CT引导下经肺或肋膈角射频消融治疗肝顶部肿瘤

目的探讨CT引导下、经肋膈角或肺组织对肝顶部肿瘤进行射频消融治疗的安全性及可行性。方法对45例肝顶部肿瘤患者采用CT引导下经肋膈角或肺组织入路行射频消融治疗。记录过肺组织或肋膈角电极针数目及肺组织内电极针长度。分析围手术期并发症及临床疗效。结果 45例肝顶部肿瘤患者,原发性肝癌34例,转移癌11例。全身麻醉34例,局部麻醉11例。病变最大径0.91~6.67cm,中位数1.83cm。肺组织内电极长度0~59.42mm,中位数9.90mm。单针过肺13例,2针同时过肺13例,3针同时过肺3例,单独1支过肋膈角8例,1支过肋膈角同时1支过肺组织7例,1支过肋膈角同时2支过肺组织1例。无症状少量气胸11例(11/45,24.44%)。肺组织穿刺针道少量出血6例,右肩部疼痛9例,1周左右症状消失。随访3~14个月,局部复发7例(7/45,15.56%)。结论经肋膈角或肺穿刺射频消融治疗肝脏恶性肿瘤安全可行,尤其对于射频消融治疗时常规路径无法到位的肝顶部肿瘤,可采用此方法。

Trans-pulmonary or trans-costophrenic angle CT-guided radiofrequencyablation for malignant liver neoplasms abutting the diaphragm

Objective To explore the safety and feasibility of trans-pulmonary or trans-costophrenic angle CT-guided radiofrequency ablation for malignant liver neoplasms abutting the diaphragm. Methods Totally 45 patients with malignant liver neoplasms abutting the diaphragm were treated with trans-pulmonary or trans-costophrenic angle CT-guided radiofrequency ablation by CelonProSurge bipolar coagulation electrodes. The number of electrodes and the length of the electrode in the lung parenchyma were recorded. Perioperative complications and clinical efficacy were analyzed. Results Among the 45 patients, 34 patients were treated under general anesthesia and the other 11 were treated with local anesthesia, and 34 cases were primary liver cancer, the other 11 patients were liver metastasis. The median of the largest diameters of the lesions was 1.83 cm (0.91-6.67 cm). The lung tissue was punctured by 1 electrode in 13 cases, simultaneously punctured by 2 electrodes in 13 cases and 3 electrodes in 3 cases. In 7 patients, the lung tissue and the costophrenic angle was punctured separately by 1 electrode. In one patient, the lung tissue was punctured by 2 electrodes, at the same time the costophrenic angle was punctured by another 1 electrode. The median length of the electrode in the lung parenchyma was 9.90 mm (0-59.42 mm). Asymptomatic pneumothorax occured in 11 cases (11/45, 24.44%). A small amount of hemorrhage of the electrode track in the lung parenchyma occured in 6 cases. The symptom of right shoulder pain happened in 9 cases, which disappeared in 1 week. Follow-up times were 3 to 14 months, local recurrence happened in 7 cases (7/45, 15.56%). Conclusion Trans-pulmonary or trans-costophrenic angle CT-guided radiofrequency ablation of malignant liver neoplasms is a feasible and safe therapeutic option which is especially suitable for lesions in the hepatic dome and can not be treated by conventional approaches.