Lokale Ablationsverfahren als Ergänzung der Therapie maligner Leberläsionen

Zusammenfassung

Bösartige Neubildungen in der Leber stellen in der gastroenterologisch-onkologischen Praxis eines der häufigsten und schwierigsten Probleme dar. Klinisch unterscheidet man zwischen primären, d. h. von Hepatozyten und Gallenwegen selbst ausgehenden Tumoren (hepatozelluläres Karzinom HCC, Cholangiokarzinom CC) und sekundären Läsionen der Leber, die Absiedlungen leberfremder Tumoren (Metastasen) darstellen und aufgrund ihrer unterschiedlichen Biologie verschiedene therapeutische Strategien erfordern. Das Prinzip, Tumore der Leber zu entfernen, hat sich jedoch sowohl bei primären als auch bei sekundären Läsionen durchgesetzt. Für viele Patienten mit primären oder sekundären Lebertumoren ist technisch oder aufgrund der Begleitmorbidität eine chirurgische Resektion nicht möglich. Das hat zur Entwicklung minimalinvasiver Ablationsverfahren geführt. Perkutane Alkohol- und Essigsäureinjektionen, Radiofrequenz-, Mikrowellen- oder Laserablationen ergänzen das Spektrum der therapeutischen Möglichkeiten und eröffnen die Möglichkeit der Tumorentfernung auch für Patienten, die technisch oder aufgrund ihrer Begleiterkrankungen nicht operiert werden können.

Abstract

Malignant lesions of the liver are among the most frequent and difficult problems in clinical practice. Liver tumors can be classified as primary (hepatocellular carcinoma HCC, cholangiocarcinoma CC) and secondary liver lesions (metastasis). The therapeutic principle of resecting liver tumours, applies to both types of liver lesions. Unfortunately many patients with primary and secondary liver lesions are inoperable because of technical difficulties or comorbidity. This stimulated the development of percutaneous ablation methods. These procedures allow to destroy tumors percutaneously with alcohol, acetic acid, radiofrequency, microwaves or laser. Potential applications and limitations of the methods are discussed.

Schlüsselwörter

Lokale Ablation - PEI - RFTA - PAI - LITT - Mikrowellenkoagulation

Key words

Local ablation - PEI - PAI - RFTA - microwave coagulation - LITT

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