人工胸水技术在经皮射频消融治疗肝脏膈顶肿瘤中的应用  

Percutaneous radiofrequency ablation with artificial hydrothorax for liver cancer in the hepatic dome

作　　者：韩玥[1] 于雷[1] 郝玉芝 杨敏[1] 刘姗[1] 邓颖冰 贺连芳[1] 蔡建强 陈敏华 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院综合科,100021 [2]超声科 [3]腹部外科 [4]北京大学肿瘤医院超声科

出　　处：《中华肿瘤杂志》2012年第11期846-849,共4页Chinese Journal of Oncology

摘　　要：目的探讨人工胸水技术在经皮射频消融治疗肝脏膈顶肿瘤中的应用价值。方法对32例肝脏膈顶恶性肿瘤患者43个病灶采用超声引导下胸腔穿刺置管术建立人工胸水，使右肺与肝脏膈顶分离，然后完成超声引导下经皮射频消融治疗，观察疗效及不良反应。结果32例患者共实施34次胸腔穿刺置管术，注入生理盐水（1606．3±485．9）ml（1000-2500m1）。有1例2个病灶的肝癌患者，人工胸水后仅显示1个病灶，终止射频治疗。有31例患者均按计划完成经皮消融治疗，其中经过膈肌穿刺完成消融22例，经皮经肝途径完成消融9例。完全消融29例，完全消融率为93．5％。全组无一例严重并发症及相关死亡，发生气胸1例，膈肌出血2例，皮下水肿2例。结论对位于超声盲区的肝脏膈顶恶性肿瘤，实施人工胸水有助于肿瘤的显示，减少肺损伤的发生，并能提供经过膈肌的穿刺路径，可安全有效的完成超声引导下经皮射频消融治疗。Objective To assess the value of application of percutaneous radiofrequency ablation （RFA） with artificial hydrothorax for liver cancer in the hepatic dome. Methods Thirty-two patients with 43 lesions of hepatic malignant tumors in the hepatic dome underwent ultrasound-guided percutaneous radiofrequency ablation （RFA） with artificial hydrothorax. Artificial hydrothorax was created by infusion of saline via an intrathoracically placed 14-G central venous catheter, which was ultrasound-guided percutaneously inserted before RFA, separating the right lung from the hepatic dome. The adverse reaction and therapeutic efficacy were also analyzed. Results In the 32 patients with 43 lesions in the hepatic dome （4 tumors in segment IV, 21 tumors in segment VII and 18 tumors in segment Ⅷ）, 18 lesions of 14 patients were not observed by ultrasound before the operation. Thirty-two patients received the ultrasound-guided placement of intrathoracical catheter, and （1606.3 ± 485.9）ml （1000-2500 ml） saline solution was infused successfully. After obtaining an image of the whole tumor, 31 patients received percutaneous RFA therapy on schedule, and 22 patients received percutaneous transdiaphragmatic RFA therapy. One patient with 2 lesions gave up the treatment, because one of his tumors was not detectable by ultrasound. Diaphragmatic muscle hemorrhage was seen in two patients, subcutaneous edema in two patients, and pneumothorax in one patient. All the complications were cured, and no serious complications or related death occurred. 1-month follow-up with contrast-enhanced CT/MRI images showed that 29 patients had complete ablation, and the effective rate of this technique was 93.5% （29/31）. Conclusions Artificial hydrothorax helps us not only to visualize the whole tumor in the hepatic dome, but also offers a transdiaphragmatic route for therapy. Ultrasound-guided percutaneous RFA with artificial hydrothorax is a feasible, safe, and effective technique for treating liver cancer in the hepatic dome and wo

关 键 词：肝肿瘤 超声检查 介入性 导管消融术 人工胸水 治疗结果 

分 类 号：R735.7[医药卫生—肿瘤]