CAJ | 학술논문

目的探讨经皮射频消融治疗肝脏外周性恶性肿瘤中辅助注入等渗盐水技术以分离肿瘤与外周脏器结构的应用价值.方法对24例肝脏外周性恶性肿瘤,采用超声引导下穿刺注入等渗盐水的辅助技术,分离肝脏肿瘤局部区域和邻近脏器,完成经皮射频消融治疗.观察术后常见不良反应及其疗效.结果 24例肝脏恶性肿瘤中邻近右肾6例、邻近结肠6例、邻近胃5例、邻近心膈4例、邻近胆囊3例.23例在超声引导下采用22G细针经由肝组织穿刺达肿瘤近旁肝外,注入等渗盐水80 ～ 390 ml,形成0.8 ～ 2.5 cm盐水分隔带,继而完成经皮根治性射频消融治疗.其中5例邻近胃、结肠的肿瘤在消融中需要继续辅助注入等渗盐水.另1例由于有手术切除病史,局部粘连不能分离,辅助注入等渗盐水未能成功,行姑息射频消融治疗.术后平均住院4d,无一例发生周围脏器结构损伤、出血,无一例严重并发症及相关死亡.术后1个月肝脏增强CT/MRI检查显示,辅助注入等渗盐水成功的23例中22例获得完全消融,有效率为95.7％ (22/23)；无一例针道转移.结论邻近肝脏外缘的恶性肿瘤经皮射频消融治疗,采用辅助注入等渗盐水策略,使癌灶与重要邻近脏器分隔,可安全有效地消融肿瘤,从而拓展经皮消融治疗的适应证.
목적 탐토경피사빈소융치료간장외주성악성종류중보조주입등삼염수기술이분리종류여외주장기결구적응용개치.방법 대24례간장외주성악성종류,채용초성인도하천자주입등삼염수적보조기술,분리간장종류국부구역화린근장기,완성경피사빈소융치료.관찰술후상견불량반응급기료효.결과 24례간장악성종류중린근우신6례、린근결장6례、린근위5례、린근심격4례、린근담낭3례.23례재초성인도하채용22G세침경유간조직천자체종류근방간외,주입등삼염수80 ～ 390 ml,형성0.8 ～ 2.5 cm염수분격대,계이완성경피근치성사빈소융치료.기중5례린근위、결장적종류재소융중수요계속보조주입등삼염수.령1례유우유수술절제병사,국부점련불능분리,보조주입등삼염수미능성공,행고식사빈소융치료.술후평균주원4d,무일례발생주위장기결구손상、출혈,무일례엄중병발증급상관사망.술후1개월간장증강CT/MRI검사현시,보조주입등삼염수성공적23례중22례획득완전소융,유효솔위95.7％ (22/23)；무일례침도전이.결론 린근간장외연적악성종류경피사빈소융치료,채용보조주입등삼염수책략,사암조여중요린근장기분격,가안전유효지소융종류,종이탁전경피소융치료적괄응증.
Objective To assess the value of an infusion-based separation technique to assist in ulwasound (US)-guided percutaneous radiofrequency ablation (RFA) of liver cancers abutting the liver edge.Methods Twenty-four cases of malignant liver TUmors abutting the hepatic edge were treated with USguided puncture accompanied by the assistant infusion technique.The US-guided puncture was made with a 22-G needle through the hepatic tissue and into the abdominal cavity near the target tumor.Infusion of a saline solution was used to separate the liver from any surrounding structures so that percutaneous RFA could be safely performed.Complications,including gastrointestinal injury,hemorrhage and death,were recorded.Technical efficacy and safety were evaluated.Results Among the 24 patients,the target tumors were adjacent to the right kidney (n =6),colon (n=6),stomach (n=5),pericardium (n =4),and gall bladder (n =3).Twenty-threc patients received a successful radical percutaneous RFA with assistant infusion.The assistant infusion volumes ranged from 80～390 ml and created spaces ranging from 0.8～2.5 cm between the liver and surrounding structures.Five of the cases with tumors adjacent to the stomach or colon received the largest volume infusions.The infusion failed to create a separation space in only one case,due to the presence of an adhesion; as a result,this patient was treated with palliative RFA.The mean hospital stay for all 24 patients was four days after surgery.No severe complications or deaths occurred.At l-month follow-up,computed tomography images showed that 22 cases had complete ablation,yielding a technical success rate of 95.7％ (22/23).No needle track implantation was observed.Conclusion Assistant infusion for percutaneous radiofrequency ablation creates a protective space between the liver and surrounding structures in patients with liver tumors abutting the liver edge.This safe and effective assistant technique broadens the range of patients available for percutaneous RFA treatment.