超声导引下经皮微波消融治疗邻近危险区域肝癌临床观察

The clinical observation of sonographically guided percutaneous microwave coagulation of liver tumors abutting danger areas

目的探讨经皮微波消融(PMCT)治疗邻近胃肠、胆囊、膈肌、心脏、肾脏等危险区域(即肿瘤距上述脏器最短距离≤0.5 cm)肝癌的有效性和安全性,寻找合适的治疗条件,从而实现对肝脏肿瘤完全凝固坏死而邻近重要器官无明显热损伤。方法选择邻近胃肠(4例)、胆囊(10例)、膈肌(24例)、心脏(4例)、肾脏(3例)等危险区域肝癌患者45例均行PMCT治疗。术前术后均行B超,增强CT扫描,检测甲胎蛋白(AFP),判断疗效。同时常规查肝肾功能。观察不良反应及并发症的发生率,血清AFP变化,肿瘤缓解率。结果⑴PMCT后8周增强CT提示肿瘤完全坏死38例,坏死率84.44%;4周复查AFP,35例AFP术前阳性患者中23例转为阴性(65.71%),与文献报道非危险区域肝癌微波消融治疗的疗效无差异。⑵1例邻近膈顶肝癌患者PMCT治疗后出现血胸,经止血对症治疗7 d后出血吸收出院;1例出现针尖断开滞留于消融中心区域,无症状,随访一年针尖位置无变化。其余患者均未出现与操作相关并发症。结论采取适当措施下对于邻近危险区域肝癌进行PMCT治疗,其疗效与非危险区域PMCT疗效接近,同时可以避免出现与操作相关的并发症。

Objective To evaluate the efficacy and safety of Percutaneous microwave coagulation therapy（PMCT） for liver tumor abutting the gastrointestinal tract,the gallbladder,the diaphragm,the heart,the kidney and the other danger areas（the shortest distance of tumor from the organ ≤ 0.5cm）,to explore the optimal ablation condition in order to achieve complete tumor necrosis while these organs were not burn obviously.Methods This study was undertaken in 45 patients who were with liver cancer abutting the gastrointestinal（4 patients）,the gallbladder（10 patients）,the diaphragm（24 patients）,the heart（9 patients）,the kidney（3 patients） and accepted PMCT.All the patients underwent ultrasound and enhanced CT scan before and after the treatment,detection of AFP,liver and kidney function to determine efficacy.Adverse reaction and complication rates,changes of serum AFP,and tumor response rate were observed.Results ⑴According to the results of the CT scan,there were 38 cases of complete tumor necrosis after 8 weeks,necrosis rate is 84.44%;23 cases of AFP turning to negative after 4 weeks（65.71%） in 35 cases of AFP positive patients before operation.There was no difference in efficacy compared that of reported in the literature of non-hazardous area liver cancer.⑵1 patient who was with liver cancer close to the top of the diaphragm developed hemothorax after PMCT treatment,the hemorrhage was absorbed after 7 days of hemostasis treatment;The ablation tip was tearing off and remained in the central area of ablation in 1 patient who was asymptomatic.After 1-year following-up,there was no change in the tip position.There were no other complications arose with the operation.Conclusion The efficacy of a proper PMCT treatment for the liver cancer near danger area is closed to that of PMCT for non-hazardous area,and the complications associated with the operation could be avoid.