinoma under conscious sedation Its survival benefits require further investigations
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