人造胸水和術中超聲造影輔助下經皮射頻消融治療肝穹窿部肝癌_《中國普外基礎與臨床雜志》

作者：

李嘉鑫 ¹ , 吳泓 ¹ , 黃紀偉 ¹ , 盧強 ² , 蔣輝 ¹ , 徐纓龍 ¹ , 汪景洲 ¹ , 曾勇 ¹

1.四川大學華西醫院肝膽胰外科（四川成都 610041）;;
2.四川大學華西醫院超聲科（四川成都 610041）;

關鍵詞：

人造胸水術中超聲造影射頻消融肝腫瘤肝穹窿部

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目的探討人造胸水和術中超聲造影輔助下超聲引導的經皮射頻消融治療肝穹窿部腫瘤的安全性和可行性。方法回顧性分析2008年1月至2009年6月期間四川大學華西醫院肝膽胰外科在術中超聲造影和人造胸水輔助下行經皮射頻消融治療的9例肝穹窿部肝癌患者的臨床資料，并對圍手術期和隨訪復發情況進行分析。結果9例患者共12個病灶均成功完成了人造胸水輔助下的射頻消融治療。注入胸水量為（2 444±464） ml(2 000~3 000 ml); 每例患者消融時間為12~24 min(中位數12 min)，每個腫瘤為（15±5） min。術中未發生血胸、氣胸等，無手術相關死亡發生。術后1例患者出現腹腔中量積液約2 000 ml，考慮與低蛋白血癥有關，補充人血白蛋白后于術后第4天腹水消失。胸腔引流液總量為（717±372） ml (250~1 420 ml)，術后3~5 d拔除引流管。術后隨訪時間為7~23個月（中位數15個月）。有3例患者分別在術后5、6和7個月出現復發病灶，其中2例分別經介入和保守治療后病情穩定，1例術后6個月復發患者因高血壓心臟病和肝功能惡化于術后16個月死亡。其余患者在隨訪期內均存活，未見復發、轉移。結論術中超聲造影和人造胸水輔助經皮射頻消融治療肝穹窿部肝癌安全、有效，有較高臨床應用價值。

引用本文： 李嘉鑫,吳泓,黃紀偉,盧強,蔣輝,徐纓龍,汪景洲,曾勇. 人造胸水和術中超聲造影輔助下經皮射頻消融治療肝穹窿部肝癌. 中國普外基礎與臨床雜志, 2011, 18(2): 172-176. doi: 復制

