TACE联合微波消融治疗膈下肝癌的疗效及安全性

Efficacy and safety of TACE combined with microwave ablation for the treatment of subphrenic hepatocellular carcinoma

目的 探讨TACE联合微波消融治疗膈下肝癌的安全性及疗效.方法 选取医院确诊膈下肝癌的患者29例,所有患者先行TACE术,术后予护肝治疗,1-2周后待肝功能恢复正常后行CT引导下经皮微波消融术,术后3-4周复查CT或MRI增强扫描评价其安全性及疗效.结果 29例患者中TACE术后均无肝功能衰竭等严重并发症.微波消融术后3例患者出现肝包膜下少量出血,2例患者合并少量液气胸,1例患者合并大量气胸.术后3-4周复查CT或MRI增强扫描,其中26例（89.7％）患者评价为完全消融,3例患者（10.3％）评价为不完全消融.结论 TACE联合微波消融治疗膈下肝癌疗效明确.但因肿瘤毗邻膈肌、肺脏,微波消融时容易损伤膈肌、肺组织,微波消融术中可采取人工膈下腹水的方法提高手术安全性.

Objective To investigate the safety and efficacy of transcatheter arterial chemoembo-lization（TACE）combined with microwave ablation for the treatment of subphrenic hepatocellular carcino-ma （HCC）. Methods Twenty-nine patients with subphrenic HCC in hospital were enrolled in this stud-y. TACE were performed firstly,and then patients were treated with liver protection therapy. After 1 - 2 weeks,subcutaneous microwave ablation were performed when the liver function was normal. The exami-nations of contrast-enhanced CT or MRI were performed to evaluate the safety and efficacy 3 - 4 weeks later. Results There were no serious complications such as liver failure after TACE among the 29 pa-tients. After microwave ablation,3 patients had small amount of hemorrhage under the liver capsule,2 patients had small amount of liquid pneumothorax,1 patient had a large amount of pneumothorax. A total of 26 patients （89. 7%）were evaluated as complete ablation,and 3 patients （10. 3%）were evaluated as incomplete ablation. Conclusions TACE combined with microwave ablation is effective on subphrenic HCC. However,microwave ablation is easy to damage the diaphragm and lung tissue when the tumor is adjacent to the diaphragm and lung. Thus,microwave ablation can be taken under the artificial sub-phrenic ascites method to improve the safety of surgery.