Presentacion RFA tu hepaticos uci clc
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Presentacion RFA tu hepaticos uci clc
- 1. Ablación por Radiofrecuencia de Neoplasias Hepaticas Rodrigo Madariaga Alvarez Medico Becado Cirugía General Rotacion C.P.C Clinica Las Condes Universidad de Chile Facultad de Medicina Sede Oriente Departamento de Cirugía
- 5. - Organización Mundial de la Salud . http:// www.who.int / research /es/
- 6. HCC y HCV en Chile MUÑOZ G, VELASCO M, THIERS V, HURTADO C, BRAHM J, LARRONDO-LILLO M ET AL. Prevalencia y genotipos del virus de la hepatitis C en donantes de sangre y en pacientes con enfermedad hepática crónica y hepatocarcinoma en población chilena. Rev Méd Chile 1998; 126: 1035-42.
- 9. Diagnostico A. Linares y cols. Algoritmo diagnóstico y terapéutico del carcinoma hepatocelular, Oncología, 2004; 27 (4):223-229
- 10. Diagnostico A. Linares y cols. Algoritmo diagnóstico y terapéutico del carcinoma hepatocelular, Oncología, 2004; 27 (4):223-229
- 11. A. Linares y cols. Algoritmo diagnóstico y terapéutico del carcinoma hepatocelular, Oncología, 2004; 27 (4):223-229
- 17. Mecanismo de Accion RFA 1 a Descripción en tumores hepáticos Rossi et al. J Interv Radiol 1993, 8:97-103 El paciente es conectado a un circuito eléctrico
- 18. Mecanismo de Accion RFA Los iones en el tejido intentan seguir el cambio de dirección de la corriente alterna (agitación)
- 19. Mecanismo de Accion RFA CORRIENTE ALTERNA AGITACIÓN IÓNICA CALOR POR FRICCIÓN DESHIDRATACION CELULAR-NECROSIS POR COAGULACION IMPEDANCIA FLUJO DE CORRIENTE
- 20. Mecanismo de Accion RFA CORRIENTE ELECTRICA IGUAL AGITACION IONICA CALOR POR FRICCION CONDUCCION DEL CALOR
- 21. Temp 50 – 100° C Necrosis coagulativa
- 24. Abordaje percutaneo bajo Ecografia
- 26. Resultados de RFA Giordano y col RADIOFRECUENCIA EN TUMORES HEPÁTICOS. NUESTRA EXPERIENCIA Y REVISIÓN DE LA BIBLIOGRAFÍA Rev Argent. Cirug., 2006; 91 (1-2): 17-20
- 28. TC Pre-op 3 meses Post-op Ultrasonido 6 meses Post-op Resultados de RFA
- 29. Figure 1. Broad spectrum of major complications after RF ablation for hepatic tumors according to the survey data of the Korean Study Group of Radiofrequency Ablation. Rhim H et al. Radiographics 2003;23:123-134 ©2003 by Radiological Society of North America Complicaciones de RFA
- 30. Figure 7. Skin burns in a 62-year-old man with hepatocellular carcinoma. Rhim H et al. Radiographics 2003;23:123-134 ©2003 by Radiological Society of North America
- 31. Figure 4e. Intrahepatic bleeding in an 87-year-old man with hepatocellular carcinoma. Rhim H et al. Radiographics 2003;23:123-134 ©2003 by Radiological Society of North America
- 32. Figure 3. Peritoneal bleeding in a 75-year-old man with hepatocellular carcinoma. Rhim H et al. Radiographics 2003;23:123-134 ©2003 by Radiological Society of North America
- 33. Figure 2c. Hepatic abscess in a 55-year-old man with hepatocellular carcinoma. Rhim H et al. Radiographics 2003;23:123-134 ©2003 by Radiological Society of North America
Notas del editor
- El tiempo de espera en lista oscila entre 6 y 24 meses y la probabilidad de progresión es del 70% al año, por lo que estos pacientes son priorizados en la lista de espera. PRIORIZACIÓN EN LISTA DE ESPERA • Indice MELD -> T2 se suma 19 puntos* y por cada 3 meses en lista ↑ un 10% el MELD. *corresponde a una mortalidad esperada del 5% a los 3 meses
- Depende del equipo
- Comienzo en la punta – expansión hacia la base- expansión hacia fuera y entremedio – lesion completa
- One week Post-op shows a complete ablation. 3 months Post-op shows the gradual reabsorption of the necrotic tissue. At 6 months Post-op the ablated area is very small.
- Figure 1. Broad spectrum of major complications after RF ablation for hepatic tumors according to the survey data of the Korean Study Group of Radiofrequency Ablation. One procedure-related death occurred (due to peritoneal hemorrhage).
- Figure 7. Skin burns in a 62-year-old man with hepatocellular carcinoma. Photograph shows third-degree skin burns (arrows) that developed at the ground pad site after RF ablation of multiple hepatocellular carcinoma nodules in segment VI, which had been treated with iodized oil (Lipiodol; Guerbet, Roissy, France). The patient received skin grafts after conservative treatment for 1 month.
- Figure 4e. Intrahepatic bleeding in an 87-year-old man with hepatocellular carcinoma. (a) Contrast-enhanced CT scan shows a 3.0-cm hyperattenuating tumor (arrow) in segment VIII of the liver. (b) CT scan shows an expandable RF electrode (arrow), which was used to perform RF ablation. (c) Doppler US scan shows massive intrahepatic bleeding (arrow) from the margin of the ablated area. (d) Angiogram shows that the bleeding was controlled with placement of coils (arrow). (e) Three-month follow-up CT scan shows complete ablation of the tumor. Note the metallic areas of increased attenuation (arrow) adjacent to the tumor margin.
- Figure 3. Peritoneal bleeding in a 75-year-old man with hepatocellular carcinoma. Contrast-enhanced CT scan obtained immediately after RF ablation of a hepatocellular carcinoma nodule in the caudate lobe shows peritoneal hemorrhage in the perihepatic space (arrows). The bleeding was managed with transfusion.
- Figure 2c. Hepatic abscess in a 55-year-old man with hepatocellular carcinoma. (a) Contrast material-enhanced CT scan obtained before RF ablation shows a 1.5-cm-diameter hyperattenuating nodule of hepatocellular carcinoma (arrow) in segment VI. The patient was readmitted due to abrupt development of a fever 1 week after ablation. (b) One-week follow-up CT scan shows a gas-forming abscess (arrow) in the ablated area with a perihepatic fluid collection. The abscess was successfully managed with US-guided percutaneous catheter drainage. (c) One-week follow-up CT scan shows moderate improvement of the abscess (arrow).