单肺通气条件下经皮经肝射频消融治疗肝顶部肝癌

Percutaneous radiofrequency ablation therapy with left single lung ventilation for liver carcinoma in the hepatic dome

目的探讨单肺通气条件下经皮经肝射频消融(PRFA)治疗肝顶部肝癌(LCHD)的优越性。方法回顾性总结2006年1月至12月间连续应用左侧单肺通气条件下 PRFA 治疗10例LCHD 患者(单肺通气组)的临床资料,按照诊断相同、癌灶大小相近、性别相同、年龄相近的原则,选择2004年1月至2005年12月应用非单肺通气条件下 PRFA 治疗 LCHD 的10例患者,与单肺通气组一一配对(对照组)。用配对 t 检验比较两组患者的年龄和癌灶直径,用 x^2检验比较并发症发生率和不完全消融率。结果两组患者的年龄和癌灶直径无明显差异(P>0.05);单肺通气组的平均穿刺针数[(3.4±0.4)次]明显低于对照组[(6.1±0.8)次](P<0.01);两组在治疗时间和射频消融直接产生的费用方面均无明显差异(P>0.05);单肺通气组无低氧、肺不张、肺感染等气管插管相关并发症发生,也无血气胸、腹腔内出血、胆瘘等射频针穿刺相关并发症发生,对照组中发生经皮穿刺相关性并发症2例,其中气胸和胸腔积液各1例;两组均无死亡发生;单肺通气组不完全消融率为10%(1/10),对照组为40%(4/10),两组差异无统计学意义(P>0.05);单肺通气组的医疗不良事件(并发症和不完全消融)发生率(10%)明显低于对照组(60%)(P<0.05)。结论左侧单肺通气有助于提高PRFA 治疗 LCHD 的效率、疗效和安全性。

Objective To evaluate the advantages of percutaneous radiofrequency ablation （PRFA） therapy with contralateral single lung ventilation （SLV） for liver carcinoma in the hepatic dome （LCHD）. Methods The clinical data of 10 patients（ the SLV group） with LCHD consecutively treated from January to December 2006 were retrospectively analyzed. And another 10 cases（ the control group） with LCHD treated from January 2004 to December 2005 were selected with a strict inclusion criterion for compared test according to rules of same diagnosis, similar tumor bulk and site, same sex, similar age and liver function. The patients＇ ages and tumor diameters of the 2 groups were compared with t-test and the rates of complications and incomplete tumor ablation were compared with x^2-test. Results There was no statistical difference in ages and tumor diameters between the 2 groups （P 〉 0. 05 ） . The average number of radiofrequeney ablation needle punctures in the SLV group was significantly less than the control group（3.4 ±0. 4 vs. 6. 1 ±0. 8 ,P 〈 0. 01 ）. There was no bronchial intubation related complications like hypoxemia, atelectasis, lung infection and no puncture related complications like pneumothorax, hemothorax, hemoperitoneum and bile leakage in the SLV group. Two cases in the control group had complications including pneumothorax（ n = 1 ） and pleural effusion（ n = 1 ）. There was no mortality in the 2 groups. Though the rate of incomplete tumor necrosis in the SLV group was not statistically lower than that in the control group（ 10% vs. 40% ）, the occurrence rate of the undesirable event （ complication and incomplete tumor necrosis） of the SLV group was significantly lower than that of the control group（ 10% vs. 60% ,P 〈0.05） . The durations and costs of operating procedure were not significantly different between the 2 groups. Conclusion Left SLV makes PRFA for LCHD more efficient, effective and safe.