经肝动脉化疗栓塞联合C臂CT引导微波消融治疗肝癌

目的观察经导管肝动脉化疗栓塞(TACE)联合C臂CT引导微波消融(MVA)治疗肝癌的效果,评价以C臂CT动脉灌注成像评估消融范围的可行性。方法 47例肝癌(63个病灶)接受TACE联合C臂CT引导MVA治疗,于消融后即刻行经动脉插管C臂CT灌注成像判断消融范围,记录技术成功率,比较消融后即刻C臂CT与术后24 h内增强CT所示消融灶最大横径和纵径。术后随访观察治疗效果。结果对63个病灶均顺利完成TACE联合MVA治疗,技术成功率100%。消融术后即刻C臂CT测量消融灶最大横径和纵径分别为(3.44±0.95)cm和(4.13±1.01)cm,术后24 h内增强CT显示最大横径和纵径分别为(3.46±0.95)cm和(4.14±1.02)cm,差异均无统计学意义(P均0.05)。术后2例发生右侧反应性胸腔积液(积液量均100 ml),6例发热,未见其他不良反应。术后1个月,38个2.50 cm病灶完全坏死(38/38,100%);25个≥2.50 cm病灶中,24个完全坏死(24/25,96.00%)。术后随访6～25个月,仅2个病灶局部进展(2/63,3.17%),其余病灶未见进展或复发征象。结论 TACE联合C臂CT引导微波消融治疗肝癌安全有效;C臂CT灌注成像可准确评估消融范围。

Transcatheter arterial chemoembolization combined with C-arm CT guided microwave ablation for liver cancer

Objective To observe the effect of transcatheter arterial chemoembolization (TACE) combined with C-arm CT guided microwave ablation (MVA) for treatment of liver cancer, and to evaluate the feasibility of C-arm CT arterial perfusion imaging in evaluating the ablation range. Methods Totally 47 patients with liver cancer (63 lesions) underwent TACE combined with MWA under C-arm CT guidance. Immediately after ablation, C-arm CT perfusion imaging through arterial intubation was performed to observe the ablation range. The technical success rate was recorded. The maximum transverse diameter and longitudinal diameter of ablation lesions were compared between C-arm CT measured immediately after ablation and enhanced CT within 24 h after operation. Postoperative follow-up was conducted to evaluate the therapeutic effect. Results TACE combined with MVA was successfully performed in all 63 lesions, and the technical success rate was 100%. The maximum transverse diameter and longitudinal diameter measured with C-arm CT during operation was (3.44±0.95)cm and (4.13±1.01)cm, respectively, while showed on enhanced CT 24 h after operation was (3.46±0.95)cm and (4.14±1.02)cm, respectively (both P>0.05). Two patients developed right side reactive pleural effusion (effusion volume both <100 ml), 6 patients had fever, and no other adverse reaction was observed. One month after operation, the complete necrosis rate of 38 lesions less than 2.50 cm was 100% (38/38), of 24 lesions more than or equal to 2.50 cm was 96.00% (24/25). During 6-25 months'' following-up, local development was noticed in 2 lesions (2/63, 3.17%), no sign of recurrence nor development was found in the rest lesions. Conclusion TACE combined with C-arm CT guided MVA was safe and effective for treatment of liver cancer. C-arm CT perfusion imaging could accurately evaluate the ablation range of MVA.