Free hand puncture technique for hepatocellular carcinoma under diaphragmatic dome – combined treatment with PEIT+RFA *
In hepatocellular carcinoma（HCC）located just under the diaphragm, US-guided procedures including percutaneous ethanol injection therapy（PEIT）or radiofrequency ablation（RFA）are difficult because of the overlying gas of the lung. In these situations artificial pleural effusion and ascites methods have been available to allow the lesions be visualized well. But these methods are risky and complicated. Herein we tried to treat a case of HCC under the diaphragmatic dome with PEIT＋RFA by free hand puncture method. By this method lesions could be visualized well and no complications associated with puncture and ablation are noted. Different from conventional technique using needle guide attachments, angle of insertion of the needle from low angle is possible because transducer as well as needle are not fixed. It is important to keep the transducer parallel to the long axis of the needle and advance the needle under real-time guidance within the narrow beam width. Fine adjustment of the transducer is necessary during insertion of the needle in order not to loose the tip of the needle by movement of the liver by shallow respiration.（Accepted on July 27，2005）
