EKİNOKOKUS KİSTİNİN TEDAVİSİNDE RADYOFREKANS TERMAL ABLASYON (RTA): EX-VİVO HAYVAN MODELİNDE DENEYSEL BİR ÇALIŞMA
Abstract
AMAÇ: Radyofrekans
termal ablasyon (RTA), diğer komorbiditeleri olan inoperabl hastalarda sıklıkla
kullanılan minimal invaziv bir tekniktir. Eks vivo çalışmanın amacı, hayvan
modellerinde (eksplante edilen organlar) akciğer kistik ekinokokkozun
tedavisinde RTA'nın farklı sıcaklık ve sürelerinin etkinliğini
değerlendirmektir.
GEREÇ VE YÖNTEM:
Enfekte sığır akciğerleri toplandı. 9 adet sığır akciğerinde bulunan 45 adet
canlı kist kullanıldı. Canlı akciğer kistlerinin radyofrekans tedavi grupları ısıya göre,
rasgele üç ana gruba ayrıldı. Grup 1 (n = 15) 90°C 'de, grup 2 (n = 15) 100°C
'de ve grup3 (n = 15) 110 °C 'de. Gruplar radyofrekans uygulama süresine göre,
üç alt gruba ayrıldı (7 dakika n = 5; 9 dakika n = 5; 11 dakika n = 5).
Tedaviden sonra tüm kistler çıkarıldı ve patolojik olarak incelendi. Eğer
patolojik olarak korunmuş bir germinal membran mevcut ise kistler canlı olarak
değerlendirildi. Germinal membran nekrotik ise başarılı bir şekilde tedavi
edilmiş olarak değerlendirildi.
BULGULAR: RTA
uygulanan 45 numunenin 41'nin patolojik
kesitlerinde germinal membran kısmi
olarak nekrotik durumdaydı ve
canlı olarak değerlendirildi. Sadece 4
numunede tamamen nekrotik germinal membran mevcuttu ve 11 dakikada 110 ° C'de
başarılı bir şekilde tedavi edildi. Yıkım oranı, RTA’da uygulanan ısı artışıyla
pozitif korelasyon göstermektedir (Phi = 0.89, p = 0.006).
SONUÇ: 110 ° C'ye
kadar RTA uygulaması kist hidatiklerin öldürülmesinde etkili olmayabilir. Bu
tekniğin, insanda kistik ekinokokkoz tedavisi olarak kabul edilmeden önce hala
büyük miktarda ek klinik öncesi çalışma gerektirmektedir.
Keywords
References
- 1. Lamonaca V, Virga A, Minervini MI, Di Sterfano R, Provenzani A, Tagliareni P, et al. Cystic echinococcosis of the liver and lung treated by radiofrequency thermal ablation: an ex-vivo pilot experimental study in animal models. World Journal of Gastroenterology 2009;15:3232–3239.
- 2. Santivanez S, Garcia HH. Pulmonary cystic echinococcosis. Curr Opin Pulm Med 2010;16:257-261.
- 3. Arinc S, Kosif A, Ertugrul M, Arpag H, Alpay L, Unal O, et al. Evaluation of pulmonary hydatid cyst cases. Int J Surg 2009;7:192-195.
- 4. Merdin A, Ögür E, Çiçek Kolak Ç, Avcı Merdin F, Günseren F, İnan D, Turhan Ö, Ongut G. [Renal cyst hydatid]. Turkiye Parazitol Derg 2014;38:190-193. [Article in Turkish]
- 5. Siracusano A, Teggi A, Ortona E. Human cystic echinococcosis: old problems and new perspectives. Interdiscip Perspect Infect Dis 2009;2009:474368.
- 6. Tamarozzi F, Vuitton L, Brunetti E, Vuitton DA, Koch S. Non-surgical and non-chemical attempts to treat echinococcosis: do they work? Parasite 2014;21:75.
- 7.Baraket O, Moussa M, Ayed K, Kort B, Bouchoucha S. Predictive factors of morbidity after surgical treatment of hydatid cyst of the liver. Arab J Gastroenterol 2014;15:119-22
- 8. Shehatha J, Alizzi A, Alward M, Konstantinov I. Thoracic hydatid disease; a review of 763 cases. Heart Lung Circ 2008;17:502-504.
- 9. Alpay L, Lacin T, Ocakcioglu I, Evman S, Dogruyol T, Vayvada M, et al. Is Video-Assisted Thoracoscopic Surgery Adequate in Treatment of Pulmonary Hydatidosis? Ann Thorac Surg 2015;100:258-262.
