人工腹腔积液在超声引导经皮热消融肝肿瘤中的应用

目的 评估人工腹腔积液在超声引导经皮热消融肝肿瘤中的可行性、安全性及有效性.方法 61例肝肿瘤患者共70个病灶拟行超声引导经皮热消融,术前注入人工腹腔积液.观察人工腹腔积液操作成功率、注入后是否达到预期效果、并发症及消融的局部疗效.结果 人工腹腔积液操作成功率为100%(61/61).73.7%(42/57)紧邻胃肠道的病灶成功与胃肠道分离;66.7%(6/9)靠近膈肌因肺遮挡超声无法清楚显示的病灶清楚显示;88.2%(15/17)靠近腹壁的病灶成功与腹壁分离;6个靠近胆囊的病灶均未能与胆囊分离;1个大血管包绕的病灶获得更安全的穿刺路径.有腹部手术史患者注入人工腹腔积液后肝和周围肠管成功分离率低于无腹部手术史患者,差异有统计学意义[52.4%(11/21) vs 86.1%(31/36),χ2=7.782,P=0.005].未发生与人工腹腔积液操作相关的并发症;6例患者发生与人工腹腔积液操作相关的不良反应,分别为呛咳(1例)、右侧反应性胸腔积液(5例).全组未出现与治疗相关的死亡.首次消融后完全消融率达89.8%(44/49),二次消融后完全消融率为95.9%(47/49).结论 人工腹腔积液的应用,使位于超声盲区无法进行热消融的肝穹隆部肿瘤清楚显示,提高了紧邻胃肠道的肝脏肿瘤热消融安全性,为部分病例提供新的安全穿刺路径,拓宽了消融治疗适应证,使部分困难病例获得了治疗机会.人工腹腔积液安全可行,值得临床进一步推广应用.

Percutaneous ultrasound-guided thermal ablation for liver tumor with artificial ascites

Objective To assess the feasibility,safety and availability of artificial ascites in percutaneous ultrasound-guided thermal ablation procedure.Methods Artificial ascites was performed in 61 difficult cases （70 lesions） before percutaneous ultrasound-guided thermal ablation procedures.The technical success rate,the rate of approaching the procedure goal,complications,and local treatment response were assessed.Results The artificial ascites technical success rate was 100%（61/61）.73.7%（42/57） lesions were separated successfully from the gastrointestinal track after induction of artificial ascites,which were close to the gastrointestinal track; 66.7%（6/9） lesions were clearly revealed,which were adjacent to the diaphragm and could not be completely revealed before; 88.2%（15/17） lesions adjacent to the abdominal wall were separated successfully;one lesion which was surrounded by major vessels without safe puncture path,got a safe puncture path after instilling;but no lesions close to the gallbladder were separated successfully.After induction of artificial ascites,the rate of successfully separated from the gastrointestinal track was significantly lower in patients with a history of previous abdominal surgery than that in patients without a history of previous abdominal surgery [52.4%（11/21） vs 86.1%（31/36）, χ2=7.782,P=0.05].Coughing （1 case） and the pleural effusion of the right pleural cavity （5 cases） were observed after the technique of artificial ascites.No major complications and procedure-related deaths occurred.The completely ablation rate was 89.8%（44/49） at the first ablation,and 95.9%（47/49） at the second supplementary ablation.Conclusions The use of artificial ascites significantly improves the visibility of some tumors located in the blind area of ultrasonography where tumors were previously inappropriate for ultrasound-guided thermal ablation.This procedure also increases the safety of treatment for liver tumors adjacent to the gastrointestinal track,and provides a safe puncture path for some patients.Therefore,it expands the indications of thermal ablation and offers opportunities of treatment for some difficult cases.Artificial ascites are safe,feasible,which should be spread and used in large clinical population.