改良水隔离术辅助微波消融治疗胸膜下肺肿瘤

Optimized hydrodissection technique assisted microwave ablation for subpleural pulmonary tumors

目的探讨改良水隔离术(OHT)缓解患者微波消融术中疼痛的有效性和安全性。方法回顾性分析2020-01-01-2021-12-31就诊于山东省千佛山医院,经病理活检确诊并行OHT辅助CT引导下经皮微波消融治疗的327例胸膜下肺肿瘤患者病历资料。根据OHT后即刻视觉模拟量表(VAS)评分评估OHT有效率,并将患者分为OHT有效组(284例,VAS≤6分)和OHT无效组(43例,VAS≥7分)。采用描述性统计分析2组患者流行病学特点及治疗相关特点。采用U检验分析2组患者微波消融术前、术中(OHT前和OHT后即刻)以及术后6、12和24 h的VAS评分差异,采用χ2检验或Fisher精确检验分析OHT缓解疼痛效果差异的影响因素。记录术后局部控制率和主要相关并发症。结果327例胸膜下肺肿瘤患者行OHT辅助微波消融治疗,OHT有效率为86.85%(284/327)。2组患者OHT后即刻、术后6和12 h的VAS评分差异有统计学意义,U值分别为49.110、8.185和6.710,均P<0.001。影响OHT缓解疼痛效果的因素有隔离层厚度(P<0.001)和肿瘤位置(颈胸膜:P<0.001;横膈胸膜:P=0.001)。术后1、3、6和12个月的肿瘤局部控制率为98.78%(323/327)、98.78%(323/327)、95.11%(311/327)和92.35%(302/327)。术后主要并发症包括气胸67(20.49%)例、胸腔积液59(18.04%)例、咯血45(13.76%)例、恶心呕吐41(12.54%)例、便秘35(10.70%)例、血胸5(1.53%)例以及支气管胸膜瘘2(0.61%)例。结论OHT是缓解胸膜下肺肿瘤患者微波消融术中及术后疼痛的安全、有效的辅助措施,隔离层厚度和肿瘤位置是OHT缓解疼痛效果差异的影响因素。

Objective To evaluate the efficacy and safety of the Optimized Hydrodissection Technique(OHT)as an assis tive technology in relieving pain during microwave ablation.Method Aretrospectiveanalysiswas conducted on the medical records of 327 patients with subpleural pulmonary tumors diagnosed by pathological biopsy who underwent OHTassisted Computed Tomography-guided percutaneous microwave ablation in Shandong Province Qianfoshan Hospital from January 1,2020,to December 31,2021.The effectiveness of OHT was evaluated by using the immediate Visual Analogue Scale(VAS)post-OHT,with patients categorized into the OHT effective group(VAS<6 points,284 cases)and the OHT ineffective group(VAS≥7 points,43 cases).Descriptive statistical analysis was used to analyze the epidemiological and treatment-related characteristics of the two groups.The Mann-Whitney U test was employed to assess the differences in VAS scores between the two groups at various time points,including before microwave ablation,intraoperatively(both before and immediately after OHT),and postprocedural at 6,12,and 24 hours.For evaluating the influencing factors that contributed to the differential pain relief efficacy of OHT,a Chi-square test or the Fisher exact test was utilized,as appropriate.Local control rates and major complications were also recorded.Results Among the 327 patients treated with OHT-assisted microwave ablation,the effective rate of OHT was 86.85%(284/327).Significant differences in VAS scores were observed between the two groups immediately post-OHT,and at 6 and 12 hours post-OHT(U values were 49.110,8.185 and 6.710,respectively;all P<0.001).Factors affecting the pain relief effect of OHT included the thickness of the isolation layer(P<0.o01)and the tumor location(cervical pleura:P<0.00l;diaphragmatic pleura:P=0.001).The local control rates at 1,3,6,and 12 months postprocedural were 98.78%(323/327),98.78%(323/327),95.11%(311/327),and 92.35%(302/327),respectively.Notable postprocedural complications included pneumothorax in 67 cases(20.49%),pleural effusion 59 cases(18.04%),hemoptysis 45 cases(13.76%),nausea and vomiting 41 cases(12.54%),constipation 35 cases(10.70%),hemothorax 5 cases(1.53%),and bronchopleural fistula 2 cases(0.61%).Conclusions OHT is a safe and effective assistive technology for relieving pain in patients with subpleural pulmonary tumors during and after microwave ablation.The thickness of the isolation layer and tumor location are influencing factors of the pain relief effect of OHT.