肝动脉造影CT引导下经皮穿刺射频消融治疗富血管肝细胞癌的临床研究  

Clinical study of the CT hepatic arteriography guided percutaneous radiofrequency ablation of hypervascular hepatocellular carcinoma

作　　者：程洪涛 郭晨阳 耿翔 胡鸿涛 郑琳 陈呈世 肖金成 宗登伟 黎海亮 Cheng Hongtao;Guo Chenyang;Geng Xiang;Hu Hongtao;Zheng Lin;Chen Chengshi;Xiao Jincheng;Zong Dengwei;Li Hailiang(Department of Minimal-Invasive Intervention,the Affiliated Cancer Hospital of Zhengzhou University,Henan Cancer Hospital,Zhengzhou 450008,China)

机构地区：[1]郑州大学附属肿瘤医院河南省肿瘤医院微创介入科,郑州450008

出　　处：《中华放射学杂志》2022年第7期800-804,共5页Chinese Journal of Radiology

摘　　要：目的探讨肝动脉造影CT(CTHA)引导下经皮穿刺射频消融治疗肝细胞癌的可行性。方法前瞻性纳入河南省肿瘤医院2019年7月至2021年5月诊断为原发性肝癌拟行射频消融治疗的患者44例,其中33例为初治患者、8例为消融术后复发患者、3例为外科切除术后复发患者。术前增强MRI测量的肝细胞癌长径为5~44(17±8)mm。所有患者均先在DSA手术室经右股动脉置入5 F眼镜蛇导管或5 F肝管,插管至肝总动脉或肝固有动脉,随后将患者转运至CT手术室。经肝动脉留置导管高压注射对比剂,行CTHA引导下经皮肝细胞癌射频消融。靶病灶及周边至少5 mm的安全边缘在CTHA显示为无强化的消融坏死区域作为消融终点。消融结束后拔针时消融针道,最后拔除动脉导管及导管鞘。采用Wilcoxon秩和检验比较术前MRI和消融前CTHA发现的病灶数量,统计CTHA引导射频消融技术成功率及CHTA对比剂用量。结果44例患者在消融前CTHA扫描时有13例患者发现术前MRI未能显示的额外病灶。44例患者术前MRI和CTHA显示的病灶数量分别为64和91个,差异具有统计意义(Z=-3.24,P=0.001)。1例患者因消融术中CTHA扫描显示病灶数量大于5枚改为姑息性消融后退出研究,转为经动脉化疗栓塞治疗。其余43例患CTHA即时验证为完全消融,技术成功率为100%。CTHA引导下射频消融术中对比剂用量为30~80(42±14)ml。所有患者均未发生与CTHA引导下射频消融相关的并发症。结论CTHA可发现消融术前增强MRI未能发现的肝细胞癌额外病灶,提高病灶的醒目性,并使病灶重复强化,准确部署射频消融电极的位置。病灶完全消融可通过消融后即刻CTHA来确认。Objective To investigate the feasibility of CT hepatic arteriography(CTHA)guided percutaneous radiofrequency ablation of hepatocellular carcinoma(HCC).Methods Forty-four patients diagnosed with hepatocellular carcinomas were enrolled in this prospective study from September 2019 to May 2021 in Henan Cancer Hospital.Thirty-three out of the 44 patients were treatment naive,8 cases recurred after radiofrequency ablation,and the other 3 patients recurred after surgery.The mean size of HCC nodules was 5-44(17±8)mm measured on enhanced MRI images.Each patient was implanted a 5-French Cobra catheter or a 5-French RH angiographic catheter,then was catheterized into common hepatic artery or proper hepatic artery,under DSA monitoring via right femoral artery.Then the patient was transferred to CT operation room.Percutaneous radiofrequency ablation was performed by CTHA guidance using contrast agent injected via the catheter indwelled in hepatic artery.The endpoint of a complete ablation was a non-enhancing ablation necrosis zone in the target tumor and the target tumor margin at least 5 mm on CTHA.At the end of the procedure,the probe was retracted using tract ablation,and the arterial catheter and sheath were removed.The number of HCC lesions showed on the enhanced MRI and CTHA imaging were compared using Wilcoxon rank-sum test.The technical success rate and volume of contrast agent used during the CTHA ablation procedures were summarized.Results Additional tumors were founded in 13 out of the 44 patients during the CT hepatic arteriography compared with enhanced MRI.The tumors founded by enhanced MRI and CTHA were 64 and 91 respectively,with statistical significance(Z=-3.24,P=0.001).One patient dropped out of the study after palliative ablation and was transferred to transaterial chemoembolization treatment because the number of lesions showed by CTHA scan was more than 5.The other 43 patients got complete ablation verified by immediate postoperative assessment using CTHA.The technical success rate was 100%.The average

关 键 词：癌 肝细胞 导管消融术 射频消融 肝动脉造影 

分 类 号：R735.7[医药卫生—肿瘤]