超声引导微波消融术个体化方案在危险部位肝癌治疗中的应用

Ultrasound-guided microwave ablation in the individualized treatment of hepatocellular carcinoma adjacent to danger areas

目的探讨超声引导经皮微波消融(MWA)对危险部位肝癌的疗效和安全性。方法回顾性分析106例接受超声引导下MWA治疗的肝癌患者资料,共149个病灶,其中8个病灶邻近胆囊,33个病灶邻近Ⅰ~Ⅱ级胆管,39个病灶邻近膈肌,28个病灶邻近胃肠,41个病灶邻近肝被膜。肿瘤最大直径0.6~5.4(2.04±0.92) cm,对不同部位肿瘤制定不同治疗方案,1个月后行增强CT或MRI判断肿瘤早期完全消融率并定期随访。结果肿瘤早期总灭活率89.9%(134/149);邻近胆囊、邻近Ⅰ~Ⅱ级胆管、邻近膈肌、邻近胃肠、邻近肝被膜肿瘤的早期完全消融率分别是100%、84.8%、89.7%、92.9%、90.2%,局部复发率分别是0、15.2%、10.3%、7.1%、9.8%,本组患者1、2、3年生存率分别是91.6%、85.8%、74.5%。106例共消融149例次,严重并发症占6.6%,包括膈肌损伤1例、针道种植1例、腹腔出血3例、严重感染1例、胆汁瘤1例,共7例次。结论对危险部位肝癌,采用个体化方案拓展MWA在肝癌治疗运用范围,有效提高肿瘤完全消融,使MWA在肝癌治疗中发挥更大作用。

Objectives To investigate the efficiency and safety of ultrasound-guided microwave ablation (MWA) for hepatocellular carcinoma (HCC) adjacent to danger areas.Methods The 106 patients with HCC treated by ultrasound-guided MWA were retrospectively included in our study.There were 149 lesions in total,including 8 lesions adjacent to gallbladder,33 lesions adjacent to grade Ⅰ-Ⅱ bile duct,39 lesions adjacent to diaphragm,28 lesions adjacent to gastrointestinal tract and 41 lesions adjacent to hepatic capsule.The mean diameter of the tumors was (2.04±0.92)cm.Individualized treament strategies for different sites of the tumors were conducted.The early complete ablation rate of the tumors was assessed by enhanced computed tomography (CT) or magnetic resonance imaging (MRI) one month later and followed up regularly.Results The total inactivation rate was 89.9%.The early complete ablation rates of adjacent gallbladder,adjacent grade Ⅰ-Ⅱ bile duct,adjacent diaphragm,adjacent gastrointestinal tract and adjacent hepatic capsule were 100%,84.8%,89.7%,92.9%,90.2% respectively.The local progression rates were 0,15.2%,10.3%,7.1%,9.8%,respectively.The 1-,2- and 3-year survival rates were 91.6%,85.8% and 74.5%.Total cases were ablated 149 times.Serious complications accounted for 6.6%,including diaphragm injury,needle implantation,abdominal hemorrhage,severe infection,bile tumors.Conclusions Our study presented a novel individualized treament strategies using MWA in HCC patients.The individualized scheme effectively boosted the complete ablation rate of tumors and significantly improve the clinical outcome of HCC patients.