CT联合超声引导精准经皮肝穿刺技术在肝Ⅷ段病灶治疗中的应用

Application of CT combined with ultrasound-guided precision percutaneous hepatic puncture technique in treatment of little hepatic carcinoma or abscess in segment Ⅷ of liver

目的探讨精准经皮肝穿刺技术用于肝Ⅷ段小肝癌和脓肿治疗中应用的安全性和可行性。方法回顾性分析2017年1月至2021年5月期间新疆维吾尔自治区第三人民医院行肝穿刺治疗的肝Ⅷ段病灶患者63例的临床资料。根据肝穿刺引导方法不同分为2组:CT+超声组(30例),接受局麻或不插管的静脉麻醉下CT联合超声引导的经皮肝穿刺置管引流/射频消融治疗;腔镜+超声组(33例),接受插管的静脉麻醉下腹腔镜联合镜下超声引导的肝穿刺置管引流/射频消融治疗。对比分析肝穿刺治疗围手术期相关指标、手术并发症发生情况、手术后患者手术和疼痛的接受程度。结果 CT+超声组较腔镜+超声组的穿刺时间短[(39.33±6.79)min vs (50.90±5.51)min]、下床时间早[(11.07±3.44)h vs (15.73±3.25)h]、术后胃肠功能恢复时间早[(8.23±1.43)h vs (14.79±3.34)h],差异均具有统计学意义(P<0.05);两组穿刺次数[(1.13±0.35)次 vs (1.09±0.29)次]、穿刺成功率[93.3%(28/30) vs 100.0%(33/33)]无统计学差异(P>0.05)。两组肝脓肿穿刺置管(分别为7例和9例)均成功,恶性肿瘤(分别为23例和24例)消融后残留率均为零。CT+超声组手术并发症总体发生率与腔镜+超声组[26.7%(8/30) vs 27.3%(9/33),χ;=0.003,P=0.118]差异无统计学意义(P>0.05);手术疼痛接受程度高于腔镜+超声组[96.7%(29/30) vs 75.7%(25/33)],差异具有统计学意义(P<0.05)。结论局麻或不插管的静脉麻醉下CT联合超声引导的精准经皮肝穿刺技术作为肝Ⅷ段小肝癌和脓肿的辅助治疗技术安全可行,可用于≤3.5 cm的病灶穿刺,可以获得与全麻下腹腔镜联合镜下超声引导的肝穿刺技术治相近的治疗效果,且手术时间更短,手术创伤更小、接受程度更高。

objective To discuss the safety and feasibility of precise percutaneous hepatic puncture technique for treating little hepatic carcinoma or abscess in segment Ⅷ of liver. Methods Retrospective analysis was performed on 63 patients with hepatic segment Ⅷ lesions and treated by liver puncture from Jan. 2017 to May 2021 in the Third People’s Hospital of Xinjiang Uygur Autonomous Region. According to the guided methods of hepatic puncture, patients were divided into 2 groups: 33 cases in laparoscopy combined with ultrasound guided group, who received intravenous anesthesia with intubation under laparoscopic combined with ultrasound guided hepatic puncture catheter drainage or radiofrequency ablation therapy. And 30 patients in CT combined with ultrasound guided group, who underwent local anesthesia or non-intubated intravenous anesthesia under CT combined with ultrasound-guided percutaneous hepatic puncture catheter drainage or radiofrequency ablation therapy. The two groups were compared in terms of the relative indicators of hepatic puncture treatment during the perioperative period, the occurrence of operation complications, and the acceptance of the patient’s surgery and pain after the operation. Results Compared with the laparoscopy combined ultrasound guided group, CT combined with ultrasound guided group has shorter puncture time [(39.33±6.79)min vs(50.90±5.51)min], earlier time of getting out of bed [(11.07±3.44)h vs(15.73±3.25)h], and earlier recovery time of postoperative gastrointestinal function [(8.23±1.43)h vs(14.79±3.34)h]. The difference was statistically significant(P<0.05). There was no statistical difference between the two groups in terms of the puncture number [(1.13±0.35) vs(1.09±0.29)] and the puncture success rate [93.3%(28/30) vs 100.0%(33/33)]. Puncture and catheterization of hepatic abscess were successful in both groups(7 cases and 9 cases respectively). The residual rate of malignant tumors after ablation was zero(23 cases and 24 cases respectively). There was no statistical significant difference in overall incidence of operation complications between the CT combined with ultrasound guided group and the laparoscopy combined with ultrasound guided group [26.7%(8/30) vs 27.3%(9/33), χ2=0.003, P=0.118];the acceptance of surgical pain after surgery in the CT combined with ultrasound guided group was higher than that in the laparoscopy combined with ultrasound guided group [96.7%(29/30) vs 75.7%(25/33), χ2=6.351, P=0.028] and the difference was statistically significant(P<0.05). Conclusion CT combined with ultrasound guided precise percutaneous hepatic puncture under local anesthesia is a safe and feasible assisted treatment technique for small hepatic carcinoma or abscessin segment Ⅷ of liver. It can be used for punctures of lesions ≤3.5 cm. Which can achieving similar treatment effect and less operating time and surgical trauma, higher acceptance than laparoscopic hepatic puncture combined with ultrasound guided technique under general anesthesia.