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

目的探討人造胸水和術(shù)中超聲造影輔助下超聲引導(dǎo)的經(jīng)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(xué)華西醫(yī)院肝膽胰外科在術(shù)中超聲造影和人造胸水輔助下行經(jīng)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(shù)期和隨訪復(fù)發(fā)情況進(jìn)行分析。結(jié)果9例患者共12個(gè)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(shí)間為12~24 min(中位數(shù)12 min)，每個(gè)腫瘤為（15±5） min。術(shù)中未發(fā)生血胸、氣胸等，無手術(shù)相關(guān)死亡發(fā)生。術(shù)后1例患者出現(xiàn)腹腔中量積液約2 000 ml，考慮與低蛋白血癥有關(guān)，補(bǔ)充人血白蛋白后于術(shù)后第4天腹水消失。胸腔引流液總量為（717±372） ml (250~1 420 ml)，術(shù)后3~5 d拔除引流管。術(shù)后隨訪時(shí)間為7~23個(gè)月（中位數(shù)15個(gè)月）。有3例患者分別在術(shù)后5、6和7個(gè)月出現(xiàn)復(fù)發(fā)病灶，其中2例分別經(jīng)介入和保守治療后病情穩(wěn)定，1例術(shù)后6個(gè)月復(fù)發(fā)患者因高血壓心臟病和肝功能惡化于術(shù)后16個(gè)月死亡。 其余患者在隨訪期內(nèi)均存活，未見復(fù)發(fā)、轉(zhuǎn)移。結(jié)論術(shù)中超聲造影和人造胸水輔助經(jīng)皮射頻消融治療肝穹窿部肝癌安全、有效，有較高臨床應(yīng)用價(jià)值。

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

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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(xié)助超聲引導(dǎo)肝穹窿部腫瘤治療 [J]. 中山大學(xué)學(xué)報(bào)(醫(yī)學(xué)科學(xué)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(dǎo)經(jīng)皮射頻消融治療膈頂部肝癌 [J]. 臨床腫瘤學(xué)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(fā)性肝癌的射頻毀損治療進(jìn)展 [J]. 中國普外基礎(chǔ)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(qiáng)度聚焦超聲治療肝細(xì)胞癌的療效評價(jià) [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(jià)肝癌射頻消融治療近期療效 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(4): 265268.
19. 王文平, 魏瑞雪, 丁紅, 等. 肝腫瘤實(shí)時(shí)超聲造影的血流動(dòng)力學(xué)分析 [J]. 中華超聲影像學(xué)雜志, 2004, 13(5): 359362.
20. 羅葆明, 文艷玲, 智慧, 等. 實(shí)時(shí)諧波超聲造影在肝腫瘤消融治療中的應(yīng)用 [J]. 中國超聲醫(yī)學(xué)雜志, 2005, 21(7): 522524.
21. 孫海, 馬寬生, 張豐深, 等. 超聲引導(dǎo)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(chǔ)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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 11. 鄭云, 張亞奇, 鄒如海, 等. 人工胸水協(xié)助超聲引導(dǎo)肝穹窿部腫瘤治療 [J]. 中山大學(xué)學(xué)報(bào)(醫(yī)學(xué)科學(xué)版), 2005, 26(6): 696699.
  12. 12. 周鐵, 仇毓東, 張煒煒, 等. 人工胸腔積液超聲引導(dǎo)經(jīng)皮射頻消融治療膈頂部肝癌 [J]. 臨床腫瘤學(xué)雜志, 2007, 12(3): 188190.
  13. 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. 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. 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. 16. 任正剛. 原發(fā)性肝癌的射頻毀損治療進(jìn)展 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007, 14(1): 57.
  17. 17. 林玲, 桂永忠, 梁鄭, 等. 超聲造影對高強(qiáng)度聚焦超聲治療肝細(xì)胞癌的療效評價(jià) [J]. 世界華人消化雜志, 2009, 17(18): 18791882.
  18. 18. 廖錦堂, 潘瑞喆, 劉艷, 等. 超聲造影評價(jià)肝癌射頻消融治療近期療效 [J]. 中國普外基礎(chǔ)與臨床雜志, 2009, 16(4): 265268.
  19. 19. 王文平, 魏瑞雪, 丁紅, 等. 肝腫瘤實(shí)時(shí)超聲造影的血流動(dòng)力學(xué)分析 [J]. 中華超聲影像學(xué)雜志, 2004, 13(5): 359362.
  20. 20. 羅葆明, 文艷玲, 智慧, 等. 實(shí)時(shí)諧波超聲造影在肝腫瘤消融治療中的應(yīng)用 [J]. 中國超聲醫(yī)學(xué)雜志, 2005, 21(7): 522524.
  21. 21. 孫海, 馬寬生, 張豐深, 等. 超聲引導(dǎo)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(chǔ)與臨床雜志, 2007, 14(5): 547550.
  22. 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. 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. 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. 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.