| Objective:Firstly,the application value of CEUS in the establishment of artificial hydrothorax was discussed.Then,the influencing factors of 12 months recurrence of HCC3-5cm below the diaphragm were evaluated for RFA and SR guided by CEUS under the artificial thoracic water.Finally,the short-term efficacy of RFA and SR in the treatment of subphrenic 3-5cm HCC was compared and analyzed.Methods:Sixty-eight patients with HCC 3-5cm below the diaphragm were divided into RFA group(29 cases)and SR group(39 cases),and received RFA or SR treatment,respectively.In the RFA group,the artificial pleural effusion was firstly established preoperatively under the guidance of ultrasound,including 18 cases under the guidance of 2D ultrasound and 11 cases under the guidance of CEUS.The number of puncture times,the incidence of complications,the amount of artificial pleural effusion injected and the days of complete absorption of artificial pleural effusion after operation were observed for each successful establishment of artificial pleural effusion,and the application of CEUS in the establishment of artificial pleural effusion was evaluated.After the successful establishment of artificial pleural effusion,RFA treatment was conducted under the guidance of CEUS.The RFA and SR were followed up for CEUS,enhanced CT or enhanced MRI,AFP and other laboratory examinations at 1 month,3 months,6 months and 12 months after surgery to observe whether there was recurrence.Collect patients’ gender,age,preoperative CEUS related information(the presence of cirrhosis of the liver,tumor size,number,location and edge cases,internal echo and center silent dizzy and tumor necrosis,with clear),preoperative laboratory related information(AFP,CEA,CA19-9,TBIL,ALT,AST,WBC,hepatitis or not(include hepatitis A and B),etc.)and HCC recurrence within 12 months after operation.The correlation between HCC recurrence within 12 months after operation and clinical data was evaluated.Finally,the short-term efficacy between the two groups was compared and analyzed.Results:Firstly,artificial pleural effusion was established in the RFA group,and was successfully established in all 29 cases.The injection volume of artificial pleural effusion was 1000-2240(1637.2±305.8)ml,and the artificial pleural effusion was completely absorbed within 4-11(6.7±1.8)days.There were 13(13/18,72.2%)successful 2D ultrasound guided in the first time,4(4/18,22.2%)successful 2D ultrasound guided in the second time,and 1(1/18,5.6%)successful 2D ultrasound guided in the third time.There were 10 cases(10/11,90.9%)and 1 case(1/11,9.1%)successfully guided by CEUS in the second time,and there was no significant statistical difference(P>0.05).Under the guidance of two-dimensional ultrasound,there were 3 patients(3/18,16.7%)who elicits reddish-red bloody fluid in the artificial pleural effusion,and 2 patients(2/18,11.1%)who had a small amount of pneumothorax on postoperative orthostatic chest radiograph.Under the guidance of CEUS,there were 2 cases(2/11,20.0%)with pale red bloody fluid in the artificial pleural fluid.Postoperative orthostatic chest radiograph showed no pneumothorax.In the analysis of related factors for recurrence within 12 months after surgery in the RFA group and SR group,univariate analysis indicated that tumor boundary and clearance of CEUS,necrosis or not of tumor center,hepatitis,AFP,ALT and AST were significantly correlated with tumor recurrence within 12 months after surgery(P<0.05).Cox regression analysis showed that CEUS boundary,clearance and AFP were independent factors affecting the total recurrence rate.The recurrence risk of patients with unclear CEUS boundary was higher than that of patients with clear CEUS boundary,P=0.011,HR=7.897(95%CI:1.613-38.665);Patients with CEUS clearance grade divided into 3 categories had a lower recurrence risk than those with CEUS clearance grade of 4 categories,P=0.035,HR=0.149(95%CI:0.025-0.877).AFP positive patients had a higher risk of recurrence than negative patients,P=0.027,HR=13.001(95%CI:1.340-126.160).There was no significant difference between the RFA group and SR group in general information and related factors affecting postoperative recurrence(P>0.05).In terms of HCC recurrence within 12 months,7 cases(7/29,24.14%)recurred in the RFA group and 7 cases(7/39,17.95%)in the surgery group,and there was no significant difference between the two groups(P>0.05).In terms of length of hospital stay,the RFA group averaged about 16.17±6.45 days,and the SR group averaged about 21.28±4.87 days,with significant statistical difference between the two groups(P<0.05).In terms of hospitalization expenses,the average was about 41130.94± 10020.59 yuan in the RFA group and about 52,197.55±9536.37 yuan in the SR group,and there was also a significant statistical difference between the two groups(P<0.05).Conclusion:In the establishment of artificial pleural fluid before RFA,CEUS can more accurately indicate the puncture needle location,reduce the number of repeated puncture,thus reducing the incidence of complications,and improve the confidence of the operator.Preoperative AFP index and CEUS assessment of tumor boundary and clearance type had a better prediction effect on tumor recurrence in 12 months after RFA or SR surgery in diaphragmic top liver cancer.Patients with positive AFP had a higher short-term recurrence risk than those with negative AFP,and patients with unclear tumor boundary and faster clearance had a higher risk of recurrence.In the comparative analysis of the short-term efficacy of RFA and SR,the recurrence rate of RFA was slightly higher than that of SR,but there was no statistical difference(P>0.05),so it could be considered that the short-term efficacy of RFA was consistent with that of SR.While RFA of average hospital stay than the SR is shorter,the average hospitalization costs are lower than those of SR,the difference was statistically difference(P<0.05),we think the artificial hydrothorax joint CEUS guided RFA in the treatment of diaphragmatic top 3-5 cm is of clinical value of liver cancer,at the same time,it can shorten the hospitalization time,relieve the pain of patients and save hospitalization costs. |
PDF Full Text Request