超声引导微波消融治疗老年肝癌及并发症防范

目的总结超声引导经皮微波消融(PMWA)治疗老年肝癌的效果及并发症的防范措施。方法对207例65岁老年肝癌患者374个病灶按肿瘤大小和数量分为两组,肿瘤直径4 cm且少于3个病灶称为A组;肿瘤直径4 cm多于3个病灶或者单个病灶6 cm称为B组,两组均进行超声引导PMWA治疗,术后观察疗效和并发症,以超声造影或增强核磁检查病灶无强化为完全消融,治疗后定期随访6~60个月,对有肿瘤进展或复发者行再次消融治疗。结果全组病例经皮微波消融术后1个月增强检查显示完全消融326个病灶,占87.2%(326/374),A、B两组的1、2、3、4、5年存活率为分别为:A组95.3%、84.6%、82.5%、79.2%、68.8%;B组62.5%、55.6%、31.2%、27.3%、0.0%,两组差异有统计学意义(P=0.021)。B组术后出现严重并发症4例,占1.07%(4/374),包括2例腹腔出血,2例肝脓肿。无胃肠及胆管损伤、胆瘘、针道种植。结论 PMWA是治疗老年肝癌的有效方法,肿瘤大小和个数、肝功能基础是影响术后生存期的重要因素,消融针型和功率及时间组合是防止胃肠、胆道、膈肌损伤的有效措施,术后全身支持、抗腹腔感染等综合治疗可减少致命并发症。

Ultrasound-guided percutaneous microwave ablation for liver cancer in the elderly: efficiency and complication prevention

Objective To determine the therapeutic effect of percutaneous microwave ablation (PMWA) on the elderly patients with liver cancer and investigate the precautionary measures for its complications. Methods A total of 207 elderly patients(>65 years old) with 374 lesions of liver cancer were enrolled in this study. They were divided into 2 groups according to tumor size and number, that is, group A (the tumor diameter less than 4 cm with number less than 3) and group B (over 3 tumors with diameter greater than 4 cm, or a single lesion over 6 cm in size). The patients of both groups were treated with PMWA. The curative effect and complications were observed after surgery, and contrast enhanced ultrasound examination or MR imaging were employed to evaluate the complete ablation. The patients were regularly followed up for 6 to 60 months after treatment. PMWA was carried out again for those with local tumor progression or recurrence. Results In 1 month after PMWA, totally 326 lesions were completely ablated, accounting for 87.2% (326/374). The 1-, 2-, 3-, 4-and 5-year survival rates were 95.3%, 84.6%, 82.5%, 79.2% and 68.8% respectively for group A, and 62.5%, 55.6%, 31.2%, 27.3%, and 0.0% for group B, and significant differences were found between the 2 groups (P=0.021). There were 4 cases (1.07%, 4/374) out of group B having serious complications, including abdominal bleeding in 2 cases and liver abscess in 2 cases. No gastrointestinal and bile duct injury, biliary fistula, or needle tract implantation were found in the subjects. Conclusion PMWA is an effective treatment for liver cancer in the elderly. Tumor size and number, and liver function are main factors for postoperative survival. Ablation needle types, and regimens of power and time are effective measures to prevent the injuries of gastrointestinal tract, bile duct and diaphragm. Postoperative systemic support, anti-abdominal infections and other comprehensive treatment can reduce fatal complications.