Artificial Pleural And Peritoneal Effusion In Percutaneous Microwave Ablation Of Hepatic Tumors Near The Diaphragm Under The Guidance Of Ultrasound

Part 1:Artificial pleural effusion in percutaneous microwave ablation of hepatic tumors near the diaphragm(5?10mm)under the guidance of ultrasoundObjective:To evaluate the feasibility,safety and efficacy of artificial pleural effusion in percutaneous microwave ablation of hepatic tumors adjacent to the diaphragm(5-1 Omm)under ultrasound guidance by Comparative study.Methods:From October 2010 to October 2013 we received 40 patients needed ultrasound guided percutaneous microwave ablation for the treatment of liver tumor near the diaphragm(5-10mm).According to if artificial pleura 1 effusion undergoing or not,all cases were divided into group A and group B.group A included patients whose lesion close to the diaphragm showed unclear or incomplete with the conventional ultrasound and need artificial pleural effusion.Artificial pleural effusion was in.jected to right pleural under guidance of ultrasound before microwave ablation was performed.Success rate of artificial pleural effusion was investigated after injection.Patients of group B were treated directly with percutaneous microwave ablation under the ultrasound guidance.The incidence of complications,complete tumor ablation rate,the local recurrence and survival rate after 1 year of two groups was analyzed.Results:1.patients of group A(17 cases)were successfully completed the artificial hydrothorax.With artificial pleural effusion technique,lesions that partly or completely occluded by lung tissue,can be clearly shown.It became easy to show diaphragmatic muscle,liver and diaphragm surface,to find the appropriate puncture path,to puncture with ultrasound and to monitor the ablation process.2.For patients of group A,artificial water operation process need 30 to 45 min,injecting water in 1000 to 2000ml,postoperative lead out the amount of pleural effusion 940 to 1890 ml,which 13 cases is a colorless,pleural effusion,4 cases for reddish pleural effusion,pleural hemorrhage and pneumothorax;postoperative 1 patients puncture 7 days pumping liquid treatment,more than 16 cases of complete absorption,7 days right pleural effusion absorption rate was 94.1%.lesions of 23 cases in group B were completely absorbed within 7 days after surgery,pleural effusion absorption rate was 100%.3.18 lesions in group A were achieved ultrasound guided microwave ablation therapy.and postoperative check 1 remaining lesion was found with CEUS within 15min after post operation,again after ablation,CEUS and within 24 h enhanced MR examination complete ablation,complete ablation rate was 94.7%(18/19).B group(n=23)patients,25 lesions were successfully performed ultrasound guided microwave ablation treatment,within 24 hours after the surgery enhanced MR examination found two lesions,local residual and 2 days later again after ablation is completely dissolved,the complete ablation rate was 92.3%(25/27),the difference between the two had no statistically significant.The two groups had no severe complications associated with treatment.4.Follow-up was performed for 1 year after treatment.Based on the enhanced CT/MRI findings and related tumor marker examination,we found 1 lesion of group A recurrence 5.6%(1/18);1 lesion of group B developed local recurrence 4.0%(1/25),the difference between the two group had no statistically significant.Two groups of patients were not found long-term and secondary pleural effusion,pleural adhesions,pleural metastasis and other related complicationsConclusions:With artificial pleural effusion technique,lesions that reside in ultrasonic blind region,can be showed clearly and completely,and it's possible to inactivated tumor with ultrasound guided microwave ablation under safe puncture path.Artificial pleural effusion technology broadens the scope of ultrasound guided microwave ablation treatment,so that some of patients who was considered difficult to therapy have the opportunity to get treatment.The effect of ultrasound guided microwave ablation in the treatment of liver tumor(5-10mm)adjacent to the diaphragm is significant,safe and feasible,and it is worthy of clinical applicationPart 2:Artificial peritoneal effusion in percutaneous microwave ablation of hepatic tumors near the diaphragm(<5mm)under the guidance of ultrasoundObjective:To evaluate the feasibility,safety and efficacy of artificial peritoneal effusion in percutaneous microwave ablation of hepatic tumors near the diaphragm(<5mm)under ultrasound guidance by Comparative studyMethods:From October 2010 to October 2013 we received 38 patients needed ultrasound guided percutaneous microwave ablation for the treatment of liver tumor near the diaphragm(<10mm).According to the distance between the tumor and the diaphragm and if artificial peritoneal effusion undergoing or not,all cases were divided into group A and group B.Group A included patients whose lesion close to the diaphragm(<5mm)and need artificial peritoneal effusion.Artificial peritoneal effusion was injected to right the space between the tumor and the diaphragm under guidance of ultrasound before microwave ablation was performed.Success rate of artificial peritoneal effusion was investigated after injection.Patients of group B were treated directly with percutaneous microwave ablation under the ultrasound guidance.The incidence of complications,complete tumor ablation rate,the local recurrence and survival rate after 1 year of two groups was analyzed.Results:1.patients of group A(15 cases)were successfully completed the artificial local seroperitoneum,including 6 cases punctured under the right diaphragm and 9 cases punctured under the ensisternum.With artificial peritoneal effusion technique,there are full space for lesions to be inactivated.It became easy to show diaphragmatic muscle,liver and diaphragm surface,to find the appropriate puncture path,to puncture with ultrasound and to monitor the ablation process.2.For patients of group A,punctured under the right diaphragm artificial water operation process need 15 to 30 min,injecting water in 100 to 500ml,punctured under the ensisternum artificial water operation process need 15 to 25min,injecting water in 50 to 300ml.All the cases of group A and group B,right pleural effusion and peritoneal effusion were completely absorbed within 7 days after surgery.3.17 lesions in group A were achieved ultrasound guided microwave ablation therapy.and postoperative check 1 remaining lesion was found with CEUS within 15min after post operation,again after ablation,CEUS and within 24 h enhanced MR examination complete ablation,complete ablation rate was 94.4%(17/18).B group(n=23)patients,25 lesions were successfully performed ultrasound guided microwave ablation treatment,within 24 hours after the surgery enhanced MR examination found two lesions,local residual and 2 days later again after ablation is completely dissolved,the complete ablation rate was 92.3%(25/27),the difference between the two had no statistically significant.The two groups had no severe complications associated with treatment.4.Follow-up was performed for 1 year after treatment.Based on the enhanced CT findings and related tumor marker examination,we found 1 lesion of group A recurrence 7.1%(1/17);1 lesion of group B developed local recurrence 4.0%(1/25),the difference between the two group had no statistically significant.Two groups of patients were not found no long-term secondary pleural effusion,secondary peritoneal effusion,abdominal hematoma,subphrenic abscess,peritoneal metastasis and other related complicationsConclusions:With artificial peritoneal effusion technique,lesions that approaching diaphragm without safe ablation range,can be showed clearly and completely,and it's possible to inactivated tumor with ultrasound guided microwave ablation under safe puncture path.Artificial peritoneal effusion technology broadens the scope of ultrasound guided microwave ablation treatment,so that some of patients who was considered difficult to therapy have the opportunity to get treatment.The effect of ultrasound guided microwave ablation in the treatment of liver tumor(<5mm)adjacent to the diaphragm is significant,safe and feasible,and it is worthy of clinical application.