超声引导微波消融治疗老年肝癌及并发症防范  

Ultrasound-guided percutaneous microwave ablation for liver cancer in the elderly:efficiency and complication prevention

作　　者：余松远[1] 雷冰心 屈亚莉 邓远[1] 蒋迎春[1] 张绍斌[2] 

机构地区：[1]湖北省武汉市医疗救治中心介入超声科,武汉430023 [2]湖北省武汉市医疗救治中心普外科,武汉430023

出　　处：《中华老年多器官疾病杂志》2016年第7期508-511,共4页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的：总结超声引导经皮微波消融（ PMWA）治疗老年肝癌的效果及并发症的防范措施。方法对207例＞65岁老年肝癌患者374个病灶按肿瘤大小和数量分为两组，肿瘤直径＜4 cm且少于3个病灶称为A组；肿瘤直径＞4 cm多于3个病灶或者单个病灶＞6 cm称为B组，两组均进行超声引导PMWA治疗，术后观察疗效和并发症，以超声造影或增强核磁检查病灶无强化为完全消融，治疗后定期随访6～60个月，对有肿瘤进展或复发者行再次消融治疗。结果全组病例经皮微波消融术后1个月增强检查显示完全消融326个病灶，占87.2％（326／374）， A、B两组的1、2、3、4、5年存活率为分别为：A组95.3％、84.6％、82.5％、79.2％、68.8％；B组62.5％、55.6％、31.2％、27.3％、0.0％，两组差异有统计学意义（ P＝0．021）。B组术后出现严重并发症4例，占1．07％（4／374），包括2例腹腔出血，2例肝脓肿。无胃肠及胆管损伤、胆瘘、针道种植。结论 PMWA是治疗老年肝癌的有效方法，肿瘤大小和个数、肝功能基础是影响术后生存期的重要因素，消融针型和功率及时间组合是防止胃肠、胆道、膈肌损伤的有效措施，术后全身支持、抗腹腔感染等综合治疗可减少致命并发症。Objective To determine the therapeutic effect of percutaneous microwave ablation （ PMWA ） on the elderly patients with liver cancer and investigate the precautionary measures for its complications . Methods A total of 207 elderly patients （〉65 years old） with 374 lesions of liver cancer were enrolled in this study .They were divided into 2 groups according to tumor size and number, that is, group A （the tumor diameter less than 4 cm with number less than 3） and group B （over 3 tumors with diameter greater than 4 cm, or a single lesion over 6 cm in size） .The patients of both groups were treated with PMWA .The curative effect and complications were observed after surgery , and contrast enhanced ultrasound examination or MR imaging were employed to evaluate the complete ablation .The patients were regularly followed up for 6 to 60 months after treatment .PMWA was carried out again for those with local tumor progression or recurrence .Results In 1 month after PMWA, totally 326 lesions were completely ablated , accounting for 87.2%（326/374）.The 1-, 2-, 3-, 4-and 5-year survival rates were 95.3%, 84.6%, 82.5%, 79.2%and 68.8%respectively for group A, and 62.5%, 55.6%, 31.2%, 27.3%, and 0.0% for group B, and significant differences were found between the 2 groups （P=0.021）.There were 4 cases （1.07%, 4/374） out of group B having serious complications , including abdominal bleeding in 2 cases and liver abscess in 2 cases.No gastrointestinal and bile duct injury , biliary fistula, or needle tract implantation were found in the subjects .Conclusion PMWA is an effective treatment for liver cancer in the elderly .Tumor size and number , and liver function are main factors for postoperative survival .Ablation needle types , and regimens of power and time are effective measures to prevent the injuries of gastrointestinal tract , bile duct and diaphragm .Postoperative systemic support , anti-abdominal infections and other comprehensive treatment can reduce fatal complications .

关 键 词：老年人 肝癌 微波消融 并发症 

分 类 号：R592[医药卫生—老年医学] R735.7[医药卫生—内科学]