导管鞘辅助穿刺技术在CT引导微波消融治疗原发性肝癌中的应用  

Application of catheter sheath-assisted puncture technique in CT-guided percutaneous microwave ablation therapy for primary hepatocellular carcinoma

作　　者：高峰[1] 黄祥忠[1] 任冬青[1] 沈炜[1] 郭新春[1] 高福磊[1] 包凯沪[1] 

机构地区：[1]东南大学医学院附属江阴医院介入科,江苏江阴214400

出　　处：《介入放射学杂志》2016年第12期1074-1077,共4页Journal of Interventional Radiology

摘　　要：目的回顾性病例对照研究CT引导导管鞘辅助穿刺技术在微波治疗原发性肝癌的优势及临床应用价值。方法收集2013年10月至2015年9月接受微波治疗的临床或病理诊断的原发性肝癌患者41例，所有患者均先行TACE治疗，TACE治疗后1个月行经皮微波消融（MWA）治疗．共消融56枚病灶，最大径〈3cm 43枚，3—5cm8枚，〉5cm5枚。导管鞘辅助穿刺技术在传统穿刺基础上，先引入导管鞘，再经鞘管同轴送入微波针进行消融。采用传统微波针直接穿刺16例20枚病灶：导管鞘辅助穿刺25例36枚病灶。MWA治疗后1个月查增强MR评估疗效。结果41例患者成功完成TACE联合经皮MWA治疗。两种穿刺术1次穿刺成功率比较差异具有统计学意义（P=0．004）：病灶最大径〈3cm两组1次穿刺成功率比较差异具有统计学意义（P=0．008），而病灶最大径3—5cm及〉5cm两组1次穿刺成功率则无明显差异（P〉0．05）；同一种穿刺方法不同大小病灶1次穿刺成功率均无明显差异（P〉0．05）。两种穿刺均有一定的并发症发生，其中出血、血管瘘发生率两者比较差异具有统计学意义（P=0．008．P〈0．001），而针道转移发生率则无明显差异（P〉0．05）。治疗后1个月两组疗效比较差异无统计学意义（P〉0．05）。结论CT引导导管鞘辅助穿刺技术的应用可有效减少原发性肝癌微波治疗中的穿刺次数，从而降低了出血、血管瘘等穿刺并发症的发生率，提高了手术的安全性，临床值得进一步推广应用。Objective To retrospectively evaluate the advantages and clinical application of catheter sheath-assisted puncture technique in CT-guided percutaneous microwave ablation （MWA） therapy for primary hepatoccllular carcinoma （HCC）. Methods A total of 41 patients with pathologically or clinically confirmed HCC, who received MWA at authors＇ department during the period from October 2013 to September 2015, were collected. In all patients TACE was performed first, which was followed by MWA one month later. A total of 56 lesions were ablated; 43 lesions had a maximum diameter of 〈3 cm, 8 lesions had a maximum diameter of 3-5 cm and 5 lesions had a maximum diameter of 〉5 cm. The performance of the catheter sheath-assisted puncture technique was as follows： the catheter sheath was placed first, then the microwave needle was inserted through the catheter sheath in a coaxial way to conduct ablation. One month after MWA, contrast-enhanced MRI was performed to evaluate the therapeutic response. Results TACE and subsequent MWA were successfully accomplished in all 41 patients. The success rates of single puncturing of two puncture methods （direct puncture of traditional MWA needle and catheter sheath-assisted puncture） were significantly different （P=0.004）. For lesions with maximum diameter of 〈3 cm, the difference in the success

关 键 词：肝癌 微波 CT引导 导管鞘辅助 

分 类 号：R735.7[医药卫生—肿瘤]