- 10.Ben Fredj N, Chaabane A, Chadly Z, Ben Fadhel N, Boughattas NA, Aouam K. Albendazole-induced associated acute hepatitis and bicytopenia. Scand J Infect Dis 2014;46:149-151.
- 11. Imamkuliev KD, Alekseev VG, Dovgalev AS, Avdiukhina TI. A case of alopecia in a patient with hydatid disease treated with Nemozole (albendazole). Med Parazitol (Mosk) 2013;3:48-50. [Article in Russian]
- 12. Hinshaw JL, Lubner MG, Ziemlewicz TJ, Lee FT Jr, Brace CL. Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation--what should you use and why? Radiographics 2014;34:1344-1362.
- 13. Rhim H, Goldberg SN, Dodd GD 3rd, Solbiati L, Lim HK, Tonolini M et al., Essential techniques for successful radio-frequency thermal ablation of malignant hepatic tumors. RadioGraphics 2001;21:17-35.
- 14. Goldberg SN, Gazelle GS, Mueller PR. Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, techniques, anddiagnostic imaging guidance. AJR Am J Roentgenol 2000;174:323-331.
- 15. Brunetti E, Filice C. Radiofrequency thermal ablation of echinococcal liver cysts. Lancet 2001;358:1464.
- 16. Bastid C, Ayela P, Sahel J. Percutaneous treatment of a complex hydatid cyst of the liver under sonographic control. Report of the first case. Gastroenterol Clin Biol 2005;29:191-192.
- 17. Giorgio A, de Stefano G, Di Sarno A. Preliminary results of percutaneous radiofrequency (RF) ablation of viable hydatid liver cysts. In: The EASL Monothematic Conference: Immune Mediated Liver Injury. Hamburg, Germany; 2008.
- 18. Brunetti E, Gulizia R, Garlaschelli A, Filice C, 2004. Radio-frequency thermal ablation of echinococcal cysts of the liver: results at 12-month follow-up. Am J Trop Med Hyg 71: 182.
- 19 Junghanss T, da Silva AM, Horton J, Chiodini PL, Brunetti E. Clinical management of cystic echinococcosis: state of the art, problems, and perspectives. Am J Trop Med Hyg 2008;79:301-311.
- 20 Giorgio A, Calisti G, de Stefano G, Farella N, Scognamiglio U, Giorgio V. Percutaneous treatment of hydatid liver cysts: an update. Recent Pat Antiinfect Drug Discov. 2012;7:231-236.
- 21. Ozbek O, Nayman A, Koç O, Küçükapan A, Ozbek S, Kerimoğlu U. Radiofrequency ablation of phalangeal osteoid osteoma: technical challenges encountered in small bones. Eklem Hastalik Cerrahisi 2011;22:107-109.
- 22. Tatli S, Tapan U, Morrison PR, Silverman SG. Radiofrequency ablation: technique and clinical applications. Diagn Interv Radiol 2012;18:508-516.
- 23. Wood BJ, Ramkaransingh JR, Fojo T, Walther MM, Libutti SK. Percutaneous tumor ablation with radiofrequency. Cancer 2002;94:443-451.
- 24. Goldberg SN, Gazelle GS, Halpern EF, Rittman WJ, Mueller PR, Rosenthal DI. Radiofrequency tissue ablation: importance of local temperature along the electrode tip exposure in determining lesion shape and size. Acad Radiol 1996;3:212–218
- 25. Goldberg NS, Dupuy DE. Image guided radiofrequency tumor ablation: challenges and opportunities—part I. J Vasc Interv Radiol 2001;12:1021–1032.
- 26. Kruskal JB, Oliver B, Huertas JC, Goldberg SN. Dynamic intrahepatic flow and cellular alterations during radiofrequency ablation of liver tissue in mice. J Vasc Interv Radiol 2001;12:1193-201.
- 27. Thanos L, Mylona S, Brontzakis P, Ptohis N, Karaliotas K. A complicated postsurgical echinococcal cyst treated with radiofrequency ablation. Cardiovasc Intervent Radiol 2008;31:215-218.
- 28. Papaconstantinou I, Kontos M, Prassas E, Karavorkyros J, Bakoyiannis C, Pikoulis E, et al. Radio frequency ablation (RFA)-assisted pericystectomy for hepatic echinococcosis: an alternative technique. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 2006;16: 338–341.
- 29. Zacharoulis D, Poultsidis A, Roundas C, Tepetes K, Hatzitheofilou C. Liver hydatid disease: radiofrequency-assisted pericystectomy. Annals of the Royal College of Surgeons in England 2006;88: 499–500.
- 30. Filice C, Brunetti E. Percutaneous drainage of hydatid cysts. N Engl J Med.1998;338:392.
