Study On The Safty Of Sonographically Guided Percutaneous Microwave Ablation Of Liver Tumors Abutting The Gastrointestinal Tract, The Gallbladder And The Diaphragm

ObjectiveTo study the safety of sonographically guided percutaneous microwave ablation of liver tumor abutting the gastrointestinal tract, the gallbladder and the diaphragm, to explore the optimal ablation condition in order to achieve complete tumor necrosis while these organs were not burn obviously.Materials and methods1 Study on the safety of sonographically guided percutaneous microwaveablation of liver tumor abutting the gastrointestinal tract(1) Experimental study: Eleven healthy adult dogs underwent sonographicallyguided percutaneous microwave ablation liver tissue abutting the bowel.Measure the temperature of liver margin abutting the bowel and dogs weredivided into three groups according to the temperature: ①55℃～65℃,②65℃-75℃, ③75℃-95℃, lasting 5 to 8 minutes. 2450MHz Microwavefrequency and 50W600s was applied. Contrast enhanced contrast ultrasound(CEUS) was performed to evaluate the location and size of the ablation areaimmediately after ablation, then dogs were sacrificed and bowel and liver wereharvested and examined for appearance of thermal damage. Choose the optimalablation condition and ablated dogs' liver tissue adjacent to bowel and observed28 days. CEUS, enhanced CT, gross anatomy and histopathological examinationwere used to evaluate liver necrosis and thermal damage of bowel at 28th days.(2) Clinical study: Ten patients with liver cancer abutting the gastrointestinaltract underwent sonographically guided percutaneous microwave ablation. Eighttumors were located directly adjacent to the gastrointestinal tract and two werelocated within 3 mm of the gastrointestinal tract. Tumor size ranged from 1.4 to4.2 cm (mean, 2.6 cm). Measure the temperature of tumor margin abuttinggastrointestinal tract, the highest temperature were controlled at 52℃～53℃. Allpatients were followed up 3 to 12 months after ablation. Therapeutic efficacy and safety were evaluated with follow-up CEUS and multiphase helical CT.2 Study on the safety of sonographically guided percutaneous microwave ablation of liver tumor abutting the gallbladder(1) Experimental study: Ten healthy adult dogs underwent sonographically guided percutaneous microwave ablation liver tissue abutting the gallbladder. Measure the temperature of gallbladder wall abutting the liver ablation zone and dogs were divided into three groups according to the temperature: ①50℃～ 60℃ ,② 60℃ ～70℃, ③70℃～95℃. lasting 5 to 8 minutes .Other procedures as the same describtion in the part one.(2) Clinical study: Nine patients with liver cancer abutting the gallbladder underwent sonographically guided percutaneous microwave ablation. Six tumors were located directly adjacent to the gallbladder and three were located within 0.5 cm of the gallbladder. Tumor size ranged from0.8 to 3.7 cm (mean, 2.4 cm). Measure the temperature of the gallbladder wall abutting the tumor ablation area, and the highest temperature were controlled at 50℃～51℃. All patients were followed up 3 to 12 months after ablation. Therapeutic efficacy and safety were evaluated with follow-up CEUS and multiphase helical CT.3 Study of sonographically guided percutaneous microwave ablation of liver tumor abutting the diaphragm(1) Experimental study: Eight healthy adult dogs underwent sonographically guided percutaneous microwave ablation liver tissue abutting the diaphragm. The end of the microwave antenna was implanted directly adjacent to the diaphragm, and measure the temperature of the margin of the liver ablation zone abutting the diaphragm. Dogs were divided into three groups according to the temperature: ①50℃～60℃, ②60℃～70℃, ③70℃～95℃, lasting 4 to 8 minutes. CEUS was performed to evaluate the location and size of the ablation area immediately after ablation. Dogs were observed for 28 days. CEUS, enhanced CT, gross anatomy were used to evaluate liver necrosis and thermal damage of diaphragm.(2) Clinical study: Seventeen patients with liver cancer abutting the diaphragm underwent sonographically guided percutaneous microwave ablation. Twelve tumors were located directly adjacent to the gastraintestine and five were locatedwithin 5 mm of the diaphragm. Tumor size ranged from1.2 to 7.9 cm (mean, 3.0 cm). All patients were followed up 3 to 10 months after ablation. Therapeutic efficacy and safety were evaluated with follow-up CEUS and multiphase helical CT.Results 1 Study on the safety of percutaneous ablation of liver tumor abutting thegastrointestinal tract(1) Experimental study: CEUS immediately after ablation showed all the ablation area directly adjacent to the bowel.