微波消融治疗特殊部位肝脏恶性肿瘤的有效性及安全性  

Efficacy and safety of microwave ablation for liver malignant tumors in special locations

作　　者：关海涛[1] 袁春旺[2] 王健[1] 范则杨 宋莉[1] 邹英华[1] GUAN Haitao;YUAN Chunwang;WANG Jian;FAN Zeyang;SONG Li;ZOU Yinghua(Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing 100034, China;Department of Hepatology and Interventional Therapy, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China)

机构地区：[1]北京大学第一医院介入血管外科,北京100034 [2]首都医科大学附属北京佑安医院肝病与肿瘤介入治疗科,北京100069

出　　处：《中国介入影像与治疗学》2022年第3期134-137,共4页Chinese Journal of Interventional Imaging and Therapy

摘　　要：目的观察微波消融对特殊部位肝脏恶性肿瘤的有效性及安全性。方法对34例肝脏恶性肿瘤患者的38个病灶行CT和/或超声引导下微波消融治疗,其中毗邻膈肌、毗邻肝包膜各16个,毗邻门静脉一、二级分支3个,毗邻胆囊2个,毗邻肝静脉(下腔静脉旁)1个。消融后1个月复查腹部增强CT或MRI,以改良实体瘤疗效评价标准(mRECIST)评估治疗效果。采用Clavien-Dindo并发症分级法评估并发症。结果对34例均顺利完成微波消融治疗。术后1个月,腹部增强CT或MRI示37个(37/38,97.37%)消融区域呈边界清晰的低密度/低信号改变,动脉期无明显强化,判定为完全缓解;1个(1/38,2.63%)毗邻下腔静脉病灶可见部分残留,为部分缓解。术后24例出现Clavien-DindoⅠ级并发症,包括20例腹部隐痛、3例恶心及1例呕吐,经对症处理后均缓解;2例出现Ⅱ级并发症,其中感染、发热各1例,予抗生素及退热治疗后好转;1例Ⅲa级并发症,表现为腹腔积液,经腹腔穿刺引流后缓解。结论微波消融治疗特殊部位肝脏恶性肿瘤安全、有效。Objective To observe the efficacy and safety of microwave ablation(MWA)for liver malignant tumors in specific locations.Methods Totally 34 patients with 38 lesions of hepatic malignant tumors underwent CT and/or ultrasound-guided MWA,including 16 lesions adjacent to the diaphragm,16 near hepatic capsule,3 adjacent to the first and second branches of portal vein,2 adjacent to the gallbladder and 1 lesion adjacent to the hepatic vein(beside the inferior vena cava).One month after MWA,abdominal enhanced CT or MR examination was performed to evaluate the efficacy of the treatment using the modified response evaluation criteria in solid tumors(mRECIST).Complications were evaluated using Clavien-Dindo complication grading.Results MWA was successfully performed in all 34 patients.One month after MWA,abdominal enhanced CT or MRI showed that the ablation area of 37 lesions(37/38,97.37%)presented as low density/single with clear boundary without obvious arterial enhancement,and the efficacy was judged as complete response.Meanwhile,local residual tumor was found in 1 lesion(1/38,2.63%)adjacent to the inferior vena cava and judged as partial remission.Clavien-Dindo gradeⅠcomplications occurred in 24 cases,including 20 cases of abdominal pain,3 of nausea and 1 of vomiting,which were relieved after symptomatic treatment.GradeⅡcomplications were observed in 2 cases,including 1 case of infection and 1 of fever,which improved after antibiotics and antipyretic therapy.GradeⅢa complication occurred in 1 case,presenting as peritoneal effusion,which was relieved after peritoneal puncture drainage.Conclusion MWA was safe and effective for treatment of liver malignant tumors in specific locations.

关 键 词：肝肿瘤 微波消融 体层摄影术 X线计算机 特殊部位 

分 类 号：R735.7[医药卫生—肿瘤] R815[医药卫生—临床医学]