人工腹水及人工软组织水肿辅助超声引导经皮热消融治疗特殊部位肝脏肿瘤

Ultrasound-guided percutaneous thermal ablation assisted by artificial ascites and soft tissue edema in the treatment of special-region hepatic tumors

目的探讨人工腹水和(或)人工软组织水肿辅助超声引导经皮热消融治疗邻近膈肌、心脏、胃肠、胆囊及肾脏等特殊部位肝脏恶性肿瘤的应用价值及操作技巧。方法回顾分析132例特殊部位肝脏恶性肿瘤患者的临床资料。患者均在超声引导下建立人工腹水和(或)人工软组织水肿后实施热消融。评价建立人工腹水和(或)人工软组织水肿的完成情况、肿瘤完全消融情况及并发症发生情况。结果 132例患者中, 81例成功建立单纯人工腹水, 人工腹水量(1 301±685)ml;19例成功建立单纯人工软组织水肿, 人工软组织水肿量(534±258)ml;30例成功联合建立人工腹水及人工软组织水肿。水隔离技术总成功率为98.5%(130/132)。74例(108个病灶)行射频消融, 58例(82个病灶)微波消融。共129例患者(186个病灶)顺利完成超声引导经皮热消融治疗, 首次完全消融率为92.5%(172/186)。患者术后平均住院3 d, 未出现肝表面肿瘤破裂、胃肠道穿孔、膈肌穿孔等严重并发症及治疗相关死亡。结论对于邻近膈肌、心脏、胃肠、胆囊及肾脏等特殊部位的肝脏恶性肿瘤, 适时建立人工腹水和(或)人工软组织水肿辅助进行超声引导经皮热消融治疗, 可提高肿瘤治疗的安全性, 减少相邻重要脏器损伤, 降低肝表面肿瘤破裂及膈肌穿孔的发生率, 是一种安全有效的技术方法。

Objective To explore the application value and operation skills of ultrasound-guided percutaneous thermal ablation assisted by artificial ascites or/and soft tissue edema in the treatment of special hepatic tumors located nearby the diaphragm,heart,stomach,gastrointestinal tract,gall bladder,kidney,and other organs.Methods The clinical data of 132 patients with special-region hepatic tumors treated with ultrasound-guided percutaneous thermal ablation aided by artificial ascites and/or artificial soft tissue edema were retrospectively analyzed.Intraoperative contrast-enhanced ultrasound was used to guide ablation when necessary.During the operation,the ablation needle was lifted or pressed down,or the direction of the needle handle was changed to protect vital organs.The technical success rate of artificial ascites and/or soft tissue edema formation,the complete in activation rate of the tumor,and the complications were observed.Results There were 74 patients(108 lesions)treated with radiofrequency ablation and 58 patients(82 lesions)treated with microwave ablation.Among them,81 cases was successfully injected artificial abdominal ascites,with a water volume of(1301±685)ml;artificial soft tissue edema was successfully formed for 19 patients,with a water volume of(534±258)ml.Both artificial ascites and artificial soft tissue edema were built for 30 patients.The success rate of this hydro-isolation technique was 98.5%(130/132).129 patients successfully completed the treatment,and the complete inactivation rate of the tumor was 92.5%(172/186).The average postoperative hospital stay was three days.No patient had serious complications,such as surface tumor rupture,gastrointestinal injury,or diaphragm perforation.Conclusions For hepatic tumors located adjacent to other organs such as the diaphragm,heart,gastrointestinal tract,gallbladder,and kidney,the application of artificial ascites and/or artificial soft tissue edema can reduce the damage to these organs,as well as reduce the possibility of tumor rupture and diaphragm perforation.These methods are safe and effective in ultrasound-guided percutaneous thermal ablation.