肝脏恶性肿瘤射频消融治疗及其术后影像表现  

Radiofrequency ablation of hepatic malignant tumor and postoperative imaging findings

作　　者：孙文杰 高知玲[2] 高雨佳 张永梅[2] 张伟[2] 牛建栋[2] 邱海静 陈勇[3] SUN Wenjie;GAO Zhiling;GAO Yujia;ZHANG Yongmei;ZHANG Wei;NIU Jiandong;QIU Haijing;CHEN Yong(Ningxia Medical University ,Yinchuan 750004,China;Department of Radiology,General Hospital of Ningjcia Medical University ,Yinchuan 750004 ,China;Department of Radiology Interventional,General Hospital of Ningjcia Medical University ,Yinchuan 750004 ,China)

机构地区：[1]宁夏医科大学,宁夏银川750004 [2]宁夏医科大学总医院放射科,宁夏银川750004 [3]宁夏医科大学总医院放射介入科,宁夏银川750004

出　　处：《实用放射学杂志》2019年第8期1303-1306,1335,共5页Journal of Practical Radiology

基　　金：国家自然科学基金项目(61061005,61761039);宁夏自治区人社厅留学人员创新项目([2017]659);宁夏回族自治区重点研发计划项目(2018BFH03021).

摘　　要：目的探讨射频消融(RFA)技术在肝脏恶性肿瘤治疗中的意义及术后的影像学改变。方法回顾性分析166例行RFA的肝脏恶性肿瘤患者术后消融效果、术中反应、术后并发症以及术后影像学变化。结果(1)本组98例原发性肝癌患者中,完全消融率为96.94%;68例转移瘤患者中,完全消融率为100%;二者之间无统计学差异。(2)术中不良反应:疼痛,Ⅰ度疼痛82例,Ⅱ度疼痛76例,Ⅲ度疼痛8例;血压变化,平稳113例,升高66例,降低4例;胃肠道反应,恶心16例,恶心伴呕吐5例;(3)本组患者中1例出现心包填塞;肝脏包膜下少量出血5例;胸腔少量积液7例;气胸3例;(4)术后即刻CT表现:炎性反应带,肝癌出现率93.88%,肝转移瘤出现率89.71%,二者无统计学差异(P=0.384);术区高密度灶,肝癌出现率77.55%,肝转移瘤出现率45.59%,差异有统计学意义(P=0.002);气泡影,肝癌出现率82.65%,肝转移瘤出现率38.24%,差异有统计学意义(P<0.001);动静脉分流,肝癌出现率31.63%,肝转移瘤出现率17.65%,差异有统计学意义(P=0.001)。结论 RFA在肝脏肿瘤治疗方面具有治疗较彻底、创伤小、并发症少、可重复性好等特点,并且术后随访方案成熟,是肝脏恶性肿瘤局部治疗的重要方法之一。Objective To explore the significance of radiofrequency ablation( RFA) in the treatment of hepatic malignant tumors and postoperative imaging findings. Methods A retrospective analysis of intraoperative response, postoperative complications and postoperative imaging changes of 166 patients with hepatic malignant tumor was performed after RFA.Results (1) In this group of 98 patients with primary liver cancer,the complete ablation rate was 96.94%;in 68 patients with metastatic tumors, the complete ablation rate was 100%;there was no statistical difference between them.(2) Intraoperative adverse reactions:82 cases of degree I pain,76 cases of degree U pain,8 cases of degree DI pain;blood pressure changes: 113 cases with stable blood pressure,66 cases with elevated blood pressure,4 cases with decreased blood pressure;gastrointestinal reactions: 16 cases of nausea, 5 cases of nausea and vomiting.(3) Complication 1 case had pericardial tamponade;5 cases had the few hemorrhages under the liver capsule;7 cases had pleural effusion in the chest;3 cases had pneumothorax.(4) Postoperative CT imaging findings:the incidence rate of inflammatory reaction zone, there was no statistical difference between liver cancer and hepatic metastases (93.88% vs 89.71%,P=0.384);the incidence rate of high density area,there was statistical difference between liver cancer and hepatic metastases(77.55% vs 45.59%,P=0.002);the incidence of air bubble,there was statistical difference between liver cancer and hepatic metastases(82.65% vs 38.24%,P<0.001);the incidence of hepatic arteriovenous shunt,there was statistical difference between liver cancer and hepatic metastases (31.63% vs 17.65%,P=0.001).Conclusion In the treatment of hepatic tumors,it has the characteristics of thorough treatment Jess trauma Jess complications. good reproducibility, etc,and the postoperative follow-up program is mature,which is one of the important methods for local treatment of hepatic malignant tumors.

关 键 词：肝脏 恶性肿瘤 射频消融 

分 类 号：R735.7[医药卫生—肿瘤] R815[医药卫生—临床医学]