呼吸针控联合病灶最大面积投影用于CT引导下经皮经肺穿刺近膈肝肿瘤微波消融术

Application of breathing needle control combined with the maximum area projection of the lesion in CT-guided percutaneous transpulmonary puncture for microwave ablation of subphrenic hepatic tumors

目的探讨“呼吸针控”联合“病灶最大面积投影”用于CT引导下经皮经肺穿刺近膈肝肿瘤微波消融术(MWA)的应用价值。方法回顾性分析CT引导下经皮经肺穿刺近膈肝肿瘤行MWA术的53例患者,对其中29例(研究组)在CT引导下经皮经肺穿刺MWA中采用“呼吸针控”消除呼吸运动对穿刺的影响,联合“病灶最大面积投影”准确规划进针路径、预测消融范围;24例(对照组)行常规CT引导下经皮经肺穿刺MWA。比较两组术中穿刺次数、并发症及消融病灶的近期疗效。结果研究组术中穿刺次数少于对照组[(1.1±0.3)次vs(3.1±0.9=)次],差异有统计学意义(P<0.05)。两组患者术后并发症表现为气胸、肝包膜下出血、膈肌损伤(主要表现为术中和/或术后肩背部疼痛);研究组气胸、肝包膜下出血、膈肌损伤发生率均低于对照组[(6.9%(2/29)、10.3%(3/29)、0%(0/29))比54.2%(13/24)、37.5%(9/24)、33.3%(8/24)],差异均有统计学意义(P<0.05)。研究组术后6个月内肝肿瘤完全消融率明显高于对照组[93.1%(27/29)比70.8%(17/24)],差异有统计学意义(P<0.05)。结论“呼吸针控”联合“病灶最大面积投影”可提高CT引导下经皮经肺穿刺近膈肝肿瘤微波消融术的完全消融率,减少并发症,值得推广。

Objective To investigate the application value of"breathing needle control"together with maximum area projection of the lesion"technique in performing CT-guided percutaneous transpulmonary puncture microwave ablation(MWA)for subphrenic hepatic tumors.Methods The clinical data of 53 patients,who received CT-guided percutaneous transpulmonary puncture MWA of subphrenic hepatic tumors,were retrospectively analyzed.The patients were divided into the study group(n=29)and the control group(n=24).With the help of"breathing needle control"technique to eliminate the effect of respiratory movement on puncturing and with the use of"maximum area projection of the lesion"technique to accurately plan the needle path and to predict the ablation extent,CT-guided percutaneous transpulmonary puncture MWA was carried out in the patients of the study group,while routine CT-guided percutaneous transpulmonary puncture MWA was performed in the patients of the control group.The number of puncturing,the complications and the short-term curative effect were compared between the two groups.Results The number of puncturing in the study group was(1.1±0.3)times,which was less than(3.1±0.9)times of that in the control group,the difference was statistically significant(P<0.05).The postoperative complications in the two groups included pneumothorax,hepatic subcapsular hemorrhage,diaphragmatic injury(mainly manifested as intraoperative and/or postoperative back and shoulder pain).The incidences of pneumothorax,hepatic subcapsular hemorrhage and diaphragm injury in the study group were 6.9%(2/29),10.3%(3/29)and 0%(0/29)respectively,which were 54.2%(13/24),37.5%(9/24)and 33.3%(8/24)respectively in the control group,the differences between the two groups were statistically significant(P<0.05).The complete ablation rate of hepatic tumors in the study group was 93.1%(27/29),which was 70.8%(17/24)in the control group,the difference between the two groups was statistically significant(P<0.05).Conclusion In performing CT-guided percutaneous and transpulmonary puncture MWA for subphrenic hepatic tumors,the combination use of"breathing needle control"and"maximum area projection of the lesion"technique can improve the complete ablation rate and reduce complications.Therefore,this technique is worthy of promotion.