人工腹水辅助超声引导下经皮微波消融治疗邻近横膈肝癌的应用价值

目的探讨人工腹水辅助超声引导下经皮微波消融（MWA）治疗邻近横膈肝癌的应用价值。 方法选取浙江中医药大学附属西溪医院2016年1月至2019年10月，行经皮MWA治疗邻近横膈原发性肝癌的患者83例，共96个病灶。83例患者依据是否建立人工腹水分为：人工腹水组（A组）40例；非人工腹水组（B组）43例。依据病灶声像图显示清晰完整度进行评分，比较2组病例声像图质量。术后1个月行增强MRI或增强CT检查以评估近期疗效，后续每隔3~6个月行增强MRI或增强CT评估局部肿瘤进展情况。对2组患者的不良反应、并发症以及术后疗效进行对比观察。 结果术中病灶声像图显示清晰完整度评分A组为（4.81±0.35）分，B组为（3.54±0.48）分，2组差异有统计学意义（t=15.352，P<0.05）。不良反应及并发症：发热A组19例（19/40，47.5%），B组20例（20/43，46.5%），2组差异无统计学意义（P=0.928）；上腹部隐痛A组16例（16/40，40.0%），B组19例（19/43，44.2%），2组差异无统计学意义（P=0.700）；胸腔积液A组1例（1/40，2.5%），B组12例（12/43，27.9%），2组差异有统计学意义（χ²=8.295，P=0.004）；横膈损伤A组0例，B组6例（6/43，14.0%），2组差异有统计学意义（P=0.026）。消融后1个月，A组完全消融率为97.5%（39/40），B组完全消融率为95.3%（41/43），2组差异无统计学意义（P=0.600）。83例患者中位随访时间21个月，A组与B组局部肿瘤进展率分别为5.0%（2/40）、7.0%（3/43），2组差异无统计学意义（P=0.705）。 结论人工腹水辅助超声引导下经皮MWA治疗邻近横膈肝癌可提高病灶声像图质量且消融安全性更高。

Value of ultrasound-guided percutaneous microwave ablation with artificial ascites in treatment of liver cancer adjacent to the diaphragm

ObjectiveTo explore the value of ultrasound-guided percutaneous microwave ablation (MWA) with artificial ascites in the treatment of liver cancer adjacent to the diaphragm. MethodsEighty-three patients with 96 lesions of primary liver cancer adjacent to the diaphragm treated by percutaneous MWA from January 2016 to October 2019 at Xixi Hospital Affiliated to Zhejiang Chinese Medical University were selected. According to whether artificial ascites was used during ablation, the patients was divided into either an artificial ascites group (group A, 40 cases) or a non-artificial ascites group (group B, 43 cases). The lesions were scored according to the clarity and completeness on images. The quality of sonogram was compared between the two groups. Contrast-enhanced MRI or contrast-enhanced CT was performed one month after ablation to evaluate the short-term efficacy, and then every 3-6 months to evaluate local tumor progression. The adverse reactions, complications, and postoperative efficacy of the two groups were compared. ResultsThe score of clarity and completeness was 4.81±0.35 in group A and 3.54±0.48 in group B, and the difference between the two groups was statistically significant (t=15.352, P<0.05). The statistics of adverse reactions and complications are as follows: 19 cases with fever in group A (19/40, 47.5%) and 20 cases in group B (20/43, 46.5%), with no significant difference between the two groups (P=0.928);16 cases with upper abdominal dull pain in group A (16/40, 40.0%) and 19 cases in group B (19/43, 44.2%) , with no significant difference between the two groups (P=0.700); 1 case with pleural effusion in group A (1/40, 2.5%) and 12 cases in group B (12/43, 27.9%), with a significant difference between the two groups (χ²=8.295, P=0.004); 0 cases with diaphragmatic injury in group A and 6 cases in group B (6/43, 14.0%) with a significant difference between the two groups (Fisher's exact test, P=0.026). One month after ablation, the complete ablation rate was 97.5% (39/40) in group A and 95.3% (41/43) in group B; there was no significant difference between the two groups (P=0.600). The median follow-up time for the 83 patients was 21 months. The rate of local tumor progression was 5.0% (2/40) in group A and 7.0% (3/43) in group B, and there was no significant difference between the two groups (P=0.705). ConclusionArtificial ascites assisted ultrasound-guided percutaneous MWA can improve the quality of sonogram and the safety of ablation in the treatment of liver cancer adjacent to the diaphragm.