水隔离技术对降低肝被膜下肿瘤微波消融术后残存的效果评价  

Application of hydrodissection technique in reducing residual tumor tissue of hepatic subcapsular malignancy after microwave ablation and evaluation of its curative effect

作　　者：刘冲 何金瞳 李天 隋凯达 张洲博 洪铎[1] 苏洪英[1] 邵海波[1] LIU Chong;HE Jintong;LI Tian;SUI Kaida;ZHANG Zhoubo;HONG Duo;SU Hongying;SHAO Haibo(Department of Interventional Radiology,First Hospital of China Medical University,Shenyang,Liaoning Province 110001,China)

机构地区：[1]中国医科大学附属第一医院介入科,沈阳110001

出　　处：《介入放射学杂志》2020年第3期267-273,共7页Journal of Interventional Radiology

摘　　要：目的探索水隔离技术是否可降低肝被膜下恶性肿瘤行微波消融术(MWA)后肿瘤残存。方法回顾性分析2015年7月至2019年2月诊断为肝被膜下恶性肿瘤(原发性肝癌或肝转移瘤)并行影像引导下MWA治疗102例患者,共122个肿瘤,根据肿瘤是否行水隔离技术分为水隔离组和对照组,水隔离组为应用注水方法隔离肝脏及邻近结构后行MWA,37例患者47个肿瘤;对照组直接行MWA,65例患者75个肿瘤。比较两组治疗后1个月后影像学检查的肿瘤残存情况,并运用单因素、多因素、Cochran’s and Mantel-Haenszel(CMH)分层分析等方法分析肿瘤残存的影响因素。结果消融技术成功率100%,水隔离技术成功率97.9%。水隔离组与对照组残存率分别为6.5%、21.3%(P=0.03),单因素分析提示水隔离(P=0.03)、肿瘤大小(P<0.001)与肿瘤残存相关;logistic回归分析显示水隔离技术可显著降低肿瘤残存率[OR=0.202,95%CI(0.048~0.849),P=0.029],而肿瘤>3 cm显著增加肿瘤残存率[OR=18.449,95%CI(5.242~64.933),P<0.001]。CMH分层分析显示,相比肝继发恶性肿瘤、术前未行TACE治疗的肿瘤、非膈下(靠近胃肠实质脏器、单纯被膜下)肝被膜下肿瘤,肝脏原发肿瘤[OR=0.123,95%CI(0.015~1.019),P=0.025]、术前行TACE治疗的肿瘤[OR=0.123,95%CI(0.015~1.019),P=0.025]和膈下肝被膜下肿瘤[OR=0.081,95%CI(0.009~0.741),P=0.022]应用水隔离技术降低肿瘤残存率方面的作用更加明显。结论水隔离技术可显著降低肝被膜下恶性肿瘤MWA术后肿瘤残存率,尤其在原发性肝癌、术前行TACE治疗的肿瘤和膈下肝被膜下肿瘤中作用更为明显。Objective To explore whether hydrodissection technology can reduce the residual tumor tissue of hepatic subcapsular malignancy after microwave ablation(MWA).Methods The clinical data of a total of 102 patients with hepatic subcapsular malignancy(primary liver cancer or liver metastasis;122 tumor lesions in total),who underwent image-guided MWA during the period from July 2015 to February 2019 at the First Hospital of China Medical University of China,were retrospectively analyzed.The patients were divided into hydrodissection group(n=37,47 tumor lesions in total)and control group(n=65,75 tumor lesions in total).For the patients of hydrodissection group MWA was performed after liver and adjacent structures were isolated by injection of water,while for the patients of control group MWA was directly carried out.Imaging examination was performed one month after treatment to check the residual survival of tumors,and the factors related to tumor residues were analyzed by univariate and multivariate analysis as well as by Cochran’s and Mantel-Haenszel(CMH)stratified analysis.Results The technical success rate of MWA was 100%,and the technical success rate of hydrodissection was 97.9%.The tumor residual rates in hydrodissection group and control group were 6.5%and 21.3%respectively(P=0.03).Univariate analysis indicated that hydrodissection(P=0.03)and tumor size(P<0.001)were closely related to tumor residual.Logistic regression analysis showed that hydrodissection could significantly reduce tumor residual rate(OR=0.202,95%CI:0.048-0.849,P=0.029),and the tumor diameter>3 cm would remarkably increase tumor residual rate(OR=18.449,95%CI:5.242-64.933,P<0.001).CMH stratified analysis revealed that the effect of hydrodissection technique in reducing tumor residual rate was more obvious for primary liver tumors(OR=0.123,95%CI:0.015-1.019,P=0.025),tumors having been treated with preoperative TACE(OR=0.123,95%CI:0.015-1.019,P=0.025)and subphrenic hepatic subcapsular tumors(OR=0.081,95%CI:0.009-0.741,P=0.022)than for hepatic meta

关 键 词：肝恶性肿瘤 微波消融 水隔离技术 

分 类 号：R735.7[医药卫生—肿瘤]