Efficacy Evaluation Of Ultrasound-guided Percutaneous Microwave Ablation In The Treatment Of Small Hepatocellular Carcinoma In High-risk Location

Objective: Small hepatocellular carcinoma adjacent to the perihepatic organs and intrahepatic ducts have a high risk and difficulty in ablation.Previous studies have referred to them as high-risk location.With the development of ablation techniques,some studies have found that small hepatocellular carcinoma in highrisk location can also be better obtained by local ablation effect.This study retrospectively compared the clinical data of patients with small hepatocellular carcinoma at high-risk location and non-high-risk location treated by ultrasoundguided microwave ablation,and evaluated the efficacy of ultrasound-guided percutaneous microwave ablation in the treatment of small liver cancers at highrisk location.Methods: The clinical data of 90 patients with small hepatocellular carcinoma who underwent ultrasound-guided percutaneous microwave ablation at the General Surgery Department of the Second Affiliated Hospital of Guangxi Medical University from January 2017 to August 2020 were retrospectively analyzed.According to the tumor location,it was divided into high-risk location group(n=36)and non-high-risk location group(n=54).Diagnosis criteria for high-risk location: There are large blood vessels and bile ducts,gastrointestinal tract,diaphragm,gallbladder,kidneys and other structures within 5mm of the tumor boundary.The differences in basic preoperative data,operative data,single complete ablation rate,tumor-free survival rate,postoperative AFP changes,severe complications,and postoperative hospital stay were compared between the two groups.Results:(1)There were no significant differences in gender,age,pathological type,hepatitis B surface antigen,tumor diameter,tumor number,AFP,total bilirubin,albumin,ALT,AST,PLT,PT,liver function grade between highrisk location group and non-high-risk location group(P > 0.05).(2)There were no significant differences in the number of ablation needles between two group(P>0.05);The ablation time in high risk location group was longer then that in non-high risk location group(P<0.005);(3)The single complete ablation rates of the high-risk location group and the non-high-risk location group were 97.2%(35/36)and 98.1%(53/54),respectively,and there was no significant difference between the two groups(P>0.05);There were no significant differences in reduction rate of AFP between two group(P>0.05);The 1-year and 2-year tumorfree survival rates in the high-risk location group were 79.9% and 67.2%,respectively.The 1-year and 2-year tumor-free survival rates in the non-high-risk location group were 77.4% and 66.2%,respectively.There was no significant difference between the two groups(P>0.05);(4)The incidence of serious postoperative complications in the high-risk location group and non-high-risk location group was 8.3% and 5.6%,respectively.There was no significant difference between the two groups(P>0.05);The median postoperative hospital stay was 2 days,and there was no significant difference(P>0.05).Conclusion: The ablation rate and 1-year and 2-year tumor-free survival rates of small hepatocellular carcinoma in high-risk location receiving ultrasoundguided percutaneous microwave ablation are equivalent to those of non-high-risk location,and there is no significant difference in the incidence of serious complications and postoperative hospital stay.But the small hepatocellular carcinoma in high-risk location require longer ablation time.