人工胸腔积液超声引导经皮射频消融治疗膈顶部肝癌

Percutaneous ultrasound-guided radiofrequency ablation for hepatocellular carcinoma in the diaphragm dome with artificial pleural effusion

目的：经皮超声引导射频消融是治疗肝脏肿瘤的一种有效的微创方法。但当肿瘤位于肝膈顶部时，由于肺脏气体的干扰肿瘤难以显示，治疗受到了限制。本文将评估射频结合人工胸腔积液治疗肝膈顶部肿瘤的安全性与可行性，并初步探讨其临床应用价值。方法：15例原发性肝细胞肝癌患者，男性12例，女性3例，肿瘤均位于肝膈顶部。采用超声引导下冷循环射频结合人工胸腔积液的方法对肿瘤进行治疗。术后1月对所有治疗患者均进行增强CT或磁共振检查。结果：所有病例均安全完成射频治疗，未发生手术相关的并发症。随访时间2-18个月，11例患者存活。结论：人工胸腔积液结合经皮射频消融术可能是治疗肝脏膈顶部肿瘤一种安全可行的方法，值得进一步研究。

Objective：Radiofrequency thermal ablation （RFA） is an effective and invasive treatment for hepatocellular carcinoma. But because of pulmonary air, this technique can not easily be used in the patients whose nodules locate in the hepatic diaphragm dome. The objective of our study is to evaluate the efficacy and safety of percutaneous ultrasound-guided radiofrequeney ablation for hepatocellular carcinoma with the concurrent use of artificial pleural effusion. Methods： Fifteen patients （ 12 men and 3 women） whose tumor lesions located near the diaphragm were treated with RF using internally cooled electrodes. Before ablation session, We infused saline glucose solution into right pleural cavity to separate the lung and liver. Contrast-enhanced CT or magnetic resonance imagine were performed one month after ablation of all percutaneous treated patients. Results：RF treatment could proceed safely in all patients and no cases were found with correlative complications. Follow-up ranged from 2 to 18 months. And at the end of this study, 11 patients had surrived. Condusion：Radiofrequency ablation with artificial pleural effusion may be a safe and feasible treatment for treat hepatocellular carcinoma in the hepatic dome which needs further study.