超声引导经皮射频消融膈下肝肿瘤的安全性研究及疗效观察

Safety and Efficacy of Subdiaphragmatic Liver Tumors Treated with Percutaneous Guided Radiofrequency Ablation by Ultrasound

目的:探究超声引导下经皮射频消融对膈下肝肿瘤疗效及安全性。方法:射频治疗79例共1 38个肝肿瘤,其中膈下肿瘤组76个,非膈下肿瘤组62个。比较两组并发症、完全消融、局部肿瘤复发发生率。结果:两组完全消融率分别为92.1%(70/76)、98.4%(61/62),两组比较差异无统计学意义(x^2=2.49,P=0.12)。随访局部肿瘤复发两组分别19.7%(15/76)、6.5%(4/62),差异有统计学意义(x^2=5.08,P=0.02);无瘤生存期分别为膈下肿瘤组(21.0±1.4)个月、非膈下肿瘤组(24.7±1.7)个月,差异有统计学意义(x^2=3.84,P=0.05)。10例患者发生并发症,胸水并发症发生率存在差异(x^2=4.52,P=0.034),无射频治疗相关死亡,无针道转移发生,消融技术成功率为100%。结论:射频消融是一种安全有效的微创治疗技术。肿瘤位置影响消融效果,膈下肿瘤较肝中央处肿瘤易发生消融区域肿瘤复发,术中麻醉医生的协作有利于消融的顺利完成。

Objective： To assesse the safety and effectiveness of the percutaneous radiofrequency ablation （RFA） of sub diaphragmatic liver tumors. Methods： Seventy-nine out of 138 primary or secondary liver tumor patients underwent percutaneous ultrasonography guided RFA. Overall, 76 nodules were sub diaphragmatic （group 1） and 62 were nonsubdiaphragmatic （group 2）. The completeness of the ablation was assessed with contrast-enhanced computer tomography （CT） 1 month. If residual tumor was documented, RFA was repeated. Complication occurrence, complete ablation, and local tumor progression and new lesions rates between these two groups were compared by the Z2 test or Fisher exact test. Results： The complete ablation rate in group 1 was 92.1% （70/76） and 98.4% （61/62） in group 2, with no significant statistical difference. The local tumor progression and new lesions rate were 19.7% （15/76） and 6.5% （4/ 62）, respectively （Z2 = 5.08, P = 0.02）. The disease-free survival were （21.0-4-1.4） months and （24.7 ~ 1.7） months, respectively （Z2 = 3.84, P = 0.05）. Complications were observed in 10 patients, and statistically significant differences existed between the groups in hy- drothorax occurrence rate （~2=4.52, P=0.034）. Neither RFA-related deaths nor tumor seeding occurred. The technical success rate was 100%. Conclusion： RFA is a valid and safe, minimally invasive treatment method. The location of the tumor is a risk factor in impair- ing the ablation results. Finding recurrence around the ablation area in sub diaphragmatic tumors is much easier than in centric ones. Co- ordination in operation and a shorter follow-up interval for imaging are recommended.