超声引导联合人工胸水微波消融膈顶部肝肿瘤

Ultrasound-guided microwave ablation with artificial pleural effusion for liver tumor adjacent to diaphragmatic dome

目的:探讨超声引导联合人工胸水微波消融膈顶部肝肿瘤的应用价值。方法:回顾性分析湖南省肿瘤医院自2014年1月至2015年10月收治的病灶数目≤3个,直径≤5 cm,34例膈顶部肝肿瘤患者,符合微波消融适应证;先建立人工胸水,然后采用B超引导下行微波消融治疗肝肿瘤,术后3~4周后复查增强CT或者MRI,评估肿瘤消融疗效,观察并发症情况。结果:34例患者共49个病灶,其中完全消融(complete ablation,CA)30例(88.2%),部分消融(part ablation,PA)3例(8.8%),消融进展1例(2.9%),术后出现新发病灶;34例患者人工胸水量(1 580±230.7)m L,1例出现血性胸水,1例出现膈肌热损伤、1例胆汁瘤合并感染,经对症治疗后均缓解。结论:超声引导联合人工胸水微波消融膈顶部肝肿瘤是微创、安全、有效的治疗方法。

Objective： To explore the value of ultrasound-guided microwave ablation with artificial pleural effusion for liver tumor adjacent to diaphragmatic dome. Methods： A total of 34 patients with liver tumors located at diaphragmatic dome in Hunan Provincial Tumor Hospital were recruited from January 2014 to October 2015. The number of lesions ≤ 3 or lesion diameter ≤5 cm was in line with the microwave ablation indications. B ultrasound-guided microwave ablation for the liver tumors was undertaken after the artificial pleural effusion being established. 3-4 weeks later after the microwave ablation, all patients were imaged with enhance CT or MRI. The effect of ablation and the complications were evaluated. Results： There were 49 lesions in 34 patients, including 30 cases （88.2%） of complete ablation （CA）,3 cases （8.8%） of partial ablation （PA） and one case with new lesions after ablation （2.9%）. Thirty- four patients had （1 580±230.7） mL of pleural effusion volume, while one case had bloody pleural effusion. One case had a diaphragmatic thermal injury, and one case had a biliary tumor infection. All of them showed remission after symptomatic treatment. Conclusion： Combination of ultrasound-guided microwave ablation with artificial pleural effusion is a safe and effective therapy for liver tumor adjacent to diaphragmatic dome.