超声引导下经皮微波消融治疗膈顶部肝癌的疗效观察

目的探讨超声引导下经皮微波消融(MWA)治疗膈顶部肝肿瘤的疗效及应用价值。方法对2011年3月-2017年12月期间接受超声引导下MWA治疗的133例隔顶部肝癌患者(A组)及同期接受治疗的136例肝癌患者(B组)的临床资料进行回顾性分析,总结超声引导下经皮MWA治疗膈顶部肝肿瘤的技术路线、临床疗效及安全性。结果 MWA治疗后,A、B组的完全消融率分别为88.7%和95.6%,A组患者的完全消融率明显低于B组(P=0.036)。两组间严重并发症的发生率差异无统计学意义(P>0.05)。A组患者术后6个月、12个月无复发生存率分别为53.5%和39.0%,术后12个月、24个月、36个月生存率分别为80.8%、57.7%和50.3%。B组患者术后6个月、12个月无复发生存率分别为69.0%和57.8%,术后12个月、24个月、36个月生存率分别为92.1%、77.8%和71.9%。B组患者的无瘤生存率和总生存率明显高于A组,差异有显著统计学意义(P<0.01)。结论尽管膈顶部肿瘤位置的特殊性影响MWA的治疗效果,且术后更易复发,但膈顶部肿瘤并非MWA的禁忌证,MWA仍是治疗膈顶部肝癌的一种安全有效的治疗方法。

Ultrasound-guided percutaneous microwave ablation for the treatment of hepatocellular carcinoma adjacent to diaphragmatic dome

Objective To discuss the curative effect and application value of ultrasoundguided percutaneous microwave ablation(MWA) in treating hepatocellular carcinoma(HCC) adjacent to diaphragmatic dome. Methods The clinical data of 133 patients with HCC located at diaphragmatic dome(group A) and 136 patients with HCC located in liver parenchyma(group B), who received percutaneous MWA treatment during the period from March 2011 to December 2017 at authors’ hospital, were retrospectively analyzed. The technical key points, clinical curative effect and safety of MWA were summarized. Results After MWA treatment, the complete ablation rates in group A and group B were 88.7% and 95.6%, respectively. The complete ablation rate in group A was significantly lower than that in group B(P=0.036). There was no significant difference in the incidence of severe complications between the two groups(P>0.05). In group A, the 6-month and 12-month recurrence-free survival rates were 53.5% and 39.0% respectively, and the 12-month, 24-month and 36-month survival rates were 80.8%, 57.7% and 50.3% respectively. In group B, the 6-month and 12-month recurrence-free survival rates were 69.0% and 57.8% respectively, and the 12-month, 24-month and 36-month survival rates were 92.1%, 77.8% and 71.9% respectively. Tumor-free survival rate and overall survival rate in group B were significantly higher than those in group A, the differences were statistically significant(P<0.01). Conclusion Although the particularity of the location of HCC adjacent to diaphragmatic dome affects the therapeutic effect of MWA and HCC located at such site is more likely to recur after ablation, the tumors located at diaphragmatic dome are not a contraindication of MWA, and MWA has still been a safe and effective treatment for HCC located at diaphragmatic dome.