人工胸水辅助超声引导下射频消融治疗肝肿瘤的初步研究

Preliminary study on percutaneous ultrasound-guided radiofrequency ablation for hepatocellular carcinoma with artificial pleural effusion

目的探讨人工胸水辅助下冷循环射频消融治疗位于膈面肝脏肿瘤的可行性与安全性。方法2005年1月至7月在南京大学医学院附属鼓楼医院接受射频消融治疗方法的9例患者,均为男性,平均年龄53.2岁(25～83岁);Child-Pugh分级均为A级,肿瘤位于肝Ⅳ段1例,肝Ⅶ段6例,肝Ⅷ段2例。采用人工胸水的方法,以显露肿瘤全貌,然后进行超声引导下冷循环射频消融治疗。结果人工胸水后,射频消融治疗均顺利完成,没有发生与手术相关的死亡。手术后8例患者存活,1例患者死亡。结论人工胸水辅助超声引导下射频消融是治疗肝脏肿瘤的一种安全方法,有助于拓展射频消融治疗的适应证。

Objective To study the feasibility and safety of percutaneous ultrasound-guided radiofrequency（RF） ablation with the concurrent use of artificial pleural effusion for hepatocellular carcinoma （HCC） located in the right subphrenic region. Methods During January 2005 and July 2005,9 patients （age range 25 - 38 years, mean age 53.2 years） were enrolled in this study. The Child-Pugh classification of patients was A. Six nodules were located in Couinaud＇s segment Ⅶ ,2 nodules in segment Ⅷ,and 1 nodule in segment Ⅳ. The artificial pleural effusion was adopted to push away lung tissue and the image of whole tumor was displayed. Then the hepatocellular carcinoma especially that located directly below the diaphragm could be treated by percutaneous ultrasound-guided RF ablation with cool-tip. Results Assited by artificial pleura1 effusion,RF treatment performed sucessefully and treatment-related death was not occurred. After operation, eight cases survived and 1 case died.Conclusion Radiofrequency ablation with artificial pleura1 effusion is a safe treatment option and it can enlarge therapeutic range of RF treatment on bepatocellular carcinoma.