特殊部位原发性肝癌经皮微波消融临床观察

目的探讨经皮微波消融技术在特殊部位原发性肝癌中的临床应用价值。方法纳入自2015年1月-2016年3月期间特殊部位（位置紧邻大血管、胆囊或临近重要脏器）原发性肝癌31例。超声引导下经皮微波消融治疗，消融气化范围控制在大于病灶边缘1．0cm，术中严密观察生命体征，记录消融及全程操作时间；术后即刻及术后1、3、6、12个月超声造影评估，每6个月肝脏MRI复查，详细记录并发症及病灶复发情况。结果术后即刻超声造影提示31个病灶完全灭活，但操作难度增大，整个手术操作周期较普通部位病灶延长平均25min。消融术后综合症发生率74％（23／31）：剧烈呕吐1例；上腹隐痛11例，其中9例1个月内消失，2例持续3个月；术后发热22例，体温均〈390，持续2-9d；均未出现出血等严重并发症。9．6％（3／31）术后6个月发生消融灶边缘肿瘤复发，其中2例在术后6个月复发，1例在术后1个月复发，余28例12个月内均未见明显复发。31例经皮微波消融均未出现出血等严重并发症。结论特殊部位原发性肝癌经皮微波消融操作难度增大，手术时间延长，消融术后综合症常见，但微波消融创伤小、疗效确切，仍是不能手术切除病例的主要治疗手段。

Objective To investigate the clinical value Of ultrasound-guided percutaneous microwave ablation for difficult-to-ablate primary liver cancer （ PLC ） . Methods A total of 31 eligible patients with PLC were enrolled from Jan 2015 to Mar 2016. Ultrasound-guided percutaneous microwave ablation was performed to destroy the lesions, and gasification area was controlled 1.0 cm away from rim of the lesion. The vital signs were observed during the operation, and the operation time was recorded. Contrast enhanced ultrasound （ CEUS ） was performed alone immediately and one week after treatment, then ＇together with MRI one and thrce months after ablation, to assess the therapeutic efficacy. Conditions of residual lesion and post-operation complications were analyzed. Results As evidenced by CEUS immediately after treatment, all the lesions were ablated completely. Compared with percutaneous microwave ablation in regular locations, lesions in the present study were treated very difficult, with a 25 min longer time. Post-ablation syndrome was observed in 77% of patients, including 1 case with severe vomiting, 11 with blur epigastric pain and 22 with fever. Nonetheless, severe comaplications, such as bleeding,＇ occurred to none. Marginal tumor recurrence occurred to 3 patients by the end of 6 months after ablation. Conclusion Percutaneous microwave ablation for difficult-to-ablate PLC is a great challenge by the prolonged time for operation and a relatively high incidence of post-ablation syndrome. However, microwave ablation remains a favorable choice for patients with unresectable lesions, gives the definite efficacy and less invasiveness nature.