超声引导下经皮微波消融治疗近胃肠道肝细胞癌的疗效评价

Clinical evaluation of ultrasound-guided percutaneous microwave ablation of hepatoceilular carcinoma adjacent to the gastrointestinal tract

目的评价经皮微波消融结合温度监测及无水乙醇注射治疗近胃肠道肝细胞癌的安全性及临床疗效。方法对263例患者共计319个肿瘤进行经皮微波消融治疗，其中101个距胃肠道≤5mm的肿瘤为近胃肠道组，218个距肝表面、胃肠道和肝内一、二级分支管道〉5mm肿瘤为对照组。近胃肠道组对无手术切除史患者肿瘤边缘温度控制在最高54～60℃，对有手术切除史患者边缘温度控制在最高50℃，对该组62个病灶近胃肠道边缘肿瘤组织内注射无水乙醇治疗。用独立样本t检验进行两组间均值比较，用秩和检验进行非参数分析，用卡方检验进行率的比较，用Kaplan—Meier法绘制局部肿瘤进展曲线，用Log—Rank检验分析两组不同随访时间局部肿瘤进展率之间的差异。结果近胃肠道组96个肿瘤（95．0％）及对照组208个肿瘤（95．4％）获得完全消融。所有肿瘤局部进展均发生在术后12个月内，近胃肠道组与对照组第6个月局部肿瘤进展率分别为6．90／0、7．3％，第12个月分别为11．9％、8．3％。两组均无并发症发生，无胃肠道及胆道损伤发生。结论在严格温度监测下，微波消融联合无水乙醇注射可以安全治疗邻近胃肠道肝细胞癌并取得较好的完全消融效果。

Objective The purpose of the study was to prospectively evaluate safety and assisted with ethanol injection for hepatocellular carcinoma abutting gastrointestinal tract. Methods 263 patients with 319 hepatic tumors that underwent percutaneous microwave ablation with curative intention were included. 101 lesions located less than 5 mm from gastrointestinal tract were in gastrointestinal group. 218 lesions located more than 5 mm from hepatic surface, gastrointestinal tract and first or second branch of hepatic vessels were in control group. The temperature of marginal ablation tissue proximal to gastrointestinal tract was monitored and controlled to fluctuating between 45℃ and 59℃ for more than 10min for tumors in the gastrointestinal group. Ethanol （1-21 ml） was injected into marginal tissue in 62 of 101 lesions of the G1 group. Results 96 of 101 tumors （95.0%） in the gastrointestinal group and 208 of 218 tumors （95.4%） in the control group achieved complete ablation （P = 0.89）. Local tumor progression for all the tumors were in the first year and the 6-, 12- month local tumor progression rate in the gastrointestinal group and the control group were 6.9%, 11.9% and 7.3%, 8.3%, respectively （P = 0.21）. There were neither immediate nor periprocedural complications in both groups. There was no delayed complication of gastrointestinal and bile ducts injury. Tumor seeding happened in one （1.1%） of the gastrointestinal group and three （1.8%） of the control group （P = 0.92）. Conclusion Under strict temperature monitoring, microwave ablation assisted with ethanol injection is safe and achieves a high complete ablation rate for hepatocellular carcinoma adjacent to gastrointestinal tract.