Application Of Hydrodissection Technique In Percutaneous Thermal Ablation Of Hepatic Carcinoma Near Special Sites

Objective To analyze the effect of hydrodissection technique in percutaneous thermal ablation ablation of hepatic Carcinoma near special sites,and evaluate its therapeutic effect.Methods The clinical data of liver tumor patients who received percutaneous microwave ablation from December 2019 to August 2021 and whose preoperative imaging indicated the lesion was located at a specific site were collected.A total of 98 patients（125 lesions）were enrolled and divided into water isolation group（47 patients,60 lesions）and conventional ablation group（51 patients,65 lesions）according to surgical method.In the water isolation group,ultrasound-guided abdominal puncture was performed before ablation,and ultrasound-guided microwave ablation was performed after successfully establishing a water isolation band around the lesion.The time required for establishing water isolation and the amount of water injection were recorded and analyzed.Postoperative complications were observed in the water isolation group and the conventional ablation group.Minor complications included fever,pain,reactive pleural and abdominal effusion,digestive tract symptoms,etc.,and serious complications included biliary leakage and diaphragm perforation,etc.Postoperative pain score and ablation success rate were recorded and compared between the two groups.The integrity rate of lesions before operation and after water isolation was established.To evaluate the maneuverability of water isolation technique for thermal ablation of liver tumors.Animal experiments with water isolation were designed to be ablated in different locations of isolated liver,and temperature changes in liver capsule and isolation fluid were monitored to explore the auxiliary role of water isolation in thermal ablation.Results The success rate of water isolation was 97.9%,and the average time was（15.2±3.5）min.The amount and time of spacer were different in different parts of the liver,and the amount of fluid needed in the left hepatic diaphragm and hepatogastric space was the most difficult.The diaphragmatic space and the liver and kidney space require less water and shorter time.Water isolation group of patients with conventional ablation group of patients with non-infectious fever,pain,postoperative reactivity for both the overall incidence of mild complications such as water was 52.17%and 68.62%,including conventional ablation group in 7 patients in postoperative follow-up revealed diaphragmatic muscle perforation,bile leakage,and the incidence of serious complications was statistically different between the two groups.In the pain score 6h after surgery,11.76%（6/51）of patients in the conventional ablation group had significant pain,and 2.17%（1/46）of patients in the water isolation group had significant pain.The pain scores of the water isolation group were lower than those of the conventional ablation group at 6h,24h and 48h after surgery,with statistically significant differences.The first complete ablation rate of the two groups was 93.22%and 80.00%,and the local progression rate was 5.08%and 16.92%,respectively,with statistically significant difference between the two groups.The complete display rate of liver tumor lesions in special parts was 58.2%under 2D ultrasound,and the complete display rate of liver tumor lesions with water isolation was significantly increased to 97.6%.In the isolated experiment,the temperature at the liver surface after water isolation was significantly lower than that in the control group.Conclusion The auxiliary water isolation technique in heat ablation can isolate liver and surrounding tissue and avoid the complications of heat injury in surrounding organs.It is beneficial to improve the quality of ultrasound imaging and clearly show the lesions.It is helpful to display the needle route clearly,improve the operating field of vision,and improve the confidence of the operator.Moreover,the postoperative pain of patients is reduced,the postoperative recovery is fast,and the postoperative satisfaction of patients is improved.