Percutaneous Argon Helium Knife Cryotherapy for Hepatocellular Carcinoma

Treating diseases: liver cancer Indication Percutaneous argon-helium cryoablation for liver cancer is applicable to: 1. The general condition. (1) The general condition of the patient is good, and there are no obvious organ-organic diseases such as heart, lung, kidney and brain, and the function status is good. (2) Liver function is normal or only mild damage, and liver function classification is Child A grade. 2. Local conditions (1) A single tumor, or a tumor within 3, with a tumor diameter <5 cm. (2) Liver cancer that has recently recurred after hepatectomy is not suitable for other healers. (3) After TAE, single or multiple tumors were reduced to a diameter <5cm, and the number of tumors was less than 3, which was not suitable for surgical treatment. (4) The efficacy of TAE was not significant, but the tumor diameter was <5 cm, and the number of tumors was less than 3. (5) Large-scale liver cancer with a tumor diameter > 5 cm combined with TACE or local radiotherapy can still achieve good results. Preoperative preparation 1. routine examination of liver and kidney function, HBV third antibody, prothrombin time, AFP, CEA, blood sugar, electrocardiogram, chest X-ray, abdominal B-ultrasound or CT, MRI, blood, urine, feces three routine. 2. Liver and improve blood coagulation. According to the patient's liver function and PT conditions, hepatoprotective infusion support treatment. If there is jaundice and hypoproteinemia, anemia should be corrected. 3. Fasting 12h before surgery. 4. Preoperative medication: atropine 0.5mg or 1.0mg, meperidine 100mg intramuscular injection. Surgical procedure 1. B-ultrasound has detected the tumor that has been located, and designed the needle route. Select the needle point and cut the skin about 1cm. 2. Using 18G with inner core puncture needle to puncture the tumor close to the bottom, introduce the guide wire into the core, remove the expansion tube with the outer sheath along the guide wire, remove the expansion tube after the position, remove the guide wire, and introduce the argon-helium super along the outer sheath. Guide the knife, according to the size of the tumor, the outer sheath is moved back from the superconducting tip position by 3 to 5 cm. 3. Open the Cryocare Surgical System and confirm that the tip temperature drops to -120 ~ -140 °C within 1 min. Observe the echo changes of the tumor tissue and the boundary of the ice hockey by B-ultrasound. 4. After 15 to 20 minutes of freezing, turn on the helium gas heating system to raise the temperature of the tool tip to above 20 °C, and repeat the above cycle. 5. Through the B-ultrasound to observe the degree of integration of the hockey range and the tumor range from various levels and angles, the ideal treatment should make the ice hockey more than 1cm above the tumor range. 6. After the end of freezing, the argon-helium superconducting knife is withdrawn, and the gelatin sponge and the hemostatic bio-gel are inserted into the sheath to prevent the bleeding. 7. For larger tumors, multiple superconducting scalpels combined with cryotherapy can be used simultaneously or sequentially. complication 1. Postoperative hemorrhage: postoperative hemorrhage occurred within 48 hours after surgery. There were mainly two types of hemorrhage: hemorrhage and hepatic capsular hemorrhage. In severe cases, hemorrhagic shock may occur. In milder cases, bleeding can be controlled by conservative treatment. In severe cases, it is necessary to open the stomach to stop bleeding. 2. Upper gastrointestinal bleeding after operation: Postoperative upper gastrointestinal bleeding occurred more than 2 weeks after argon-helium cryoablation, clinically manifested as symptoms of gastrointestinal bleeding such as blood in the stool. The incidence is very low, the specific cause is unknown, and may be related to poor liver function and a wide range of freezing. 3. Myoglobinuria: Some patients with advanced liver cancer have soy sauce-colored urination within 1 to 3 days after freezing, and myoglobinuria occurs. In severe cases, renal insufficiency, decreased urine output, and often too large a range of freezing, liver Functional damage is clearly related. Alkaline urine, diuretics, urine volume, kidney function and urine routine can be recovered. 4. In the case of liver cancer argon-helium surgery, if the range is too large, cold shock may occur, often due to the low temperature of the whole body. It can be infused with warm liquid, and the operating table is covered with electric blankets. 5. Argon-helium cryoablation in other organs such as biliary tract, gastrointestinal and poor liver function due to preoperative, excessive freezing range leading to postoperative liver failure.