足头向穿刺路径对近膈顶肝癌冷冻消融的临床应用

Clinical application of foot-head direction puncturing technique in performing cryoablation of subphrenic hepatocellular carcinoma

目的评价在冠(矢)状面图像引导下采用经腹腔足头向穿刺路径对近膈顶原发性肝癌病灶进行冷冻消融治疗的临床应用。方法在CT重建的冠状面或矢状面图像上,采用足头向穿刺路径对直径≤5 cm的近膈顶肝癌病灶进行穿刺和冷冻消融。并对穿刺相关的技术参数、疗效和并发症情况进行分析、评价。结果共治疗了33例共37个病灶,病灶平均直径3.3 cm,穿刺技术成功率91.9%(34/37),平均穿刺路径长度10.97 cm,平均扫描次数14.0次,平均穿刺操作时间35.2 min。术中、术后无严重并发症出现。病灶完全消融率82.4%(28/34)。在术后12～24个月随访中,85.2%(17/23)的病灶没有出现复发。结论在CT重建的冠(矢)状面图像上应用足头向穿刺路径对近膈顶肝癌进行冷冻消融,是一种安全、可行、有效的方法。

Objective To evaluate the clinical application of coronal（sagittal） image-guided foot-head direction puncturing technique in performing cryoablation of hepatocellular carcinoma located adjacent to diaphragmatic dome. Methods With the help of CT-reconstructed coronal or sagittal images, the foot-head direction puncturing technique was used to perform cryoablation treatment for subphrenic HCC lesions with a diameter ≤5 cm. The puncture-related technical parameters, the curative effect and the complications were recorded, and the results were analyzed and evaluated. Results A total of 37 HCC lesions in 33 patients were treated. The mean diameter of the lesions was 3.3 cm. The technical success rate was 91.9%（34/37）,the average length of puncturing route was 10.97 cm, the average number of CT scans was 14.0, the mean time spent for puncturing was 35.2 min. No serious complications occurred during and after the operation. The complete ablation rate of lesions was 82.4%（28/34）. During the follow-up period lasting for 12-24 months,85.2% of lesions（17/23） showed no signs of recurrence. Conclusion In treating HCC lesions that are located adjacent to diaphragmatic dome, CT-reconstructed coronal or sagittal image-guided foot-head direction puncturing technique is a safe, feasible and effective method.