CAJ | 학술논문

目的探讨人工胸水技术在经皮射频消融治疗肝脏膈顶肿瘤中的应用价值.方法对32例肝脏膈顶恶性肿瘤患者43个病灶采用超声引导下胸腔穿刺置管术建立人工胸水,使右肺与肝脏膈顶分离,然后完成超声引导下经皮射频消融治疗,观察疗效及不良反应.结果 32例患者共实施34次胸腔穿刺置管术,注入生理盐水(1606.3 ±485.9)ml (1000 ～2500 ml).有1例2个病灶的肝癌患者,人工胸水后仅显示1个病灶,终止射频治疗.有31例患者均按计划完成经皮消融治疗,其中经过膈肌穿刺完成消融22例,经皮经肝途径完成消融9例.完全消融29例,完全消融率为93.5％.全组无一例严重并发症及相关死亡,发生气胸1例,膈肌出血2例,皮下水肿2例.结论对位于超声盲区的肝脏膈顶恶性肿瘤,实施人工胸水有助于肿瘤的显示,减少肺损伤的发生,并能提供经过膈肌的穿刺路径,可安全有效的完成超声引导下经皮射频消融治疗.
목적 탐토인공흉수기술재경피사빈소융치료간장격정종류중적응용개치.방법 대32례간장격정악성종류환자43개병조채용초성인도하흉강천자치관술건립인공흉수,사우폐여간장격정분리,연후완성초성인도하경피사빈소융치료,관찰료효급불량반응.결과 32례환자공실시34차흉강천자치관술,주입생리염수(1606.3 ±485.9)ml (1000 ～2500 ml).유1례2개병조적간암환자,인공흉수후부현시1개병조,종지사빈치료.유31례환자균안계화완성경피소융치료,기중경과격기천자완성소융22례,경피경간도경완성소융9례.완전소융29례,완전소융솔위93.5％.전조무일례엄중병발증급상관사망,발생기흉1례,격기출혈2례,피하수종2례.결론 대위우초성맹구적간장격정악성종류,실시인공흉수유조우종류적현시,감소폐손상적발생,병능제공경과격기적천자로경,가안전유효적완성초성인도하경피사빈소융치료.
Objective To assess the value of application of percutaneous radiofrequency ablation (RFA) with artificial hydrothorax for liver cancer in the hepatic dome.Methods Thirty-two patients with 43 lesions of hepatic malignant tumors in the hepatic dome underwent ultrasound-guided percutaneous radiofrequency ablation (RFA) with artificial hydrothorax.Artificial hydrothorax was created by infusion of saline via an intrathoracically placed 14-G central venous catheter,which was ultrasound-guided percutaneously inserted before RFA,separating the right lung from the hepatic dome.The adverse reaction and therapeutic efficacy were also analyzed.Results In the 32 patients with 43 lesions in the hepatic dome (4 tumors in segment Ⅳ,21 tumors in segment Ⅶ and 18 tumors in segment Ⅷ),18 lesions of 14 patients were not observed by ultrasound before the operation.Thirty-two patients received the ultrasound-guided placement of intrathoracical catheter,and (1606.3 ±485.9) ml (1000-2500 ml) saline solution was infused successfully.After obtaining an image of the whole tumor,31 patients received percutaneous RFA therapy on schedule,and 22 patients received percutaneous transdiaphragmatic RFA therapy.One patient with 2 lesions gave up the treatment,because one of his tumors was not detectable by ultrasound.Diaphragmatic muscle hemorrhage was seen in two patients,subcutaneous edema in two patients,and pneumothorax in one patient.All the complications were cured,and no serious complications or related death occurred.1-month follow-up with contrast-enhanced CT/MRI images showed that 29 patients had complete ablation,and the effective rate of this technique was 93.5％ (29/31).Conclusions Artificial hydrothorax helps us not only to visualize the whole tumor in the hepatic dome,but also offers a transdiaphragmatic route for therapy.Ultrasound-guided percutaneous RFA with artificial hydrothorax is a feasible,safe,and effective technique for treating liver cancer in the hepatic dome and worthy of being promoted.