Clinical Summary
Treatment of hepatic cysts by B-ultrasoundguided radiofrequency ablation
Xi-Lin Du, Qing-Jiu Ma, Tao Wu, Jian-Guo Lu, Guo-Qiang Bao and Yan-Kui Chu
Xi'an, China
BACKGROUND: The traditional therapy for hepatic
cysts has limited success because of recrudescence.
Radiofrequency ablation (RFA) has become popular because
of its advantages including little damage, therapeutic effect
and reduced suffering. This report describes the effects and
reliability of RFA in the treatment of 29 patients with hepatic
cysts.
METHODS: B-ultrasound-guided RFA was used to treat
hepatic mono-cyst or multi-cysts of 29 patients (63 tumors).
Ablative efficiency and complications were assessed by
imaging and clinical symptoms.
RESULTS: The tumors were abated completely in 34 cysts
with a diameter <5 cm and no recurrence was seen after
3 months. In 21 cysts with a diameter of 5-10 cm, tumor
volume was decreased by over 70%, then reduction and
fiberosis were found. In 8 cysts with a diameter greater
than 10 cm, tumor volume was decreased by more than
60%, and in 2 cysts it was increased more slightly than
that at 1 month after RFA. In subsequent follow-up (6 and
12 months after RFA), tumors <10 cm in diameter were
fully ablated. No significant discomfort and complications
were found in any patient.
CONCLUSION: RFA for the treatment of hepatic cysts is
safe, and free from complications.
(Hepatobiliary Pancreat Dis Int 2007; 6: 330-332)
KEY WORDS: hepatic cysts;
radiofrequency ablation;
B -ultrasound-guided
Author Affiliations: Department of General Surgery, Tangdu Hospital,
Fourth Military Medical University, Xi'an 710038, China (Du XL, Ma QJ,
Wu T, Lu JG, Bao GQ and Chu YK)
Corresponding Author: Xi-Lin Du, MD, Department of General
Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an
710038, China (Tel: 86-29-84777732; Fax: 86-29-84777732; Email:
[email protected])
© 2007, Hepatobiliary Pancreat Dis Int. All rights reserved.
Introduction
R
adiofrequency ablation (RFA) has been widely
used in the treatment of liver disease, especially
liver cancer, with considerable effects. Various
image-guided tumor ablation techniques have
provided a new therapeutic modality for hepatic
tumors.[1, 2] RFA is based on resistive ionic heating,[3, 4]
a new concept for treating hepatic cysts. We recently,
used RFA in the treatment of primary hepatic cysts
with satisfactory effect.[5]
Clinical summary
B-ultrasound-guided RFA was performed in 29
patients (12 males and 17 females; mean age, 47.2
years) with 63 hepatic cysts, which were detected by
computed tomography (CT) or magnetic resonance
imaging (MRI). Eleven cysts were located in the left
lobe, and 37 in the right lobe. In these patients, the
largest diameter of space-occupying lesions ranged
from 4 to 21 cm. Twelve patients had renal cysts with
normal renal function.
A RF-2000 RF system (Radio Therapeutic, USA)
with 10 expandable hooks, a 450 ultrasound scanning
system (Hitachi, Japan), and a Campus computer
were used. Local anesthesia was induced by 1%
lidocaine, from the insertion point on the skin to the
peritoneum along the puncture line.[6, 7] After pricking
the skin with a small lancet, a clustered electrode
needle and a transfixion pin were simultaneously
inserted into a chosen cyst under B-ultrasound
guidance. For cysts >10 cm, two electrodes or more
needles were inserted. After drawing out the hydatid
fluid completely, the clustered electrode needle was
opened for RFA. The power was set at 20 W initially
and increased to 40 W after 3 minutes. Then it was
increased by 10 W/min until 90 W delivered. While
the impedance rose continuously to 999, the RFA
generator stopped under computer control, and onepoint RFA was achieved. Then the second or more
330 • Hepatobiliary Pancreat Dis Int，Vol 6，No 3 • June 15，2007 • www.hbpdint.com
Treatment of hepatic cysts by B-ultrasound-guided radiofrequency ablation
needles were inserted into the cyst to destroy the cyst
wall.
Patient reaction during RFA, liver function before
and after RFA, orexis, and symptoms after RFA were
evaluated. After RFA, all patients were evaluated by
serum tests and ultrasonography, CT or MRI at 1,
3, 6 and 12 months in order to assess the dynamic
therapeutic response.
After RFA, symptoms like superior belly distention
were relieved significantly and appetite increased.
During RFA, none of the patients experienced
significant discomfort. In patients tumors with a
diameter of >10 cm or multiple tumors, sweating,
local distention, and fever, were noted in the early
stage. In 3 patients the level of serum bilirubin was
increased but returned to normal after 1 week.
In our patients 34 cysts <5 cm in diameter were
abated completely under B-ultrasound guidance
without recurrence after 3 months. In 21 cysts 5-10 cm
in diameter, the volume was decreased by >70%, but
subsequent reduction and fiberosis were noted. The
volume of 8 cysts >10 cm in diameter was decresed by
>60%. Six cysts reduced by 80% and showed fiberosis,
and 2 cysts increased slightly over that at 1 month
after RFA. Six and 12 months after RFA, tumors less
than 10 cm in diameter were fully ablated.
Discussion
Hepatic cyst is a benign liver disease, caused by
genetic factors. Clinically, patients can be divided into
those with single and those with multiple hepatic cysts
(multicystal liver). The hepatic cyst is usually found
through ultrasonography or CT, and is distinguished
from other hepatic lesions by imaging and biopsy.[8, 9]
General treatment includes operation, laparoscopy,[10]
percutaneous alcohol sclerosis therapy,[11] and
tetracycline injection.[12]
Operation has been given up because of
serious wound injuries which often exceed benefit.
Laparoscopy has less damage but many problems,
or complications including recurrence, bleeding,
stomachache and infection.[13, 14]
RFA is a relatively new procedure for the
treatment of hepatic tumors that are not amenable
to resection.[15, 16] We have successfully used RFA in
the treatment of hepatic multiple hemangioma since
1996.[17] RFA is the most advanced "mesenchymal
therapy" for the removal of the tumor with less injury
to the patient.[18] On this basis, the RFA technique
has been widely used for the treatment hepatic and
renal cysts. Briefly, after drawing out the hydatid fluid
completely, RFA is introduced with a multi-electrode
needle to kill the cells in the hepatic cyst wall and
induce necrosis, adhesion and fiberosis.[12] In this
study, 63 cysts in the 29 patients were abated with
satisfactory curative effect, but without significant
complications.
Compared with other approaches, RFA is an
efficient and safe method for the treatment of primary
hepatic cysts. At least it is an alternative for the
management of hepatic cysts. But its long-term effect
and underlying mechanism need to be clarified.
Funding: None.
Ethical approval: Not needed.
Contributors: DXL proposed the study and wrote the first
draft. MQJ and WT analyzed the data. All authors contributed
to the design and interpretation of the study and to further
drafts. DXL is the guarantor.
Competing interest: No benefits in any form have been received
or will be received from a commercial party related directly or
indirectly to the subject of this article.
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Received September 15, 2006
Accepted after revision March 3, 2007
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