经皮射频消融治疗肝脏恶性肿瘤中辅助注入等渗盐水技术的应用价值

Ultrasound-guided assistant infusion technique for percutaneous radiofrequency ablation of liver cancer

目的探讨经皮射频消融治疗肝脏外周性恶性肿瘤中辅助注入等渗盐水技术以分离肿瘤与外周脏器结构的应用价值。方法对24例肝脏外周性恶性肿瘤，采用超声引导下穿刺注入等渗盐水的辅助技术，分离肝脏肿瘤局部区域和邻近脏器，完成经皮射频消融治疗。观察术后常见不良反应及其疗效。结果24例肝脏恶性肿瘤中邻近右肾6例、邻近结肠6例、邻近胃5例、邻近心膈4例、邻近胆囊3例。23例在超声引导下采用22G细针经由肝组织穿刺达肿瘤近旁肝外，注入等渗盐水80～390ml，形成0．8～2．5cm盐水分隔带，继而完成经皮根治性射频消融治疗。其中5例邻近胃、结肠的肿瘤在消融中需要继续辅助注入等渗盐水。另1例由于有手术切除病史，局部粘连不能分离，辅助注入等渗盐水未能成功，行姑息射频消融治疗。术后平均住院4d，无一例发生周围脏器结构损伤、出血，无一例严重并发症及相关死亡。术后1个月肝脏增强CT／MRI检查显示，辅助注入等渗盐水成功的23例中22例获得完全消融，有效率为95．7％（22／23）；无一例针道转移。结论邻近肝脏外缘的恶性肿瘤经皮射频消融治疗，采用辅助注入等渗盐水策略，使癌灶与重要邻近脏器分隔，可安全有效地消融肿瘤，从而拓展经皮消融治疗的适应证。

Objective To assess the value of an infusion-based separation technique to assist in ultrasound （US）-guided percutaneous radiofrequency ablation （RFA） of liver cancers abutting the liver edge. Methods Twenty-four cases of malignant liver tumors abutting the hepatic edge were treated with US- guided puncture accompanied by the assistant infusion technique. The US-guided puncture was made with a 22-G needle through the hepatic tissue and into the abdominal cavity near the target tumor. Infusion of a saline solution was used to separate the liver from any surrounding structures so that percutaneous RFA could be safely performed. Complications, including gastrointestinal injury, hemorrhage and death, were recorded. Technical efficacy and safety were evaluated. Results Among the 24 patients, the target tumors were adjacent to the right kidney （n =6）, colon （n =6）, stomach （n =5）, pericardium （n =4）, and gall bladder （n = 3）. Twenty-three patients received a successful radical percutaneous RFA with assistant infusion. The assistant infusion volumes ranged from 80-390 ml and created spaces ranging from 0.8-2.5 cm between the liver and surrounding structures. Five of the cases with tumors adjacent to the stomach or colon received the largest volume infusions. The infusion failed to create a separation space in only one case, due to the presence of an adhesion; as a result, this patient was treated with palliative RFA. The mean hospital stay for all 24 patients was four days after surgery. No severe complications or deaths occurred. At 1-month follow-up, computed tomography images showed that 22 cases had complete ablation, yielding a technical success rate of 95.7% （22/23）. No needle track implantation was observed. Conclusion Assistant infusion for percutaneons radiofrequency ablation creates a protective space between the liver and surrounding structures in patients with liver tumors abutting the liver edge. This safe and effective assistant technique broadens the range of patients available for percutaneons RFA treatment.