CAJ | 학술논문

目的探讨CT引导下经皮微波消融(PMA)治疗邻近横膈肝肿瘤的近期疗效与安全性.方法回顾分析中山大学附属肿瘤医院影像介入中心从2011年1月到2012年12月69例行CT引导下PMA治疗的肝肿瘤患者,其中75个邻近横膈肝肿瘤(肿瘤距横膈≤5 mm).按病灶邻近横膈的部位分为邻近肌性部组(A组)和邻近腱性部组(B组),按病灶大小分为＜2.5 cm组(Ⅰ组)和≥2.5 cm组(Ⅱ组).统计消融术中及术后2周内的并发症,对比分析PMA治疗的安全性.消融后1、3、6个月行增强CT(CECT)或增强MRI(CEMRI)检查,后续每隔3～6个月行CEMRI或CECT检查,随访12 ～ 30个月,对比分析近期疗效.结果 PMA治疗后1个月肿瘤完全消融(CR)率为86.7％(65/75),局部残留(ICR)率为13.3％ (10/75)(其中5个病灶经补充消融后达CR).A组和B组的CR率差异无统计学意义(85.7％比87.9％);而Ⅰ组的CR率明显高于Ⅱ组(95.0％比77.1％).总体患者的1年生存率为97.1％.轻微并发症发生率为42.0％(29/69),严重并发症发生率为2.9％(2/69).A组和B组的轻微并发症的发生率无统计学差异(38.1％比45.5％),但其中膈肌灼伤、肺内渗出及气胸的发生率,两组均存在统计学差异;Ⅰ组轻微并发症的发生率明显低于Ⅱ组(30.0％比54.3％),而且严重并发症均发生在Ⅱ组.轻微并发症均为可逆性的,无特殊处理或对症治疗后恢复.2例严重并发症均经规范的临床治疗后方好转.结论 CT引导下PMA治疗邻近横膈肝肿瘤是一种安全、有效的治疗方法,但要根据肿瘤的大小及邻近横膈的部位合理设定进针路线及消融功率/时间.
목적 탐토CT인도하경피미파소융(PMA)치료린근횡격간종류적근기료효여안전성.방법 회고분석중산대학부속종류의원영상개입중심종2011년1월도2012년12월69례행CT인도하PMA치료적간종류환자,기중75개린근횡격간종류(종류거횡격≤5 mm).안병조린근횡격적부위분위린근기성부조(A조)화린근건성부조(B조),안병조대소분위＜2.5 cm조(Ⅰ조)화≥2.5 cm조(Ⅱ조).통계소융술중급술후2주내적병발증,대비분석PMA치료적안전성.소융후1、3、6개월행증강CT(CECT)혹증강MRI(CEMRI)검사,후속매격3～6개월행CEMRI혹CECT검사,수방12 ～ 30개월,대비분석근기료효.결과 PMA치료후1개월종류완전소융(CR)솔위86.7％(65/75),국부잔류(ICR)솔위13.3％ (10/75)(기중5개병조경보충소융후체CR).A조화B조적CR솔차이무통계학의의(85.7％비87.9％);이Ⅰ조적CR솔명현고우Ⅱ조(95.0％비77.1％).총체환자적1년생존솔위97.1％.경미병발증발생솔위42.0％(29/69),엄중병발증발생솔위2.9％(2/69).A조화B조적경미병발증적발생솔무통계학차이(38.1％비45.5％),단기중격기작상、폐내삼출급기흉적발생솔,량조균존재통계학차이;Ⅰ조경미병발증적발생솔명현저우Ⅱ조(30.0％비54.3％),이차엄중병발증균발생재Ⅱ조.경미병발증균위가역성적,무특수처리혹대증치료후회복.2례엄중병발증균경규범적림상치료후방호전.결론 CT인도하PMA치료린근횡격간종류시일충안전、유효적치료방법,단요근거종류적대소급린근횡격적부위합리설정진침로선급소융공솔/시간.
Objective To assess the safety and short-term therapeutic efficacies of computed tomography (CT)-guided percutaneous microwave ablation (PMA) for diaphragm-abutting liver tumors.Methods A total of 69 patients with 75 diaphragm-abutting liver tumors (tumor from diaphragmc ≤ 5 mm) underwent CT-guided PMA.According to the site of diaphragm-abutting lesions,they were divided into neighboring muscle group (group A) and neighboring aponeurosis group (group B) ; According to the size of lesions,they were divided into ＜2.5 cm group (group Ⅰ) and ≥2.5 cm group (group Ⅱ).The complications of intra and post-ablation within 2 weeks were recorded.They underwent contrast enhanced CT (CECT) or contrast enhanced MRI (CEMRI) at Month 1,3 and 6 post-ablation.Then CEMRI or CECT was re-checked every 3-6 months.All patients were followed up for 12-30 months.Comparative analyses were performed for short-term therapeutic efficacies.Results At Month 1 post-PMA,complete response (CR) rate was 86.7％ (65/75) and incomplete response (ICR) rate 13.3％ (10/75).After additional ablation,5 lesions transformed into CR.No statistical difference in CR rate existed between groups A and B (95.0％ vs 77.1％).The CR rate of group Ⅰ was obviously higher than that of group Ⅱ (95.0％ vs 77.1％).The 1-year survival rate was 97.1％.The occurring rate of minor complications was 42.0％ (29/69) and that of serious complications 2.9％ (2/69).No statistical difference of occurring rates of minor complications existed between groups A and B (38.1％ vs 45.5％).But the occurring rates of diaphragmatic burns,pulmonary exudation and pneumothorax had obvious statistical differences between two groups.The occurring rate of minor complications in group Ⅰ was obviously lower than that of group Ⅱ (30.0％ vs 54.3％) and serious complications occurred in group Ⅱ.Minor complications were reversible and recovered after non-special or symptomatic treatment.Two cases of serious complications improved after standard clinical treatment.Conclusion CT-guided PMA for diaphragm-abutting liver tumors is both safe and effective.However puncture route and power/time should be optimized according to tumor size and location.