人工胸腔积液在超声引导经皮消融肝肿瘤中的应用

目的评估人工胸腔积液在超声引导经皮消融肝肿瘤中应用的可行性、安全性及有效性。方法 25例肝肿瘤患者共31个病灶,因病灶位于肝穹隆部受肺气影响显示不清或病灶一侧有大血管包绕、胆囊阻挡常规消融无穿刺路径,术前注入人工胸腔积液。观察注入人工胸腔积液成功率、注入胸腔积液后是否达到预期效果、并发症及消融局部疗效。结果注入人工胸腔积液操作成功率为96.0%(24/25)。注入人工胸腔积液后100%(24/24)达到预期目的。28个位于肝S7或S8区原显示不清或显示不全的病灶显示清晰,且其中常规消融穿刺路径被胆囊阻挡的2个病灶均获得经肋膈角处进针的路径;2个常规消融穿刺路径受大血管阻碍的病灶也均获得经胸腔经膈肌的安全穿刺路径。2例患者发生与人工胸腔积液操作相关的并发症,分别为皮下积液以及气胸;1例患者出现不良反应,该例患者在操作过程中出现呛咳。全组未出现严重并发症及与治疗相关的死亡。第1次消融后完全消融率达84.0%(21/25),二次消融后完全消融率达92.0%(23/25)。结论人工胸腔积液的应用,使位于超声盲区无法进行消融的肝穹隆部肿瘤得以清楚显示、对部分病例能提供新的安全穿刺路径,因此拓宽了消融治疗适应证,使部分困难病例获得了治疗机会。人工胸腔积液安全、可行,值得临床进一步推广应用。

Percutaneous ultrasound-guided ablation for liver tumor with artificial pleural effusion

Objective To assess the feasibility, safety and availability of artificial pleural effusion in percutaneous ultrasound-guided ablation for liver tumor procedure. Methods Twenty-five difficult cases （total 30 lesions） were infused with artificial pleural effusion before percutaneous ultrasound-guided ablation procedures, the lesions were not clearly revealed when located in the hepatic dome, or had no proper puncture path because of blocking by major vessels or gallbladder. The technique successful rate, the rate of approaching the procedure goal, complications and local treatment response had been observed. Results The technique successul rate of artificial pleural effusion was 96.0% （24/25） , the achieved puq0ose rates was 100% （24/24） after artificial pleural effusion injection. Twenty-eight lesions near the hepatic dome, which were partially or completely sheltered by gas-containing pulmonary tissue originally were clearly visualized in the S7 or S8 of the liver after of artificial pleural effusion. Moreover, two of the 28 lesions surrounded by gallbladder at the same time, got safe puncture paths through pleural cavity. Another two lesions surrounded by major vessels were safely punctured via the pleural cavity. Subcutaneous effusion （1 case ） and pneumothorax （1 case） were observed as the minor complications associated specifically with the intrapleural fluid infusion procedure, coughing was observed in 1 case as the adverse effect. No major complications and procedure-related death occurred. The complete ablation rate was 84.0% （21/25） after the first ablation,92.0% （23/25） after the second supplementary ablation. Conclusions The use of artificial pleural effusion significantly can improve the visibility of tumors located in the hepatic dome （ the blind area of uhrasonography） which is difficult for ultrasound-guided ablation, and provide a safe puncture path for some lesions. Therefore, it expands the indication of thermal ablation and offers opportunities of treatment for some difficult cases. Artificial pleural effusion is safe, feasible, and should be more widely used in clinically.