超声引导下经皮经肝微波消融术治疗肝癌的疗效及安全性分析

Efficacy and safety analysis of ultrasound-guided percutaneous transhepatic microwave ablation in the treatment of liver cancers

目的:评估超声引导下经皮经肝微波消融治疗肝癌的治疗效果及安全性。方法:回顾并分析2015年4月—2020年1月江苏省太仓市第一人民医院采用超声引导下行微波消融术治疗的35例(共49个病灶)原发性或转移性肝癌患者,术后定期随访超声造影及肝功能指标丙氨酸氨基转移酶(ALT)评价治疗效果以及肝脏损伤情况;以及观察并发症发生情况。结果:术后即时超声造影显示所有病灶均完全灭活。术后超声造影随访结果:3个月肝内未见复发;6个月原肿瘤消融部位复发2例;至9及12个月原肿瘤消融部位复发仍为2例,无新增复发患者。术后1周ALT较术前明显上升(P<0.05),术后1及3个月复查ALT均降至术前相仿水平(P>0.05)。消融术并发症:术中1例因疼痛致手术暂停,休息5 min缓解后继续手术;术后切口或右上腹轻度不适15例;术后1周内发热23例;术后胸腔少量积液3例;术后腹腔出血1例。结论:采用超声引导下经皮经肝微波消融技术治疗肝癌是安全可行的,可取得比较满意的治疗效果,值得临床推广使用。

To evaluate the efficacy and safety of ultrasound-guided percutaneous transhepatic microwave ablation in the treatment of liver cancer.Methods:Retrospective analysis of 35 cases(49 lesions)of primary or metastatic liver cancer treated by ultrasound-guided microwave ablation in Taicang First People's Hospital from Apr.2015 to Jan.2020,regular postoperative follow-up of contrast-enhanced ultrasonography(CEUS)and hepatic function(ALT)were performed to evaluate the therapeutic effect and liver injury,and to observe the complications.Results:All the lesions were completely inactivated by CEUS after operation.The results of follow-up showed that there was no recurrence in the liver at 3 months.There were 2 cases with recurrence of the original ablation site at 6 months,and no new cases at 9 months and 12 months.ALT increased significantly at 1 week after operation(P<0.05),and decreased to the same level at 1 month and 3 months after operation(P>0.05).The complications of ablation included 1 case was stopped during operation due to pain,rest for 5 min;15 cases had slight discomfort in incision or right upper abdomen;23 cases had fever within 1 week after operation;3 cases had small pleural effusion after operation;1 case of postoperative abdominal hemorrhage.Conclusion:Ultrasound-guided percutaneous microwave ablation is a safe and effective method for the treatment of liver cancer.It is worthy of clinical application.