Use of radiofrequency ablation for controlling liver hemorrhage in the emergency setting; report of two cases and review of the literature

Abstract

Active liver hemorrhage with hemodynamic instability is a serious situation often requiring surgical intervention. The most common causes of hepatic bleeding are trauma and tumors of the liver parenchyma: mainly hepatocellular carcinoma and adenoma. Liver hemorrhage from blunt trauma or spontaneous tumor rupture is sometimes difficult to control with traditional methods and postoperative complications are frequent. Recently, the radiofrequency ablation system (RF) has been used for obtaining haemostasis of ruptured hepatic tumors or for controlling hemorrhage due to liver trauma in experimental models. We report two cases where the radiofrequency ablation system (RF) has been efficiently used during emergency laparotomy in humans in order to control massive hemorrhage from spontaneous rupture of a liver metastatic testicular germ cell tumor and from a Grade IV blunt liver trauma. RF ablation system combined with traditional techniques was effective in controlling liver bleeding during laparotomy in both cases. No recurrence of the hemorrhage or any side effects associated with the RF system were recorded postoperatively. RF system is an effective strategy for achieving hemostasis in patients with active liver hemorrhage. In cases of bleeding liver tumors, RFA could also be helpful in synchronous tumor elimination, maximizing the chances of longer term survival.Key Words: Hemorrhage; liver; radio frequency ablation.Hemodinamik instabiliteyle birlikte aktif karaciğer kanaması sıklıkla cerrahi girişimi gerektiren ciddi bir durumdur. Karaciğer kanamasının en sık görülen nedenleri travma, başlıca hepatoselüler karsinom ve adenom olmak üzere karaciğer parankimi tümörleridir. Künt travma veya spontane tümör rüptürünü bazen klasik yöntemlerle kontrol altına almak zorlaşmakta ve sık sık ameliyat sonrası komplikasyonlar görülmektedir. Son zamanlarda rüptüre karaciğer tü-mörlerinde hemostazı sağlamak veya deneysel modellerde karaciğer travmasına bağlı kanamayı kontrol altına almak için radyofrekans ablasyon (RFA) sistemi kullanılmakta-dır. İnsanlarda karaciğerde metastatik testis germ hücreli tümörün spontane rüptürüne ve grade IV künt karaciğer travmasına bağlı masif kanamanın kontrol altına alınma-sı için acil laparatomi sırasında RFA sisteminin etkinlikle kullanılmış olduğu iki olgu sunuyoruz. Klasik tekniklerle kombine edilmiş RFA sistemi her iki olguda da laparotomi sırasında karaciğer kanamasını kontrol altına almada etkili olmuştur. Ameliyat sonrası dönemde RFA sistemiyle ilişki-li herhangi bir kanama nüksü veya yan etki kaydedilmedi. Aktif karaciğer kanaması olan hastalarda hemostazı sağla-ma açısından RFA sistemi etkili bir stratejidir. Kanayan karaciğer tümörlerinde RFA aynı zamanda eş zamanlı olarak tümörün ortadan kaldırılmasına yardımcı olarak daha uzun sağkalım şansını en üst düzeye çıkartabilir.

Thermal ablation of hepatocellular carcinoma in patients with abnormal coagulation function

“…TAE or surgery was thought to be treatment for large arterial haemorrhage [32]. However, thermal ablation has been reported for the successful treatment of trauma-caused bleeding in solid organs [33]. Compared with TAE and surgery, Figure 2.…”

Hemostatic mechanism underlying microbubble-enhanced non-focused ultrasound in the treatment of a rabbit liver trauma model

“…Recently, several novel minimally invasive techniques have been developed for stoppage of bleeding, including percutaneous radio-frequency coagulation, 7,8 microwave coagulation, 9,10 and high-intensity focused ultrasound (HIFU). [11][12][13][14][15] These techniques can significantly promote hemostasis, with minimal invasiveness and rapid recovery.…”

Μελέτη Της Έκφρασης Δεικτών Του Κυτταρικού Κύκλου Καθώς Και Αγγειογενετικών Παραγόντων Σε Ασθενείς Με Ηπατοκυτταρικό Καρκίνωμα, Οι Οποίοι Υπέστησαν Μερική Ηπατεκτομή Για Θεραπευτικούς Λόγους

“…Πορεύεται οπισθίως και δεξιά στον ηπατοδωδεκαδακτυλικό σύνδεσμο και στην πύλη του ήπατος και χωρίζεται σε δύο κλάδους (με μεταξύ τους γωνία απόκλισης 90 μοίρες), στον βραχύ 1-2εκ και ευρύτερης διαμέτρου δεξιό κλάδο προς τον δεξιό λοβό του ήπατος και στον μακρύτερο 3-5εκ και μικρότερης διαμέτρου αριστερό κλάδο προς τον αριστερό λοβό του ήπατος. Φυσιολογικά, η πίεση εντός του πυλαίου συστήματος είναι πολύ χαμηλή (3)(4)(5), αλλά σε καταστάσεις πυλαίας υπέρτασης μπορεί να αυξηθεί σημαντικά (20-30 mmHg).…”