1.	Machi J, Uchida S, Sumida K, et al. Ultrasoundguided radiofrequency thermal ablation of liver tumors: percutaneous, laparoscopic, and open surgical approaches [J]. J Gastrointest Surg, 2001, 5(5): 477489.
2.	Bruix J, Sherman M, Llovet JM, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona2000 EASL conference. European Association for the Study of the Liver [J]. J Hepatol, 2001, 35(3): 421430.
3.	Rossi S, Di Stasi M, Buscarini E, et al. Percutaneous RF interstitial thermal ablation in the treatment of hepatic cancer [J]. AJR Am J Roentgenol, 1996, 167(3): 759768.
4.	Livraghi T, Goldberg SN, Lazzaroni S, et al. Small hepatocellular carcinoma: treatment with radiofrequency ablation versus ethanol injection [J]. Radiology, 1999, 210(3): 655661.
5.	Podnos YD, Henry G, Ortiz JA, et al. Laparoscopic ultrasound with radiofrequency ablation in cirrhotic patients with hepatocellular carcinoma: technique and technical considerations [J]. Am Surg, 2001, 67(12): 11811184.
6.	Ohmoto K, Tsuzuki M, Yamamoto S. Percutaneous microwave coagulation therapy with intraperitoneal saline infusion for hepatocellular carcinoma in the hepatic dome [J]. AJR Am J Roentgenol, 1999, 172(1): 6566.
7.	Shibata T, Shibata T, Maetani Y, et al. Transthoracic percutaneous radiofrequency ablation for liver tumors in the hepatic dome [J]. J Vasc Interv Radiol, 2004, 15(11): 13231327.
8.	Ishikawa T, Kohno T, Shibayama T, et al. Thoracoscopic thermal ablation therapy for hepatocellular carcinoma located beneath the diaphragm [J]. Endoscopy， 2001, 33(8): 697702.
9.	Minami Y, Kudo M, Kawasak T, et al. Percutaneous ultrasoundguided radiofrequency ablation with artificial pleural effusion for hepatocellular carcinoma in the hepatic dome [J]. J Gastroenterol, 2003, 38(11): 10661070.
10.	Koda M, Ueki M, Maeda Y, et al. Percutaneous sonographically guided radiofrequency ablation with artificial pleural effusion for hepatocellular carcinoma located under the diaphragm [J]. AJR Am J Roentgenol, 2004, 183(3): 583588.
11.	鄭云, 張亞奇, 鄒如海, 等. 人工胸水協助超聲引導肝穹窿部腫瘤治療 [J]. 中山大學學報(醫學科學版), 2005, 26(6): 696699.
12.	周鐵, 仇毓東, 張煒煒, 等. 人工胸腔積液超聲引導經皮射頻消融治療膈頂部肝癌 [J]. 臨床腫瘤學雜志, 2007, 12(3): 188190.
13.	Shimada S, Hirota M, Beppu T, et al. A new procedure of percutaneous microwave coagulation therapy under artificial hydrothorax for patients with liver tumors in the hepatic dome [J]. Surg Today, 2001, 31(1): 4044.
14.	Kume A, Nimura Y, Kamiya J, et al. Percutaneous ethanol injection via an artificially induced right hydrothorax for hepatocellular carcinoma in the hepatic dome [J]. Cardiovasc Intervent Radiol, 2003, 26(6): 543549.
15.	Wu H, Lu Q, Luo Y, et al. Application of contrastenhanced intraoperative ultrasonography in the decisionmaking about hepatocellular carcinoma operation [J]. World J Gastroenterol, 2010, 16(4): 508512.
16.	任正剛. 原發性肝癌的射頻毀損治療進展 [J]. 中國普外基礎與臨床雜志, 2007, 14(1): 57.
17.	林玲, 桂永忠, 梁鄭, 等. 超聲造影對高強度聚焦超聲治療肝細胞癌的療效評價 [J]. 世界華人消化雜志, 2009, 17(18): 18791882.
18.	廖錦堂, 潘瑞喆, 劉艷, 等. 超聲造影評價肝癌射頻消融治療近期療效 [J]. 中國普外基礎與臨床雜志, 2009, 16(4): 265268.
19.	王文平, 魏瑞雪, 丁紅, 等. 肝腫瘤實時超聲造影的血流動力學分析 [J]. 中華超聲影像學雜志, 2004, 13(5): 359362.
20.	羅葆明, 文艷玲, 智慧, 等. 實時諧波超聲造影在肝腫瘤消融治療中的應用 [J]. 中國超聲醫學雜志, 2005, 21(7): 522524.
21.	孫海, 馬寬生, 張豐深, 等. 超聲引導下犬肝注射醋酸高滲氯化鈉混合液對射頻消融毀損體積的影響 [J]. 中國普外基礎與臨床雜志, 2007, 14(5): 547550.
22.	Ding H, Kudo M, Onda H, et al. Hepatocellular carcinoma: depiction of tumor parenchymal flow with intermittent harmonic power Doppler US during the early arterial phase in dualdisplay mode [J]. Radiology, 2001, 220(2): 349356.
23.	Ding H, Kudo M, Onda H, et al. Evaluation of posttreatment response of hepatocellular carcinoma with contrastenhanced coded phaseinversion harmonic US: comparison with dynamic CT [J]. Radiology, 2001, 221(3): 721730.
24.	Ding H, Kudo M, Onda H, et al. Contrastenhanced subtraction harmonic sonography for evaluating treatment response in patients with hepatocellular carcinoma [J]. AJR Am J Roentgenol, 2001, 176(3): 661666.
25.	Kudo M. Contrast harmonic ultrasound is a breakthrough technology in the diagnosis and treatment of hepatocellular carcinoma [J]. J Med Ultrasonics, 2001, 28(3): 7981.

