肝癌肝移植术后肺寡转移瘤的微波消融治疗效果分析

Efficacy and imaging changes of microwave ablation on pulmonary oligometastasis for liver transplant recipients

目的观察微波消融对肝癌肝移植术后肝脏无瘤患者肺寡转移瘤的控制效果及影像动态变化。方法回顾性分析肝癌肝移植术后肝脏无瘤患者14例15个肺寡转移瘤微波消融后的局部控制效果、并发症及随访资料。15个转移瘤分成两组,分别为40 W消融5 min组和60 W消融3 min组,测量消融区的长径及短径。观察消融后12 h、1~3个月、6个月及长期的CT变化。结果所有病例均一次消融成功,消融区表现为“靶征”,后逐渐减小,仅残留少量索条。40 W消融5 min和60 W消融3 min可达到相同的消融效果。消融区长径、短径均比以前增大(P<0.05)。气胸比例较高达71.4%,其中60%需要引流。针道出血及疼痛占比分别为21.4%、28.6%。无进展生存期为7.4个月。结论微波消融治疗肺寡转移瘤局部控制效果良好,并发症可以接受。消融后的CT表现为靶征。

Objective To investigate the effect of microwave ablation on pulmonary oligometastasis of liver transplant recipients without hepatic carcinoma.To observe the imaging changes after ablation.Methods A total number of 14 patients with 15 lesions were analyzed retrospectively.The ablation effect,complication and progression-free survival(PFS)were calculated.A total number of 15 lesions were divided into two groups,one group used the energy of 40 watt for 5 minutes,another group used the energy of 60 watt for 3 minutes.The short diameter and long diameter of ablation area were compared.The patient received follow up regularly.Results All the lesions were ablated by one procedure.The ablation area displayed“target sign”on CT image at first,then the lesion decreased in size during follow up,only fibrous scar can be observed at last.Different energy of 60 watt for 3 minutes and 40 watt for 5 minutes can get the same ablation effect.After ablation,the size of the short diameter and long diameter increased significant.The complication of pneumothorax was high(up to 71.4%)and 60%needed drainage.Incidence of bleeding of puncture tunnel and pain were 21.4%、28.6%respectively.Progression-free survival(PFS)was 7.4 months.Conclusion Microwave ablation can control pulmonary metastasis with acceptable complication.The ablation area displaied“target sign”on CT image.