论文部分内容阅读
目的根据超声引导射频消融(RFA)治疗胆囊旁肝肿瘤的过程及特点,探讨总结治疗方法及疗效,并分析治疗中和治疗后并发症的对应措施。方法行超声引导射频治疗的338例肝肿瘤患者763个病灶中,43例计48个病灶经超声或CT确认与胆囊关系密切;其中原发性肝细胞癌32例,肝转移癌11例。48个病灶中17个与胆囊壁分界不清,9个对胆囊壁有压迹,二者共占54.2%(26个灶);余22个灶(45.8%)邻近胆囊距离≤0.5cm。肿瘤大小平均2.7cm(1.0～7.4cm)。患者随访时间平均19.9个月。结果射频布针次数为1～11次,平均3次。治疗后24h或1个月CT检查肿瘤完全灭活41个病灶(85.4%);利用KaplanMeier统计学方法显示治疗后半年无复发率为83.7%,1年无复发率78.8%。治疗中出现的生命体征改变及并发症状如下:38例(82.6%)出现心前区疼痛、右肩部疼痛或右上腹痛;16例(37.2%)治疗中发生不同程度心率减慢,最低达27次/min,均采用立即注射阿托品并吸氧后改善;18例(39.1%)治疗中及治疗后发生胆囊壁增厚;2例(4.4%)治疗后并发亚急性胆囊炎,经保守治疗后症状缓解;无一例需外科干预治疗的严重并发症。结论对胆囊旁肝肿瘤射频消融治疗重视操作技巧及应用附加方法,多数可获得较高的灭活效果,并且较少发生严重并发症,为安全可行的治疗方法。
Objective To summarize the treatment methods and curative effects according to the procedure and characteristics of ultrasound guided radiofrequency catheter ablation (RFA) in treating gallbladder liver tumors and to analyze the corresponding measures of postoperative and postoperative complications. Methods Totally 763 lesions of 338 patients with liver cancer underwent ultrasound-guided radiofrequency ablation. Forty-four lesions of 48 lesions were confirmed by ultrasound or CT, which were closely related to the gallbladder. Among them, 32 were primary hepatocellular carcinoma and 11 were liver metastases. Among the 48 lesions, 17 were indistinguishable from the gallbladder wall and 9 were compressed against the gallbladder wall, accounting for 54.2% (26 lesions). The remaining 22 lesions (45.8%) had a distance of ≤ 0.5cm from the gallbladder. The average tumor size was 2.7cm (1.0 ~ 7.4cm). Patients were followed up for an average of 19.9 months. Results RF cloth needle times 1 to 11 times, an average of 3 times. At 24 h or 1 month after treatment, tumors were completely inactivated by 41 lesions (85.4%). KaplanMeier statistical analysis showed that the recurrence rate was 83.7% at 6 months and 78.8% at 1 year. Vital signs and concomitant symptoms during treatment were as follows: 38 cases (82.6%) had precordial pain, right shoulder pain or right upper quadrant pain; 16 cases (37.2%) had varying degrees of heart rate slowing down to a minimum of 27 Times per minute, both of them were treated with immediate injection of atropine and improved after oxygen inhalation; eighteen patients (39.1%) had thickening of gallbladder wall during and after treatment; two patients (4.4%) were complicated with subacute cholecystitis after conservative treatment No symptoms of severe complications requiring surgical treatment. Conclusions The radiofrequency ablation of gallbladder paracental liver tumor places great importance on the operation skills and the application of additional methods, most of which can obtain higher inactivation effect, and less serious complications, safe and feasible treatment.