超声引导下第二肝门旁肝细胞癌热消融疗效  

Ultrasound-guided thermal ablation for hepatocellular carcinoma adjacent to the second porta hepatis

作　　者：凌云彪[1] 张小丹 吴宇轩[2] 罗丽萍 曾庆劲[2] 李凯[2] 郑荣琴[2] 许尔蛟[3] Ling Yunbiao;Zhang Xiaodan;Wu Yuxuan;Luo Liping;Zeng Qingjin;Li Kai;Zheng Rongqin;Xu Erjiao(Department of Hepatobiliary Surgery,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Ultrasound,the Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Department of Medical Ultrasonics,the Eighth Affilicated Hospital of Sun Yat-sen University,Guangzhou 518033,China)

机构地区：[1]中山大学附属第三医院肝胆外科,广州510630 [2]中山大学附属第三医院超声科,广州510630 [3]中山大学附属第八医院超声医学科,深圳518033

出　　处：《中华肝脏外科手术学电子杂志》2020年第5期479-483,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家重点研发计划(2017YFC0112000);国家自然科学基金重点项目(81430038);国家自然科学基金(81401434);广东省科技计划项目(2017A020215082,2017A020215137);广州市科技计划项目(201704020164);高校基本科研业务费项目(20ykpy37);深圳市福田区卫生公益性科研项目(FTWS2020022)。

摘　　要：目的探讨超声引导下第二肝门旁肝细胞癌(HCC)热消融治疗的疗效及安全性。方法回顾性分析2014年1月至2019年9月于中山大学附属第三医院行超声引导下热消融治疗的34例第二肝门旁HCC患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男30例,女4例;平均年龄(53±14)岁;病灶最大径≤5 cm。患者行超声引导经皮射频消融或微波消融治疗。观察局部肿瘤进展率、复发率及并发症发生率等。结果 34例患者共34个病灶顺利完成消融治疗,其中射频消融28例,微波消融6例;单针消融病灶27个,双针消融病灶7个。所有病灶术中即时超声造影均显示消融范围完全覆盖原肿瘤病灶,并未见明确血管损伤征象。无发生消融相关死亡。1例患者术后第4天超声检查发现门静脉右支及其分支内血栓形成,未做特殊处理。中位随访时间19(2~61)个月。术后1个月发现1例病灶残留,肿瘤完全消融率为97%(33/34)。术后7个月1例局部肿瘤进展,局部肿瘤进展率为3%(1/34)。结论选择合适病例,采用合理的消融策略,超声引导下对第二肝门旁HCC进行热消融治疗安全有效。Objective To evaluate the efficacy and safety of ultrasound-guided thermal ablation for hepatocellular carcinoma(HCC) adjacent to the second porta hepatis. Methods Clinical data of 34 patients with HCC near the second porta hepatis who underwent ultrasound-guided thermal ablation in the Third Affiliated Hospital of Sun Yat-sen University from January 2014 to September 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 30 patients were male and 4 female, aged(53±14) years on average. The maximum diameter of lesions was ≤5 cm. Patients were treated with ultrasound-guided percutaneous radiofrequency ablation or microwave ablation. The local tumor progression rate, recurrence rate and incidenceof complications were observed. Results 34 patients(34 lesions) received ablation therapy successfully, including 28 cases of radiofrequency ablation and 6 cases of microwave ablation. 27 lesions were treated with single-needle ablation, and 7 lesions were treated with double-needle ablation. All lesions were evaluated with intraoperative real-time contrast-enhanced ultrasound showing that the ablation zone completely covered the original tumor lesions, and no signs of vascular injury were found. No ablation-related death occurred. Thrombus in the right branch and its subbranches of portal vein were found by ultrasonography on the 4th day after operation, and no special treatment was delivered. The median follow-up time was 19(2-61) months. 1 case was found with residual lesion at postoperative 1 month. The tumor ablation rate was 97%(33/34). 1 case experienced local tumor progression with local tumor progression rate of 3%(1/34) 7 months after operation. Conclusions Ultrasound-guided thermal ablation is a safe and efficacious treatment for HCC near the second porta hepatis in suitable cases with reasonable ablation strategies.

关 键 词：癌 肝细胞 消融技术 超声检查 介入性 

分 类 号：R735.7[医药卫生—肿瘤]