1. Machi J, Uchida S, Sumida K, et al. Ultrasoundguided radiofrequency thermal ablation of liver tumors: percutaneous, laparoscopic, and open surgical approaches [J]. J Gastrointest Surg, 2001, 5(5): 477489.
2. Bruix J, Sherman M, Llovet JM, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona2000 EASL conference. European Association for the Study of the Liver [J]. J Hepatol, 2001, 35(3): 421430.
3. Rossi S, Di Stasi M, Buscarini E, et al. Percutaneous RF interstitial thermal ablation in the treatment of hepatic cancer [J]. AJR Am J Roentgenol, 1996, 167(3): 759768.
4. Livraghi T, Goldberg SN, Lazzaroni S, et al. Small hepatocellular carcinoma: treatment with radiofrequency ablation versus ethanol injection [J]. Radiology, 1999, 210(3): 655661.
5. Podnos YD, Henry G, Ortiz JA, et al. Laparoscopic ultrasound with radiofrequency ablation in cirrhotic patients with hepatocellular carcinoma: technique and technical considerations [J]. Am Surg, 2001, 67(12): 11811184.
6. Ohmoto K, Tsuzuki M, Yamamoto S. Percutaneous microwave coagulation therapy with intraperitoneal saline infusion for hepatocellular carcinoma in the hepatic dome [J]. AJR Am J Roentgenol, 1999, 172(1): 6566.
7. Shibata T, Shibata T, Maetani Y, et al. Transthoracic percutaneous radiofrequency ablation for liver tumors in the hepatic dome [J]. J Vasc Interv Radiol, 2004, 15(11): 13231327.
8. Ishikawa T, Kohno T, Shibayama T, et al. Thoracoscopic thermal ablation therapy for hepatocellular carcinoma located beneath the diaphragm [J]. Endoscopy， 2001, 33(8): 697702.
9. Minami Y, Kudo M, Kawasak T, et al. Percutaneous ultrasoundguided radiofrequency ablation with artificial pleural effusion for hepatocellular carcinoma in the hepatic dome [J]. J Gastroenterol, 2003, 38(11): 10661070.
10. Koda M, Ueki M, Maeda Y, et al. Percutaneous sonographically guided radiofrequency ablation with artificial pleural effusion for hepatocellular carcinoma located under the diaphragm [J]. AJR Am J Roentgenol, 2004, 183(3): 583588.
11. 鄭云, 張亞奇, 鄒如海, 等. 人工胸水協助超聲引導肝穹窿部腫瘤治療 [J]. 中山大學學報(醫學科學版), 2005, 26(6): 696699.
12. 周鐵, 仇毓東, 張煒煒, 等. 人工胸腔積液超聲引導經皮射頻消融治療膈頂部肝癌 [J]. 臨床腫瘤學雜志, 2007, 12(3): 188190.
13. Shimada S, Hirota M, Beppu T, et al. A new procedure of percutaneous microwave coagulation therapy under artificial hydrothorax for patients with liver tumors in the hepatic dome [J]. Surg Today, 2001, 31(1): 4044.
14. Kume A, Nimura Y, Kamiya J, et al. Percutaneous ethanol injection via an artificially induced right hydrothorax for hepatocellular carcinoma in the hepatic dome [J]. Cardiovasc Intervent Radiol, 2003, 26(6): 543549.
15. Wu H, Lu Q, Luo Y, et al. Application of contrastenhanced intraoperative ultrasonography in the decisionmaking about hepatocellular carcinoma operation [J]. World J Gastroenterol, 2010, 16(4): 508512.
16. 任正剛. 原發性肝癌的射頻毀損治療進展 [J]. 中國普外基礎與臨床雜志, 2007, 14(1): 57.
17. 林玲, 桂永忠, 梁鄭, 等. 超聲造影對高強度聚焦超聲治療肝細胞癌的療效評價 [J]. 世界華人消化雜志, 2009, 17(18): 18791882.
18. 廖錦堂, 潘瑞喆, 劉艷, 等. 超聲造影評價肝癌射頻消融治療近期療效 [J]. 中國普外基礎與臨床雜志, 2009, 16(4): 265268.
19. 王文平, 魏瑞雪, 丁紅, 等. 肝腫瘤實時超聲造影的血流動力學分析 [J]. 中華超聲影像學雜志, 2004, 13(5): 359362.
20. 羅葆明, 文艷玲, 智慧, 等. 實時諧波超聲造影在肝腫瘤消融治療中的應用 [J]. 中國超聲醫學雜志, 2005, 21(7): 522524.
21. 孫海, 馬寬生, 張豐深, 等. 超聲引導下犬肝注射醋酸高滲氯化鈉混合液對射頻消融毀損體積的影響 [J]. 中國普外基礎與臨床雜志, 2007, 14(5): 547550.
22. Ding H, Kudo M, Onda H, et al. Hepatocellular carcinoma: depiction of tumor parenchymal flow with intermittent harmonic power Doppler US during the early arterial phase in dualdisplay mode [J]. Radiology, 2001, 220(2): 349356.
23. Ding H, Kudo M, Onda H, et al. Evaluation of posttreatment response of hepatocellular carcinoma with contrastenhanced coded phaseinversion harmonic US: comparison with dynamic CT [J]. Radiology, 2001, 221(3): 721730.
24. Ding H, Kudo M, Onda H, et al. Contrastenhanced subtraction harmonic sonography for evaluating treatment response in patients with hepatocellular carcinoma [J]. AJR Am J Roentgenol, 2001, 176(3): 661666.
25. Kudo M. Contrast harmonic ultrasound is a breakthrough technology in the diagnosis and treatment of hepatocellular carcinoma [J]. J Med Ultrasonics, 2001, 28(3): 7981.

《中國普外基礎與臨床雜志》

人造胸水和術中超聲造影輔助下經皮射頻消融治療肝穹窿部肝癌

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《中國普外基礎與臨床雜志》

人造胸水和術中超聲造影輔助下經皮射頻消融治療肝穹窿部肝癌

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