超声引导经皮微波消融脾肿瘤的疗效分析

目的分析超声引导经皮微波消融脾肿瘤的可行性、安全性和有效性。方法7例患者共8个病灶行微波消融治疗，病理诊
断分别为卵巢转移癌2个，肺、胃、肝、直肠转移癌各1个，血管瘤1个，炎性假瘤1个，肿瘤最大直径1.3~6.2（3.1±1.9）cm。水冷微
波天线在超声引导下经皮植入肿瘤内，消融中一根20 G热敏电偶测温针植入瘤周5 mm处实时监测热场温度。微波辐射功率
设置50~60 W。治疗后1、3、6月以及之后每隔6个月行增强影像（超声造影、CT/MRI）检查评判疗效。结果所有肿瘤均经1次
微波消融治疗达到完全坏死。在中位随访13（4 ~92）月内无肿瘤局部进展发生。影像检查消融区边界清晰且随时间延长逐渐
缩小。1 例卵巢癌脾转移患者消融后11 月脾脏新生另一病灶，再次行微波消融后完全坏死。转移癌患者消融后中位生存期
13.0（4.0~92.0）月。除发热和腹痛外无治疗相关严重并发症发生。结论微波消融治疗适合的脾脏肿瘤患者是一种安全有效的
微创介入技术。

Clinical evaluation of ultrasound-guided percutaneous microwave ablation of splenictumors

Objective To investigate the feasibility, safety and efficacy of ultrasound-guided percutaneous microwave ablation
(MWA) of splenic tumors. Methods Seven patients with 8 pathologically confirmed splenic tumors (including 2 metastases
from the ovary and 4 from the lung, gastric adenocarcinoma, hepatocellular carcinoma, or rectal carcinoma; 1 hemangioma
and 1 inflammatory pseudotumor) with sizes ranging from 1.3 to 6.2 cm (mean 3.1±1.9 cm) were treated with MWA. A cooled
shaft needle antenna was percutaneously inserted into the tumor under ultrasound guidance. A thermocouple was placed
about 0.5 cm away from the tumor to monitor the temperature in real time during the ablation. The microwave emitting power
was set at 50-60 W. The treatment efficacy was assessed by contrast-enhanced imaging at 1, 3 and 6 months following the
procedure, and every 6 months thereafter. Results All the tumors were completely ablated in a single session and no
complications occurred. No local tumor progression was observed during a median follow up time of 13 months (4 to 92
months). The ablation zone, well defined on contrast-enhanced imaging, was gradually reduced with time. A new metastatic
lesion was detected in the spleen at 11 months after the ablation in a ovarian carcinoma patient and was successfully treated by
a second MWA. The post-ablation survival of the patients with splenic metastasis was 13 months (range 4 to 92 months). No
complications other than fever and abdominal pain were observed in these patients. Conclusion Ultrasound-guided
percutaneous MWAis a safe and effective minimally-invasive technique for treatment of splenic tumors in selected patients.