- 31. Kishi R, Mimura H, Hiraki T, Gobara H, Uka M, Toyooka S, Kanazawa S. Bleeding into a pulmonary cyst caused by pulmonary radiofrequency ablation. J Vasc Interv Radiol 2013;24:1069-71.
RADIOFREQUENCY THERMAL ABLATION FOR TREATMENT OF CYCTIC ECHINOCOCCOSIS: AN EX-VIVO EXPERIMENTAL STUDY IN ANIMAL MODELS
Abstract
OBJECTIVE: Radiofrequency thermal ablation (RTA) is a minimally invasive technique often used in inoperable patients with other comorbidities. The aim of the ex-vivo study was to evaluate the efficacy of different temperatures and durations of RTA for treatment of lung cystic echinococcosis in animal models (explanted organs).
MATERIAL AND METHODS: Infected lungs from 45 slaughtered bovines were collected. Live pulmonary cysts were randomly divided into three main following radiofrequency treatment groups according to the heat. Group 1 (n=15) at 90 °C, group 2 (n=15) at 100 °C, and group 3 (n=15) at 110 °C. Then the groups were divided into three sub-groups according to duration of radiofrequency application (7 minute n= 5; 9 minute n=5; and 11 minute n=5). After treatment, all cysts were sectioned and examined by histology. Cysts were defined as alive if a preserved germinal layer at histology was evident, and as successfully treated if the germinal membrane was necrotic.
RESULTS: Following RTA application, 41 of 45 samples consisted of partial necrotic sections of the germinal membrane defined as alive. Only 4 of 5 samples with completely necrotic germinal membrane defined as successfully treated in 11 minute 110 °C group. The destruction rate has a positive correlation with heat of RTA application (Phi =0.89, p=0.006).
CONCLUSIONS: In our study, we determined pathologically that RTA treatment was not effective below 110 ° C. Therefore, we believe that RTA technique has not yet been used in clinical use according to the results of our study, and further studies are needed in order to be able to enter into clinical use.
References
- 1. Lamonaca V, Virga A, Minervini MI, Di Sterfano R, Provenzani A, Tagliareni P, et al. Cystic echinococcosis of the liver and lung treated by radiofrequency thermal ablation: an ex-vivo pilot experimental study in animal models. World Journal of Gastroenterology 2009;15:3232–3239.
- 2. Santivanez S, Garcia HH. Pulmonary cystic echinococcosis. Curr Opin Pulm Med 2010;16:257-261.
- 3. Arinc S, Kosif A, Ertugrul M, Arpag H, Alpay L, Unal O, et al. Evaluation of pulmonary hydatid cyst cases. Int J Surg 2009;7:192-195.
- 4. Merdin A, Ögür E, Çiçek Kolak Ç, Avcı Merdin F, Günseren F, İnan D, Turhan Ö, Ongut G. [Renal cyst hydatid]. Turkiye Parazitol Derg 2014;38:190-193. [Article in Turkish]
- 5. Siracusano A, Teggi A, Ortona E. Human cystic echinococcosis: old problems and new perspectives. Interdiscip Perspect Infect Dis 2009;2009:474368.
- 6. Tamarozzi F, Vuitton L, Brunetti E, Vuitton DA, Koch S. Non-surgical and non-chemical attempts to treat echinococcosis: do they work? Parasite 2014;21:75.
- 7.Baraket O, Moussa M, Ayed K, Kort B, Bouchoucha S. Predictive factors of morbidity after surgical treatment of hydatid cyst of the liver. Arab J Gastroenterol 2014;15:119-22
- 8. Shehatha J, Alizzi A, Alward M, Konstantinov I. Thoracic hydatid disease; a review of 763 cases. Heart Lung Circ 2008;17:502-504.
- 9. Alpay L, Lacin T, Ocakcioglu I, Evman S, Dogruyol T, Vayvada M, et al. Is Video-Assisted Thoracoscopic Surgery Adequate in Treatment of Pulmonary Hydatidosis? Ann Thorac Surg 2015;100:258-262.
- 10.Ben Fredj N, Chaabane A, Chadly Z, Ben Fadhel N, Boughattas NA, Aouam K. Albendazole-induced associated acute hepatitis and bicytopenia. Scand J Infect Dis 2014;46:149-151.
- 11. Imamkuliev KD, Alekseev VG, Dovgalev AS, Avdiukhina TI. A case of alopecia in a patient with hydatid disease treated with Nemozole (albendazole). Med Parazitol (Mosk) 2013;3:48-50. [Article in Russian]
- 12. Hinshaw JL, Lubner MG, Ziemlewicz TJ, Lee FT Jr, Brace CL. Percutaneous tumor ablation tools: microwave, radiofrequency, or cryoablation--what should you use and why? Radiographics 2014;34:1344-1362.