①55℃ to 65 ℃ group: Gross anatomy showed the liver ablation area zone located at liver margin abutting intestine with 2.8～3.1cm in maximum diameter, and bowels were not burn obviously. Dogs were observed for 28 days. Enhanced CT immediately after ablation showed the ablation area directly adjacent to bowel and the bowel wall was normal. At 28th days, enhanced CT showed liver ablation zone and the bowel wall was normal, and gross anatomy demonstrated the ablation area directly adjacent to bowel and was covered by the greater omentum, Histological examination confirmed repairing appearance of the greater omentum. ②65℃ to 75℃ group: In one dog, gross anatomy and histological examination confirmed the liver ablation area located at liver margin abutting intestine with 28～3.2cm in maximum diameter, and bowels were not burn obviously. While another dog gross anatomy and histological examination confirmed pancreas was burned slightly with 1.5cm in maximum diameter in one dog immediately after ablation. Another dog was sacrificed at 5^th days after ablation and gross anatomy showed pancreas adhered to the liver ablation. Histological examination confirmed repairing appearance of pancreas. ③75℃ to 95℃ group: CEUS immediately after ablation showed the ablation area directly adjacent to the bowel. Dogs were immediately sacrificed and the liver ablation area located at liver margin abutting intestine with 3.0～3.3 cm in maximum diameter, and gross anatomy and histological examination confirmed that intestine in the area of thermal injury adjacent to ablations demonstrated full thickness burns with 3.0-5.1cm in maximum diameter.(2) Clinical study No severe complications were seen. At 1-month follow-up, one (10%) of the ten tumors showed residual unablated tumor in the ablation zoneadjacent to the gastrointestinal tract. Of the remaining nine liver tumor (90%) with no evidence of residual unablated tumor and none showed local tumor progression in the ablation zones on subsequent follow-up. Tumor showed residual unablated size is 2.4cm.2 Study on the study of sonographically guided percutaneous microwave ablation of liver tumor abutting the gallbladder(1) Experimental study CEUS immediately after ablation showed all the ablation zone directly adjacent to the gallbladder.① 50℃ to 60℃ group: Gross anatomy and Histological examination confirmed the gallbladders were not hurt obviously. Two dogs were observed for 28 days. CEUS, enhanced CT, gross anatomy and histopathological examination all showed the gallbladder wall abutting the ablation zone was not burn obviously. ② 60℃ to 70℃ group: Gross anatomy and histopathological confirmed that the local gallbladder wall was slightly burned.③ 70℃ to 95℃ group: Immediate gross anatomy and histopathological examination demonstrated full thickness burns with 3.0～ 3.1cm in maximum diameter. While another dog showed repairing appearance of gallbladder 1 week after ablation.(2) Clinical study No severe complications were seen. At 1-month follow-up, none of the nine tumors showed residual unablated tumor in the ablation zone and with no evidence of local tumor progression in the ablation zones on subsequent follow-up.3 Study on safty of sonographically guided percutaneous microwave ablation of liver tumor abutting the diaphragm(1) Experimental study ① 50℃ to 60℃ group: Gross anatomy and histopathological examination immediately and at 28^th days after ablation group: demonstrated diaphragm was not hurt obviously. ② 60℃ to 70℃ group: one dog was sacrificed 1 week after ablation, and the diaphragm showed repairing appearance of slight burn with 5.5～3.8cm in maximum diameter. Another dog showed diaphragmatic hernia at 28^th day. (3)70℃ to 95℃ group: One dog died 3 days after ablation. Liver, diaphgram and base of right lung were adhered together, and plenty of pleural fluid was detected. Another dog formed diaphragmatic hernia, part of liver, intestine, stamch, gallbladder, and greatometum get into the thoracic cavity through a cleft of diaphgram at 28th day.(2) Clinical study No severe complications were seen. At 1-month follow-up, one (6%) of the seventeen tumors showed residual unablated tumor in the ablation zone adjacent to the gastrointestinal tract. Tumor size is 1.5cm. Of the remaining sixteen hepatocellular carcinomas (94%) with no evidence of residual unablated tumor, none showed local tumor progression in the ablation zones on subsequent follow-up.Conclusions1. Sonographically guided percutaneous microwave ablation of dog liver tissue abutting the bowel,, when the temperature of liver margin abutting the bowel fluctuated from 55℃ to 65℃ lasting 4 to 8 minutes, the bowel was not burn obviously.2. Sonographically guided percutaneous microwave ablation of liver tumor abutting the gatraintestinal tract, when the highest temperature of the tumor ablation zone abutting the gastrointestinal tract reached at 52℃ or 53℃, the ablation is safe.3. Sonographically guided percutaneous microwave ablation of dog liver tissue abutting the gallbladder, when the temperature of the gallbladder adjacent to the liver ablation zone fluctuated from 50℃ to 60℃ lasting 4 to 8 minutes, the bowel was not burn obviously.4. Sonographically guided percutaneous microwave ablation of liver tumor abutting the gallbladder, when the highest temperature of the gallbladder wall abutting the tumor ablation area reached at 50℃ or 51℃, the ablation is safe.5. Sonographically guided percutaneous microwave ablation of dog liver tissue abutting the diaphgragm, The end of the microwave antenna was implanted directly adjacent to the diaphragm, when the temperature of liver margin abutting the diaphragm fluctuated from 50℃ to 60℃ lasting 4 to 8 minutes, the diaphragm was not burn obviously.6. Sonographically guided percutaneous microwave ablation of liver tumor abutting the diaphragm, when the end of the microwave antenna implanted directly adjacent to the diaphragm, the ablation is safe.