| ObjectiveTo study the safety and efficacy of sonographically guided percutaneous microwave ablation of liver malignant tumors adjacent to the gastrointestinal tract,the gallbladder, the diaphragm and hepatic hilum,to explore the optimal ablation in order to achieve complete tumor necrosis while these adjacent organs are not burn obviously.Materials and methods1.Study on the safety and efficacy of sonographically guided percutanous microwave ablation of liver malignant tumors adjacent to the gastrointestinal tractFrom January 2006 to February 2008,a total of 55 patients with 56 nodules of liver malignant tumors adjacent to the gastrointestinal tract had undergone percutaneous microwave ablation therapy combined with percutaneous ethanol injection at our hospital.All ablations were performed with curative intent.Tumors size ranged from 1.1 to 5.8cm(mean,2.7±1.2cm).Monitor the temperature of tumor margin adjacent to the gastrointestinal tract,the highest temperature were controlled at 45℃～54℃. We recorded the patients' preablation imaging,microwave ablation parameters,and course after ablation.All the patients' follow-up ranged form 1 to 26 months(mean, 8.5±7.5months).The one-month tumor necrosis rate and local tumor progression were evaluated by enhanced CT or enhanced MRI.We had a control study between the study group and the control group.The control group includes 100 patients with 127 nodules of liver malignant tumors.Tumors size ranged from 1.0 to 6.0cm(mean,2.6±1.0cm)and they were not adjacent to the important organs.All the patients' follow-up ranged form 1 to 26 months(mean,10.1±5.7months). 2.Study on the safety and efficacy of sonographically guided percutanous microwave ablation of liver malignant tumors adjacent to the gallbladderFrom January 2006 to February 2008,a total of 31 patients with 31 nodules of liver malignant tumors adjacent to the gallbladder had undergone percutaneous microwave ablation therapy combined with percutaneous ethanol injection at our hospital.All ablations were performed with curative intent.Tumors size ranged from 1.3 to 5.7cm (mean,2.5±1.1cm).Monitor the temperature of tumor margin adjacent to the gallbladder,the highest temperature were controlled at 45℃～54℃.We recorded the patients' preablation imaging,microwave ablation parameters,and course after ablation.All the patients' follow-up ranged form 1 to 26 months(mean, 10.9±7.3months).The one-month tumor necrosis rate and local tumor progression were evaluated by enhanced CT or enhanced MRI.We had a control study between the study group and the control group.The control group includes 100 patients with 127 nodules of liver malignant tumors.Tumors size ranged from 1.0 to 6.0cm(mean, 2.6±1.0cm)and they were not adjacent to the important organs.All the patients' follow-up ranged form 1 to 26 months(mean,10.1±5.7months).3.Study on the safety and efficacy of sonographically guided percutanous microwave ablation of liver malignant tumors adjacent to the diaphragmFrom January 2005 to February 2008,a total of 89 patients with 96 nodules of liver malignant tumors adjacent to the diaphragm had undergone percutaneous microwave ablation therapy at our hospital.All ablations were performed with curative intent. Tumors size ranged from 1.1 to 5.9cm(mean,3.0±1.7cm).Monitor the temperature of tumor margin adjacent to the diaphragm for 12 patients with 12 nodules and the highest temperature were controlled at 50℃-60℃.We recorded the patients' preablation imaging,microwave ablation parameters,and course after ablation.All the patients' follow-up ranged form 1 to 26 months(mean,8.1±4.3months).The one-month tumor necrosis rate and local tumor progression were evaluated by enhanced CT or enhanced MRI.We had a control study between the study group and the control group.The control group includes 100 patients with 127 nodules of liver malignant tumors.Tumors size ranged from 1.0 to 6.0cm(mean,2.6±1.0cm)and they were not adjacent to the important organs.All the patients' follow-up ranged form 1 to 26 months(mean,10.1±5.7months).4.Study on the safety and efficacy of sonographically guided percutanous microwave ablation of liver malignant tumors adjacent to the hepatic hilumFrom January 2006 to February 2008,a total of 26 patients with 26 nodules of liver malignant tumors adjacent to the hepatic hilum had undergone percutaneous microwave ablation therapy combined with percutaneous ethanol injection at our hospital.All ablations were performed with curative intent.Tumors size ranged from 1.1 to 4.9cm(mean,2.6±0.9cm).Monitor the temperature of tumor margin adjacent to the important structures,the highest temperature were controlled at 45℃～54℃.We recorded the patients' preablation imaging,microwave ablation parameters,and course after ablation.All the patients' follow-up ranged form 1 to 26 months(mean, 9.2±4.3months).The one-month tumor necrosis rate and local tumor progression were evaluated