经皮水冷式单针微波固化术治疗特殊部位肝肿瘤的临床应用

Percutaneous single cool-tip microwave coagulation for the treatment of specially located liver malignant tumor:clinical application

目的:探讨经皮水冷式微波固化单针消融系统治疗毗邻胆囊、胃肠道、肝内主要血管、膈肌的特殊部位肝肿瘤的安全性与疗效。方法:从2009年7月至2011年6月,33例特殊部位肝肿瘤患者(肿瘤最大径≤5 cm且肿瘤数目≤3,毗邻部位:胆囊8例,胃肠道9例,门静脉右支11例,下腔静脉1例,膈肌4例)接受经皮水冷式微波固化术,探讨其安全性、并发症、固化范围及其疗效。结果:33例患者共42个肿瘤[肿瘤直径介于2.1～4.6 cm,平均直径为(3.4±0.9)cm]接受微波水冷式微波固化术,围术期无严重并发症,3例患者出现右侧胸腔积液;水冷式微波固化范围为(4.8±1.1)cm(固化范围介于3.5～6.0cm),共41个肿瘤取得完全消融,完全消融率为97.6%;1例毗邻横结肠肿瘤固化不完全经补充治疗后取得完全固化。结论:水冷式微波固化单针消融系统治疗特殊部位肝肿瘤是安全的,能产生较大固化范围,对于直径≤5cm肝肿瘤基本能达到完全固化的目的,是安全的微创治疗手段。

Objective： To determine the safety and efficacy of percutaneous single cool-tip microwave coagulation system for the treatment of specially located liver malignant tumors, namely, those adjacent to gall bladder, gastrointestinal tract, major intrahepatic blood vessels or the diaphragm. Methods： Thirty-three consecutive patients with specially located liver malignant tumors [ maximal diameter ≤5 cm, number of tumors 3 ; adjacent organs ： gall bladder （ n = 8 ）, gastrointestinal tract （ n = 9 ）, right portal vein （ n = 11 ）, inferior vena cava （ n = 1 ） and diaphragm （ n = 4 ） ] were treated with percutaneous single cool-tip microwave coagulation between July 2009 and June 2011. The safety, complication, area of coagulation and efficacy were assessed. Results ： A total of 42 tumors [ mean diameter： （ 3.4 _＋ 0.9 ） cm, range ： （ 2.1 - 4.6 ） cm ] in 33 patients were treated with percutaneous single cool-tip microwave coagulation. No serious complication was reported during the perioperative period. 3 patients were revealed as having pleural effusion. The zone of cool-tip microwave coagulation was （4.8 4- 1.1 ）em [ range： （3.5 - 6.0） cm]. 41 tumors （97.6%） achieved complete ablation. Additionally, incomplete coagulation was complemented in a patient with adjacent transverse colon cancer. Conclusion： Pereutaneous single cool-tip microwave coagulation system is a safe measure for specially located liver malignant tumor. Complete coagulation can be achieved for the tumors with diameter ≤ 5 cm and may be regarded as a safe minimally invasive treatment owing to the extensive impact.