人工腹水辅助热消融有腹腔手术史患者邻近胃肠道肝肿瘤的应用价值

Value of artificial ascites assisted thermal ablation for hepatic tumors adjacent to the gastrointestinal tract on patients with a history of abdominal surgery

目的探讨有腹腔手术史的肝肿瘤患者可否使用人工腹水辅助热消融邻近胃肠道病灶。方法对32例有腹腔手术史患者共33个邻近胃肠道肝肿瘤的病灶在人工腹水辅助方法下行经皮热消融治疗。方法①：在超声引导下腹腔穿刺注人生理盐水形成液性隔热带；方法②：在病灶与胃肠道间穿刺推注生理盐水形成局限性液性隔热带；方法③：消融过程中于肿瘤与胃肠道间局部持续注入生理盐水，利用流动液体带走消融热量。术后观察患者是否出现胃肠道损伤等并发症，并于术后1个月复查增强CT／MR，评价消融治疗效果。结果在33个病灶中使用方法①、②和③的病灶数分别为27（81．8％）、4（12．1％）和2（6．1％），3种方法的人工腹水使用量分别为40（）～2000ml，600～800ml和1000～1500ml。所有患者术后复查未出现胃肠道并发症。术后1个月增强CT／MR提示33个病灶均消融完全。结论在有腹腔手术史的肝肿瘤患者中，人工腹水能安全有效地辅助热消融邻近胃肠道的病灶。

Objective To assess the safety and effectiveness of artificial ascites assisted thermal ablation for hepatic tumors adjacent to the gastrointestinal tract in patients with a history of abdominal surgery. Methods Thirty-two patients （33 lesions located adjacent to the gastrointestinal tract） with a history of abdominal surgery were included in the study. Method （1）： normal saline was injected into abdominal cavity to form water insulation band between liver and gastrointestinal tract. Method（2） ： normal saline was injected with appropriate pressure to form local water insulation band between the liver and gastrointestinal tract. Method（3） ： normal saline was injected continuously at the interval between liver and gastrointestinal tract to flush away heat energy caused by ablation. All the patients were checked for gastrointestinal tract injury after ablation. During one month after ablation, CT /MR was performed to evaluate whether the lesions were completely ablated. Results Respectively, the numbers of lesion received method （1）, （2） and （3） were 27 （81.8 % ）, 4 （12.1% ） and 2 （6.1 %）, while the usage of normal saline were 400~2 000 ml,600~800 ml and 1 000~1 500 ml. No gastrointestinal tract injury occurred. CT/MR scan during one month after ablation showed that all the 33 lesions had been completely ablated. Conclusions In patients with a history of abdominal surgery, artificial ascites is a safe and effective method in assistance of thermal ablation for hepatic tumors adjacent to the gastrointestinal tract.