- 13. Rhim H, Goldberg SN, Dodd GD 3rd, Solbiati L, Lim HK, Tonolini M et al., Essential techniques for successful radio-frequency thermal ablation of malignant hepatic tumors. RadioGraphics 2001;21:17-35.
- 14. Goldberg SN, Gazelle GS, Mueller PR. Thermal ablation therapy for focal malignancy: a unified approach to underlying principles, techniques, anddiagnostic imaging guidance. AJR Am J Roentgenol 2000;174:323-331.
- 15. Brunetti E, Filice C. Radiofrequency thermal ablation of echinococcal liver cysts. Lancet 2001;358:1464.
- 16. Bastid C, Ayela P, Sahel J. Percutaneous treatment of a complex hydatid cyst of the liver under sonographic control. Report of the first case. Gastroenterol Clin Biol 2005;29:191-192.
- 17. Giorgio A, de Stefano G, Di Sarno A. Preliminary results of percutaneous radiofrequency (RF) ablation of viable hydatid liver cysts. In: The EASL Monothematic Conference: Immune Mediated Liver Injury. Hamburg, Germany; 2008.
- 18. Brunetti E, Gulizia R, Garlaschelli A, Filice C, 2004. Radio-frequency thermal ablation of echinococcal cysts of the liver: results at 12-month follow-up. Am J Trop Med Hyg 71: 182.
- 19 Junghanss T, da Silva AM, Horton J, Chiodini PL, Brunetti E. Clinical management of cystic echinococcosis: state of the art, problems, and perspectives. Am J Trop Med Hyg 2008;79:301-311.
- 20 Giorgio A, Calisti G, de Stefano G, Farella N, Scognamiglio U, Giorgio V. Percutaneous treatment of hydatid liver cysts: an update. Recent Pat Antiinfect Drug Discov. 2012;7:231-236.
- 21. Ozbek O, Nayman A, Koç O, Küçükapan A, Ozbek S, Kerimoğlu U. Radiofrequency ablation of phalangeal osteoid osteoma: technical challenges encountered in small bones. Eklem Hastalik Cerrahisi 2011;22:107-109.
- 22. Tatli S, Tapan U, Morrison PR, Silverman SG. Radiofrequency ablation: technique and clinical applications. Diagn Interv Radiol 2012;18:508-516.
- 23. Wood BJ, Ramkaransingh JR, Fojo T, Walther MM, Libutti SK. Percutaneous tumor ablation with radiofrequency. Cancer 2002;94:443-451.
- 24. Goldberg SN, Gazelle GS, Halpern EF, Rittman WJ, Mueller PR, Rosenthal DI. Radiofrequency tissue ablation: importance of local temperature along the electrode tip exposure in determining lesion shape and size. Acad Radiol 1996;3:212–218
- 25. Goldberg NS, Dupuy DE. Image guided radiofrequency tumor ablation: challenges and opportunities—part I. J Vasc Interv Radiol 2001;12:1021–1032.
- 26. Kruskal JB, Oliver B, Huertas JC, Goldberg SN. Dynamic intrahepatic flow and cellular alterations during radiofrequency ablation of liver tissue in mice. J Vasc Interv Radiol 2001;12:1193-201.
- 27. Thanos L, Mylona S, Brontzakis P, Ptohis N, Karaliotas K. A complicated postsurgical echinococcal cyst treated with radiofrequency ablation. Cardiovasc Intervent Radiol 2008;31:215-218.
- 28. Papaconstantinou I, Kontos M, Prassas E, Karavorkyros J, Bakoyiannis C, Pikoulis E, et al. Radio frequency ablation (RFA)-assisted pericystectomy for hepatic echinococcosis: an alternative technique. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 2006;16: 338–341.
- 29. Zacharoulis D, Poultsidis A, Roundas C, Tepetes K, Hatzitheofilou C. Liver hydatid disease: radiofrequency-assisted pericystectomy. Annals of the Royal College of Surgeons in England 2006;88: 499–500.
- 30. Filice C, Brunetti E. Percutaneous drainage of hydatid cysts. N Engl J Med.1998;338:392.
- 31. Kishi R, Mimura H, Hiraki T, Gobara H, Uka M, Toyooka S, Kanazawa S. Bleeding into a pulmonary cyst caused by pulmonary radiofrequency ablation. J Vasc Interv Radiol 2013;24:1069-71.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Articles |
| Authors | |
| Publication Date | October 21, 2019 |
| Acceptance Date | December 24, 2018 |
| Published in Issue | Year 2019 Volume: 20 Issue: 4 |
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