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目的探讨人造胸水和术中超声造影辅助下超声引导的经皮射频消融治疗肝穹窿部肿瘤的安全性和可行性。方法回顾性分析2008年1月至2009年6月期间四川大学华西医院肝胆胰外科在术中超声造影和人造胸水辅助下行经皮射频消融治疗的9例肝穹窿部肝癌患者的临床资料,并对围手术期和随访复发情况进行分析。结果 9例患者共12个病灶均成功完成了人造胸水辅助下的射频消融治疗。注入胸水量为(2 444±464)ml(2 000~3 000 ml);每例患者消融时间为12~24 min(中位数12 min),每个肿瘤为(15±5)min。术中未发生血胸、气胸等,无手术相关死亡发生。术后1例患者出现腹腔中量积液约2 000 ml,考虑与低蛋白血症有关,补充人血白蛋白后于术后第4天腹水消失。胸腔引流液总量为(717±372)ml(250~1 420 ml),术后3~5 d拔除引流管。术后随访时间为7~23个月(中位数15个月)。有3例患者分别在术后5、6和7个月出现复发病灶,其中2例分别经介入和保守治疗后病情稳定,1例术后6个月复发患者因高血压心脏病和肝功能恶化于术后16个月死亡。其余患者在随访期内均存活,未见复发、转移。结论术中超声造影和人造胸水辅助经皮射频消融治疗肝穹窿部肝癌安全、有效,有较高临床应用价值。
Objective To investigate the safety and feasibility of percutaneous radiofrequency ablation guided by artificial pleural effusion and intraoperative contrast-enhanced ultrasound in the treatment of hepatic vault tumors. Methods The clinical data of 9 patients with hepatic fornix hepatocellular carcinoma treated by intraoperative ultrasound contrast and artificial pleural effusion assisted by percutaneous radiofrequency catheter ablation were retrospectively analyzed from January 2008 to June 2009 in Huaxi Hospital of Sichuan University. Perioperative and follow-up of recurrence were analyzed. Results A total of 12 lesions of 9 patients were successfully completed radiofrequency ablation assisted by artificial pleural effusion. Infusion of pleural fluid was (2 444 ± 464) ml (2 000-3 000 ml). The duration of each patient’s ablation was 12-24 min (median 12 min) and each tumor was (15 ± 5) min. No hemothorax, pneumothorax and other surgery occurred, no surgery-related deaths occurred. One patient after surgery appeared in the abdominal cavity volume of about 2000 ml, consider hypoproteinemia, supplementation of human serum albumin disappeared after 4 days of ascites. The total volume of chest drainage was (717 ± 372) ml (250-1 420 ml), and the drainage tube was removed 3 to 5 days after operation. Postoperative follow-up was 7 to 23 months (median 15 months). Three patients had recurrent lesions at 5, 6 and 7 months postoperatively, respectively. Two of them were stable after intervention and conservative treatment, and one patient with recurrent hypertension and heart failure after 6 months postoperatively Died at 16 months after surgery. The remaining patients were alive during the follow-up period, no recurrence and metastasis. Conclusion Intraoperative ultrasound and artificial pleural effusion assisted percutaneous radiofrequency ablation in the treatment of hepatic fornix hepatocellular carcinoma is safe and effective and has high clinical value.