人造胸水和术中超声造影辅助下经皮射频消融治疗肝穹窿部肝癌  

Contrast Enhanced Intraoperative Ultrasonography-Guided Percutaneous Radiofrequnecy Ablation with Artificial Hydrothorax for Hepatocellular Carcinoma in Hepatic Dome

作　　者：李嘉鑫[1] 吴泓[1] 黄纪伟[1] 卢强[2] 蒋辉[1] 徐缨龙[1] 汪景洲[1] 曾勇[1] 

机构地区：[1]四川大学华西医院肝胆胰外科,四川成都610041 [2]四川大学华西医院超声科,四川成都610041

出　　处：《中国普外基础与临床杂志》2011年第2期172-176,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨人造胸水和术中超声造影辅助下超声引导的经皮射频消融治疗肝穹窿部肿瘤的安全性和可行性。方法回顾性分析2008年1月至2009年6月期间四川大学华西医院肝胆胰外科在术中超声造影和人造胸水辅助下行经皮射频消融治疗的9例肝穹窿部肝癌患者的临床资料,并对围手术期和随访复发情况进行分析。结果 9例患者共12个病灶均成功完成了人造胸水辅助下的射频消融治疗。注入胸水量为（2 444±464）ml（2 000~3 000 ml）;每例患者消融时间为12~24 min（中位数12 min）,每个肿瘤为（15±5）min。术中未发生血胸、气胸等,无手术相关死亡发生。术后1例患者出现腹腔中量积液约2 000 ml,考虑与低蛋白血症有关,补充人血白蛋白后于术后第4天腹水消失。胸腔引流液总量为（717±372）ml（250~1 420 ml）,术后3~5 d拔除引流管。术后随访时间为7~23个月（中位数15个月）。有3例患者分别在术后5、6和7个月出现复发病灶,其中2例分别经介入和保守治疗后病情稳定,1例术后6个月复发患者因高血压心脏病和肝功能恶化于术后16个月死亡。其余患者在随访期内均存活,未见复发、转移。结论术中超声造影和人造胸水辅助经皮射频消融治疗肝穹窿部肝癌安全、有效,有较高临床应用价值。Objective To explore the safety and feasibility of contrast enhanced intraoperative ultrasonography-guided percutaneous radiofrequency ablation with artificial hydrothorax to hepatocellular carcinoma in the hepatic dome.Methods The clinical data of nine patients with hepatocellular carcinoma in the hepatic dome underwent ultrasonography-guided percutaneous radiofrequnecy ablation with artificial hydrothorax from January 2008 to June 2009 at Department of Hepatobiliopancreatic Surgery of West China Hospital were retrospectively analyzed.The perioperative results and recurrence of tumor were also analyzed.Results All of nine patients with twelve tumors received successfully radiofrequency ablation with artificial hydrothorax of（2 444±464） ml（2 000-3 000 ml）.The ablation time was 12-24 min（median 12 min）,with an average of（15±5） min for each tumor.No hemothorax,pneumothorax,and death occurred during operation.One patient had ascites of 2 000 ml after ablation due to hypoalbuminenia,and ascites disappeared by infusion of abumin on 4 d after operation.The total volume of pleural drainage was 250-1 420 ml,with an average of（717±372） ml for each patient,and the drainage tube was withdrawn on 3-5 d after operation.The follow-up time was 7-23 months（mean 15 months）.Tumor recurrence was found in three patients on 5,6,and 7 months after operation,respectively.Of them,two patients were in stable disease stage after interventional and conservative therapy,respectively,and one case recurred at six months after operation and died of hypertensive heart disease and hepatic function deterioration at sixteen months after operation.The rest patients survived and no recurrence and metastasis was observed during the follow-up period. Conclusion The technique of percutaneous radiofrequency ablation with artificial hydrothorax increases the feasibility of the minimal invasive treatment for hepatoma,which can be applied to hepatocellular carcinoma in the hepatic dome with high safety and clinical application va

关 键 词：人造胸水 术中超声造影 射频消融 肝肿瘤 肝穹窿部 

分 类 号：R735.7[医药卫生—肿瘤]