MR导向经皮微波消融治疗肝癌伴中重度肝硬化  

MR-guided Percutaneous Microwave Ablation for Hepatocellular Carcinoma With Moderate and Severe Cirrhosis

作　　者：刘一铭 许凯豪 焦德超[1] 吴昆鹏 王朝艳[1] 韩新巍[1] Liu Yiming;Xu Kaihao;Jiao Dechao(Department of Interventional Radiology,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院放射介入科,郑州450052

出　　处：《中国微创外科杂志》2022年第10期793-798,共6页Chinese Journal of Minimally Invasive Surgery

基　　金：2020年河南省中青年卫生健康科技创新杰出青年人才培养项目(YXKC2020037)。

摘　　要：目的评价MR引导经皮微波消融(percutaneous microwave ablation,PMA)治疗肝细胞癌(hepatocellular carcinoma,HCC)伴中重度肝硬化的可行性。方法2019年4月~2021年6月,对26例肝癌伴中重度肝硬化(Child-Pugh B级19例,C级7例)在3.0T闭合式MR引导下行PMA。共43枚病灶,最大径(2.86±0.93)cm(0.9~4.8 cm)。术后1个月肝脏增强MR或CT检查评价局部病灶完全消融(complete ablation,CA)或不完全消融(incomplete ablation,ICA),并随访生存情况。结果40枚病灶消融术中显示清晰,3例膈肌下病灶显示稍欠佳。穿刺需调整10次以上10枚病灶,调整7~10次14枚病灶,调整3~6次16枚病灶,3枚病灶调整1~2次即可。3例(11.5%)轻微并发症。1个月随访,局部CA率95.3%(41/43),2枚膈肌下病灶(最大径4.8和3.9 cm)为ICA。肿瘤最大径≤3 cm和>3 cm的局部CA率分别为100%(22/22)和90.5%(19/21)。平均随访18.4月(8~26个月),死亡9例。中位生存期21.0月(95%CI:16.9~25.0),1年、2年总生存率为92.0%和23.9%。结论3.0T MR引导下PMA治疗肝癌伴中重度肝硬化安全可行,对小肝癌有一定技术优势。Objective To evaluate the feasibility and effectiveness of MR-guided percutaneous microwave thermal ablation(PMA)for hepatocellular carcinoma(HCC)with moderate and severe cirrhosis.Methods From April 2019 to June 2021,26 HCC patients with moderate and severe cirrhosis(19 cases with Child-Pugh B and 7 cases with Child-Pugh C)underwent 3.0T MR-guided percutaneous PMA at our department.The maximum diameter of 43 HCC lesions was(2.86±0.93)cm(range,0.9-4.8 cm).Complete ablation(CA)or incomplete ablation(ICA)was evaluated by enhanced MR or CT examination one month after the operation.Overall survival status was evaluated during the follow-up period.Results A total of 40 lesions were clearly displayed during ablation,and 3 subdiaphragmatic lesions were slightly poorly displayed.Puncture adjustment for more than 10 times was needed at 10 lesions,puncture adjustment for 7-10 times was needed at 14 lesions,3-6 times at 16 lesions,and 1-2 times at 3 lesions.There were 3 cases(11.5%)of minor complications.The local CA rate was 95.3%(41/43).Two lesions(maximum diameter,4.8 cm and 3.9 cm,respectively)under the diaphragm were evaluated as ICA at 1 month follow-up.The local CA rates of tumors with maximum diameter≤3 cm and>3 cm were 100%(22/22)and 90.5%(19/21),respectively.The average follow-up was 18.4 months(range,8-26 months).Nine cases died.The median survival time was 21.0 months(95%CI:16.9-25.0),and the 1-year and 2-year overall survival rates were 92.0%and 23.9%.Conclusion 3.0T MR-guided PMA is safe and feasible in the treatment of HCC with moderate to severe cirrhosis and has certain technical advantages for small HCC.

关 键 词：肝细胞癌 MR导向 重度肝硬化 消融治疗 

分 类 号：R735.7[医药卫生—肿瘤] R575.2[医药卫生—临床医学]