超声引导下经皮非接触式联合接触式射频消融治疗肝包膜下小肝细胞癌  

Ultrasound-guided percutaneous non-contact combined contact radiofrequency ablation for the treatment of subcapsular small hepatocellular carcinoma

作　　者：高志玲[1] 吴凡[1] 何峥[1] GAO Zhiling;WU Fan;HE Zheng(Department of Ultrasonic Diagnosis,Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院超声医学科,上海201203

出　　处：《肿瘤影像学》2020年第6期554-558,共5页Oncoradiology

基　　金：上海中医药大学附属曙光医院中西医结合研究专项(SGZXY-201908)。

摘　　要：目的:探讨超声引导下经皮非接触式联合接触式射频消融治疗肝包膜下小肝细胞癌的疗效和安全性。方法:回顾并分析2015年1月—2019年1月于上海中医药大学附属曙光医院接受超声引导下非接触式联合接触式射频消融术治疗的32例包膜下小肝癌患者的临床资料,其中男性24例,女性8例,年龄36~82岁,平均(58.0±10.1)岁,肿瘤最大径0.80~2.95 cm,平均直径(1.84±0.53)cm。观察并记录消融治疗效果、并发症发生率及复发率。结果:32例患者,病灶共39个,均成功行超声引导下非接触式联合接触式射频消融术,术中采用人工胸腔积液3例,人工腹腔积液18例,人工胸、腹腔积液2例,无辅助手段9例。术后并发肝脓肿伴胆汁瘤1例,发热6例,其中2例体温>38℃,术中、术后未发生穿刺部位出血、未出现膈肌损伤、胃肠道损伤穿孔、胆囊损伤、腹壁和皮肤烫伤、消化道出血、腹腔内出血、腹膜炎及肝功能衰竭等严重并发症。术中即刻实时超声造影均提示病灶消融完全。射频消融术后1个月复查,39个病灶均完全灭活,完全消融率100%。随诊12~48个月,1年生存率为100%,4例患者肝内复发,肝周及腹腔内未出现复发及转移。结论:超声引导下非接触式联合接触式射频消融治疗包膜下小肝癌安全有效,值得临床推广应用。Objective:To investigate the efficacy and safety of ultrasound-guided percutaneous non-contact combined contact radiofrequency ablation in the treatment of subcapsular small hepatocellular carcinoma.Methods:The clinical data of 32 patients with subcapsular hepatocellular carcinoma who received ultrasound-guided non-contact combined contact radiofrequency ablation in Shuguang Hospital Affiliated to Shanghai University of Chinese Medicine from Jan.2015 to Jan.2019 were retrospectively analyzed.Among them,24 patients were male and 8 were female,aged from 36-82 year,with an average age of(58.0±10.1)year.The maximum diameter of the lesions ranged from 0.80 to 2.95 cm,the average diameter was(1.84±0.53)cm.The effect of ablation,complication rate and recurrence rate were observed and recorded.Results Thirty-two patients with a total of 39 lesions were successfully treated with ultrasound-guided non-contact combined contact radiofrequency ablation.Intraoperatively,artificial pleural ascites were performed in 3 cases,artificial abdominal ascites in 18 cases,artificial abdominal and pleural ascites in 2 cases,and no auxiliary interventions in 9 cases.Postoperative liver abscess accompanied by biloma occurred in 1 case,and fever occurred in 6 cases,including 2 cases whose body temperature exceeded 38℃.No serious complication such as intraoperative or postoperative bleeding at the puncture site,injury of diaphragm,gastrointestinal tract,gallbladder injury,abdominal wall and skin scald,gastrointestinal bleeding,intra-abdominal bleeding,peritonitis and liver failure occurred.Intraoperative real-time contrast-enhanced ultrasound was performed immediately,which indicated that the lesion was completely ablated.Re-examination one month after radiofrequency ablation showed that all 39 lesions were completely inactivated,with a complete ablative rate of 100%.The patients were followed up for 12 to 48 months,and the 1-year survival rate was 100%.During the postoperative follow-up,intrahepatic recurrence occurred in 4 cases.No tum

关 键 词：超声 肝包膜下 小肝细胞癌 射频消融 非接触式 

分 类 号：R735.7[医药卫生—肿瘤] R445.1[医药卫生—临床医学]