单肺通气联合人工胸水辅助经皮热消融治疗肝膈顶部肝癌

Artificial hydrothorax combined with one-lung ventilation to aid percutaneous ablation treatment of liver carcinoma in the hepatic dome

目的探讨单肺通气联合人工胸水辅助经皮热消融治疗肝膈顶部肝癌的临床价值。方法选取位于肝膈顶位置、超声显示受肺气影响的肝癌患者21例，采用双腔支气管内插管麻醉，并行胸腔内穿刺置管注入人工胸水。分别记录未使用人工胸水、单独使用人工胸水及单肺通气联合人工胸水3种情况下病灶的超声图像，并根据病灶超声显示的清晰完整程度由差至好评为1～5分，对比3种情况下病灶声像图显示的清晰完整度。术后随访观察消融疗效及不良反应。结果21例患者均成功注入人工胸水及进行单肺通气，注入人工胸水量（738±260）ml。未使用人工胸水、单独使用人工胸水及单肺通气联合人工胸水3种情况下病灶声像图评分分别为：1．13±0．35（1～2分）、3．00±0．85（2～5分）及4．53±0．64（3～5分），三组两两间比较差异均有统计学意义（P〈0．05），使用单肺通气联合人工胸水声像图明显优于未使用人工胸水或单独使用人工胸水。消融术后1个月CT／MR提示病灶完全消融率为100％。随访2～24月，1例患者局部肿瘤进展，1例患者肝内肿瘤复发，无气胸、针道转移或其他严重并发症发生。结论对位于肝膈顶部、超声显示困难的肿瘤，单肺通气联合人工胸水能有效改善肿瘤的超声显示，安全有效地协助完成超声引导下的肿瘤消融治疗。

Objective To evaluate the clinical value of artificial hydrothorax combined with one-lung ventilation to aid ablation treatment of liver carcinoma in the hepatic dome. Methods Twenty one patients with liver carcinoma located in the hepatic dome and affected by the lung gas were enrolled. Double lumen endobronchial intubation anesthesia was used and thoracical tube was used to apply artificial pleural effusion. The lesions＇ultrasound image were recorded for the patients without artificial hydrothorax,or with artificial hydrothorax only and artificial hydrothorax combined with one lung ventilation. Ultrasound images were reviewed and scored as 1 - 5 according to the clarity and completeness of the lesion. Ablation efficacy and adverse reactions were recorded in the follow-up. Results Twenty-one patients were successfully applied artificial hydrothorax and one lung ventilation. The average normal saline used for artificial hydrothorax were （738 ＋-260）ml. The ultrasound score for not using artificial hydrothorax, using artificial hydrothorax only and artificial hydrothorax combined with one-lung ventilation were 1.13 -＋ 0.35 （1 - 2）, 3.00 -＋ 0.85 （2 - 5） and 4.53 ＋ 0.64（3-5）, respectively, statistical difference was found between each method（ P ~0.05）. Artificial hydrothorax combined with one-lung ventilation had much higher ultrasound score than the other 2 methods. No complication related to artificial hydrothorax or one-lung ventilation was found. CT/MRI at one month after ablation showed that all the lesions were completely ablated. In the follow-up for 2 - 14 months on average, l case of local tumor progression and i case of intrahapetic relapse were found. Conclusions Artificial hydrothorax combine one-lung ventilation could effectively enhance ultrasound image for the lesions in the dome whose acoustic window was affected by lung gas.