原发性肝癌患者CT引导下经皮微波消融术中肿瘤位置与疼痛程度的关系

Relationship between tumor location and pain level in CT-guided percutaneous microwave ablation of hepatocellular carcinoma

目的探讨肝癌患者局部麻醉下CT引导肝癌微波消融(MWA)术中,肿瘤位置与患者疼痛程度的关系。方法 35例肝癌患者42个肿瘤病灶经肝动脉化疗栓塞术治疗后实施CT引导经皮MWA治疗。临近肝包膜组16例患者、19个病灶,病灶临近肝包膜和(或)肝段以上门静脉分支≤5 mm;远离肝包膜组19例患者、23个病灶,病灶距肝包膜及肝段以上门静脉分支均>5 mm。采用视觉模拟评分法(VAS)对两组患者疼痛程度进行评估。记录和比较两组患者的肿瘤大小、基础VAS评分、术中VAS评分(MWA中最大痛觉评分)、相对VAS评分(术中VAS评分减去基础VAS评分)、可耐受最大功率、消融时间、哌替啶用量。组间各参数比较采用Mann-Whitney U检验。结果 16例临近肝包膜组患者的术中VAS评分、相对VAS评分(3.25±0.68和3.00±0.52)明显高于19例远离肝包膜组患者(2.74±0.73和2.47±0.61),差异均有统计学意义(P值分别为0.042和0.009),即消融治疗时临近肝包膜组患者的疼痛比远离肝包膜组患者更明显。临近肝包膜组患者的哌替啶用量[(78.1±20.2)mg]亦高于远离肝包膜组患者[(64.5±17.3)mg],差异有统计学意义(P=0.039)。给予高剂量哌替啶治疗后,可耐受最大功率和消融时间在临近肝包膜组[(73.8±15.4)W、(6.6±1.8)min]与远离肝包膜组[(75.8±17.7)W、(6.4±2.1)min]之间差异无统计学意义(P值均>0.05)。结论临近肝包膜及门静脉分支的肝癌病灶行MWA治疗时,患者疼痛更明显。追加用哌替啶剂量后,可完成MWA治疗。

Objective To investigate the relationship between tumor location and pain level in computed tomography（ CT）- guided percutaneous microwave ablation（ MWA） of hepatocellular carcinoma（ HCC） under local anesthesia. Methods A total of 42 tumors in 35 HCC patients were given CT- guided percutaneous MWA under local anesthesia after transcatheter hepatic arterial chemoembolization. The 35 patients were divided into two groups based on the distance from the tumor to the Glisson＇s capsule and / or the branch of the portal vein. Group A（ 19 tumors out of 16 patients） had a distance of ≤5 mm from the tumor to the Glisson＇s capsule and / or the branch of the portal vein,and group B（ 23 tumors out of 19 patients） had a distance of 5 mm from the tumor to both the Glisson＇s capsule and the branch of the portal vein. The pain levels of the two groups were evaluated by visual analogue scale（ VAS）. The tumor size,baseline VAS score,intraoperative VAS score（ the highest VAS score during MWA）,relative VAS score（ intraoperative VAS score minus baseline VAS score）,the highest tolerated MWA power,ablation time,and meperidine hydrochloride dose were recorded and compared between the two groups. The comparison was made by Mann- Whitney U test. Results The 16 cases in group A had significantly higher intraoperative VAS score and relative VAS score than the 19 cases in group B（ 3. 25 ± 0. 68 vs 2. 74 ± 0. 73,P = 0. 042; 3. 00 ± 0. 52 vs 2. 47 ± 0. 61,P = 0. 009）. It showed that the patients whose tumor was close to the Glisson＇ s capsule had a greater pain level than the patients whose tumor was away from the Glisson＇s capsule. The dose of meperidine hydrochloride in group A was significantly higher than that in group B（ 78. 1 ± 20. 2 mg vs 64. 5± 17. 3 mg,P = 0. 039）. After treatment with high dose of meperidine hydrochloride,groups A and B showed no significant differences in the highest tolerated MWA power and ablation time（ 73. 8 ± 15. 4 W vs 75. 8 ± 17. 7 W,P〈0. 05; 6. 6 ± 1. 8 min vs 6. 4 ± 2. 1 min,P〈0. 05）. Conclusion The patients who have a longer distance between the tumor and the Glisson＇s capsule and the branch of the portal vein suffer greater pain in MWA therapy. Additional meperidine hydrochloride can help complete the MWA treatment.