超声引导联合人工胸水微波消融膈顶部肝肿瘤
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摘要
目的:探讨超声引导联合人工胸水微波消融膈顶部肝肿瘤的应用价值。方法:回顾性分析湖南省肿瘤医院自2014年1月至2015年10月收治的病灶数目≤3个,直径≤5 cm,34例膈顶部肝肿瘤患者,符合微波消融适应证;先建立人工胸水,然后采用B超引导下行微波消融治疗肝肿瘤,术后3~4周后复查增强CT或者MRI,评估肿瘤消融疗效,观察并发症情况。结果:34例患者共49个病灶,其中完全消融(complete ablation,CA)30例(88.2%),部分消融(part ablation,PA)3例(8.8%),消融进展1例(2.9%),术后出现新发病灶;34例患者人工胸水量(1 580±230.7)m L,1例出现血性胸水,1例出现膈肌热损伤、1例胆汁瘤合并感染,经对症治疗后均缓解。结论:超声引导联合人工胸水微波消融膈顶部肝肿瘤是微创、安全、有效的治疗方法。
Objective:To explore the value of ultrasound-guided microwave ablation with artificial pleural effusion for liver tumor adjacent to diaphragmatic dome.Methods:A total of 34 patients with liver tumors located at diaphragmatic dome in Hunan Provincial Tumor Hospital were recruited from January 2014 to October 2015.The number of lesions≤3 or lesion diameter≤5 cm was in line with the microwave ablation indications.B ultrasound-guided microwave ablation for the liver tumors was undertaken af ter the artificial pleural effusion being established.3–4 weeks later af ter the microwave ablation,all patients were imaged with enhance CT or MRI.The eff ect of ablation and the complications were evaluated.Results:There were 49 lesions in 34 patients,including 30 cases(88.2%)of complete ablation(CA),3 cases(8.8%)of partial ablation(PA)and one case with new lesions after ablation(2.9%).Thirtyfour patients had(1 580±230.7)m L of pleural effusion volume,while one case had bloody pleural effusion.One case had a diaphragmatic thermal injury,and one case had a biliary tumor infection.All of them showed remission after symptomatic treatment.Conclusion:Combination of ultrasound-guided microwave ablation with artificial pleural effusion is a safe and effective therapy for liver tumor adjacent to diaphragmatic dome.
Objective:To explore the value of ultrasound-guided microwave ablation with artificial pleural effusion for liver tumor adjacent to diaphragmatic dome.Methods:A total of 34 patients with liver tumors located at diaphragmatic dome in Hunan Provincial Tumor Hospital were recruited from January 2014 to October 2015.The number of lesions≤3 or lesion diameter≤5 cm was in line with the microwave ablation indications.B ultrasound-guided microwave ablation for the liver tumors was undertaken af ter the artificial pleural effusion being established.3–4 weeks later af ter the microwave ablation,all patients were imaged with enhance CT or MRI.The eff ect of ablation and the complications were evaluated.Results:There were 49 lesions in 34 patients,including 30 cases(88.2%)of complete ablation(CA),3 cases(8.8%)of partial ablation(PA)and one case with new lesions after ablation(2.9%).Thirtyfour patients had(1 580±230.7)m L of pleural effusion volume,while one case had bloody pleural effusion.One case had a diaphragmatic thermal injury,and one case had a biliary tumor infection.All of them showed remission after symptomatic treatment.Conclusion:Combination of ultrasound-guided microwave ablation with artificial pleural effusion is a safe and effective therapy for liver tumor adjacent to diaphragmatic dome.
引文
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[11]Goldberg SN,Charboneau JW,Dodd GD 3rd,et al.Image-guided tumor ablation:proposal for standardization of terms and reporting criteria[J].Radiology,2003,228(2):335-345.
[12]Liang P,Yu J,Yu XL,et al.Percutaneous cooled-tip microwave ablation under ultrasound guidance for primary liver cancer:a multicentre analysis of 1363 treatment-naive lesions in 1007 patients in China[J].Gut,2012,61(7):1100-1101.
[13]Li M,Yu XL,Liang P,et al.Percutaneous microwave ablation for liver cancer adjacent to the diaphragm[J].Int J Hyperthermia,2012,28(3):218-226.
[2]Lubner MG,Brace CL,Ziemlewicz TJ,et al.Microwave ablation of hepatic malignancy[J].Semin Intervent Radiol,2013,30(1):56-66.
[3]Liu Y,Li S,Wan X,et al.Efficacy and safety of thermal ablation in patients with liver metastases[J].Eur J Gastroenterol Hepatol,2013,25(4):442-446.
[4]Zhang D,Liang P,Yu X,et al.The value of artificial pleural effusion for percutaneous microwave ablation of liver tumour in the hepatic dome:a retrospective case-control study[J].Int J Hyperthermia,2013,29(7):663-670.
[5]Liu LN,Xu HX,Lu MD,et al.Percutaneous ultrasound-guided thermal ablation for liver tumor with artificial pleural effusion or ascites[J].Chin J Cancer,2010,29(9):830-835.
[6]李凯,王平,郑荣琴,等.超声引导下人工腹水辅助肝癌微波消融治疗研究[J].中华医学超声杂志(电子版),2010,2(10):1685-1690.LI Kai,WANG Ping,ZHENG Rongqin,et al.Ultrasound-guided artificial ascites-assisted microwave ablation of liver cancer[J].Chinese Journal of Medical Ultrasound.Electronic Edition,2010,2(10):1685-1690.
[7]Zhang D,Liang P,Yu X,et al.The value of artificial pleural effusion for percutaneous microwave ablation of liver tumour in the hepatic dome:a retrospective case-control study[J].Int J Hyperthermia,2013,29(7):663-670.
[8]Ohmoto K,Tsuzuki M,Yamamoto S.Percutaneous microwave coagulation therapy w ith intraperitoneal saline inf usion for hepatocellular carcinoma in the hepatic dome[J].A JR Am J Roentgenol,1999,172(1):65-66.
[9]Jang GS,Kim MJ,Ha HI,et al.Comparison of RECIST version 1.0and 1.1 in assessment of tumor response by computed tomography in advanced gastric cancer[J].Chin J Cancer Res,2013,25(6):689-694.
[10]王俊玲,郑慕白,李志平,等.超声造影对肝肿瘤微波局部消融治疗早期疗效评估的临床价值研究[J].中国超声医学杂志,2010(12):1102-1105.WANG Junling,ZHENG Mubai,LI Zhiping,et al.Clinical value of contrast-enhanced ultrasonography in the early evaluation of microwave ablation of hepatic tumors[J].Chinese Journal of Ultrasound in Medicine,2010(12):1102-1105.
[11]Goldberg SN,Charboneau JW,Dodd GD 3rd,et al.Image-guided tumor ablation:proposal for standardization of terms and reporting criteria[J].Radiology,2003,228(2):335-345.
[12]Liang P,Yu J,Yu XL,et al.Percutaneous cooled-tip microwave ablation under ultrasound guidance for primary liver cancer:a multicentre analysis of 1363 treatment-naive lesions in 1007 patients in China[J].Gut,2012,61(7):1100-1101.
[13]Li M,Yu XL,Liang P,et al.Percutaneous microwave ablation for liver cancer adjacent to the diaphragm[J].Int J Hyperthermia,2012,28(3):218-226.