by enhanced CT or enhanced MRI.We had a control study between the study group and the control group.The control group includes 100 patients with 127 nodules of liver malignant tumors.Tumors size ranged from 1.0 to 6.0cm(mean,2.6±1.0cm)and they were not adjacent to the important organs.All the patients' follow-up ranged form 1 to 26 months(mean,10.1±5.7months).Results1.Study on the safety and efficacy of sonographically guided percutanous microwave ablation of liver malignant tumors adjacent to the gastrointestinal tractThe number of radiofrequency ablations performed on each tumor ranged between one and three.The action time of ablation were 180～1090s(mean,404±190s).The quantum of PEI between 2～19ml(mean,6.5±4.2ml).Right upper quadrant pain developed in the immediate postablation period in all cases and ranged in duration from 2 to 14 days(mean,7.5 days).Fever developed in 38 cases(69.1%),with a mean duration of 5 days.4 cases developed nausea and vomiting after the ablation. Tumor seeding happened in 2 cases.No gastric-intestinal perforation and other severe complications were seen after ablation.Complete necrosis of all tumors was achieved in 54 nodules(96.4%)at 1-month follow up.Of these,6 nodules(10.9%)had local tumor progression after one months(2 case),9 months(one case)and 12 months(4 cases).The difference of complete necrosis rate and local tumor progression rate compared with the control group was no statistical significance.2.Study on the safety and efficacy of sonographically guided percutanous microwave ablation of liver malignant tumors adjacent to the gallbladderThe number of radiofrequency ablations performed on each tumor ranged between one and two.The action time of ablation were 240～800s(mean,402±119s).The quantum of PEI between 2～19ml(mean,6.5±4.2ml).Right upper quadrant pain developed within 24h after the ablation in all cases and ranged in duration from 3 to 7 days.1 case developed liver abscess.Fever developed in 19 cases(61.3%),with a mean duration of 3.5 days.3 cases developed nausea and vomiting within 2 days after the ablation.No gallbladder perforation and other severe complications were seen after ablation.Complete necrosis of all tumors was achieved in 30 nodules(96.8%)at 1-month follow up.Of these,2 nodules(6.5%)had local tumor progression after 1 months(one case)and 4 months(one case).The difference of complete necrosis rate and local recurrence rate compared with the control group was no statistical significance.3.Study on the safety and efficacy of sonographically guided percutanous microwave ablation of liver malignant tumors adjacent to the diaphragmThe number of radiofrequency ablations performed on each tumor ranged between one and three.The action time of ablation were 240～1200s(mean,548±217s).Upper quadrant pain developed after the ablation in all cases and ranged in duration from 3 to 8 days,with a mean duration of 4.5 days.21 cases developed pleural effussion.Fever developed in 45 cases(50.1%)and ranged in duration from one to 10 days,with a mean duration of 4 days.Right shoulder pain developed in one 9 cases(10.1%).No severe complications were seen after ablation.Complete necrosis of all tumors was achieved in 91 nodules(93.8%)at 1-month follow up.Of these,12 nodules(12.5%) had local tumor progression after 1 months(5 cases),4 months(2 cases),6 months(2 case),12 months(one case)and 14months(one case).The difference of complete necrosis rate and local recurrence rate compared with the control group was no statistical significance.4.Study on the safety and efficacy of sonographically guided percutanous microwave ablation of liver malignant tumors adjacent to the hepatic hilumThe number of radiofrequency ablations performed on each tumor ranged between one and two.The action time of ablation were 180～800s(mean,414±185s).The quantum of PEI between 2～19ml(mean,6.2±4.2ml).Right upper quadrant pain developed within 24h after the ablation in all cases and ranged in duration from 2 to 7 days.Fever developed in 16 cases(64.0%),with a duration from one to 8 days.2 cases(7.7%)developed nausea and vomiting within 2 days after the ablation. Thrombosis was developed in the fight portal vein one month after treatment in one case and disappeared 3 months later without any management.Complete necrosis of all tumors was achieved in 24 nodules(92.3%)at one-month follow up.Of these,4 nodules(15.4%)had local tumor recurrence after one month(2 cases),6 months(one case)and 9 months(one case).The difference of complete necrosis rate and local recurrence rate compared with the control group was no statistical significance.ConclusionsSonngraphically guided percutaneous microwave ablation combined with percutaneous ethanol injection is a safe and effective therapy way for the liver malignant tumors adjacent to the gastrointestinal tract,gallbladder,diaphragm and hepatic hilum. |
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