| Background and objective:Primary hepatocellular carcinoma is a malignant tumor originating from hepatocytes or intrahepatic bile duct epithelial cells,including three different pathological types: hepatocellular carcinoma(HCC),intrahepatic cholangiocarcinoma(ICC)and HCC-ICC mixed type,among which hepatocellular carcinoma is the most common.Primary hepatocellular carcinoma has insidious onset,high recurrence rate and poor prognosis,and is the first cause of death among people younger than 65 years old in China,the common treatments include hepatectomy,liver transplantation,local ablation therapy,interventional therapy,radiation therapy,targeted therapy and immunotherapy,etc.Microwave ablation(MWA)is one of the main local ablative treatment methods,which is easy to operate,repeatable and effective.Pleural effusion after microwave ablation is one of the complications observed in recent years.In this study,the clinical data of patients treated with ultrasound-guided microwave ablation for primary liver cancer and related data were analysed to investigate the factors associated with the occurrence of pleural effusion in patients after microwave ablation.Methods:In this study,465 patients with primary liver cancer treated with ultrasound-guided microwave ablation at the Department of Hepatobiliary and Pancreatic Medicine of the First Hospital of Jilin University from September 2020 to October 2022 were collected,and their general data(age,gender,BMI,disease duration,etiology,Child-Pugh classification,whether antiviral treatment,history of hypertension,history of diabetes mellitus,history of smoking,history of alcohol consumption,whether the tumor was recurrence,family history of hepatitis,length of postoperative hospital stay),preoperative laboratory-related indicators(liver function,routine blood count,coagulation routine,alpha-fetoprotein,renal function,ions,lipids),preoperative imaging data(number of tumours,maximum tumour diameter,tumour location,presence of cirrhosis,peritoneal effusion,portal hypertension,oesophageal varices,fundic varices,fatty liver),operative data(ablation time,ablation energy,number of ablation points,intraoperative bleeding or not).The incidence of pleural effusion after microwave ablation was counted and the data was collated and analysed using SPSS 25.0 statistical software to investigate the factors associated with the occurrence of pleural effusion after microwave ablation.Results:1.In this study,465 patients with primary liver cancer treated with microwave ablation were included.123 patients developed pleural effusion after surgery,and the incidence of postoperative pleural effusion was 26.45%(123/465).Among 123 patients with postoperative pleural effusion,6 patients had their pleural effusion absorbed on their own,117 patients underwent thoracentesis for drainage or tube drainage,of which 102 patients had pleural effusion of less than 500 ml,15 patients had pleural effusion of 500-1000 ml,and no patient was found to have pleural effusion of more than 1000 ml.2.Among 465 patients with primary liver cancer treated with microwave ablation,two groups were divided according to whether pleural effusion was produced after microwave ablation: the group with postoperative pleural effusion(n=123)and the group without postoperative pleural effusion(n=342),and the patients’ preoperative clinical data,laboratory indexes,imaging data and surgical data were compared in groups.The results showed that in terms of general clinical data,there were statistically significant differences between the two groups in terms of Child-Pugh classification and length of postoperative hospital stay(P < 0.05);in terms of preoperative laboratory parameters,there were statistically significant differences between the two groups in terms of Ach E,ALB,TBil,DBil,IDBil,TBA,PT,INR,PTA,WBC,HGB,PLT,Scr,K+,Na+,Ca2+(P < 0.05);in terms of preoperative imaging data,there were statistically significant differences between the two groups in terms of tumour location,number of tumours and fundic varices(P < 0.05);in terms of surgical data,there were statistically significant differences between the two groups in terms of ablation points,ablation energy and ablation time(P < 0.05).3.To investigate the factors associated with pleural effusion after microwave ablation,multi-factor logistic regression analysis was used.The results showed that tumour location,ablation time,and preoperative PT level were independently associated with the occurrence of pleural effusion after microwave ablation(P < 0.05),and that tumour location at specific sites,prolonged ablation time,and high preoperative PT level increased the risk of postoperative pleural effusion.4.A receiver operating characteristic curve(ROC curve)was constructed and the results showed that the area under the tumour location curve was 0.60(P < 0.05),with a sensitivity of 0.341 and a specificity of 0.855;the area under the ablation time curve was 0.62(P < 0.001),with a sensitivity of 0.585 and a specificity of 0.608 at a calculated cut-off value of 1055s;the area under the preoperative PT curve was 0.62(P < 0.001),with a sensitivity of 0.675 and a specificity of 0.528 at a calculated cut-off value of 12.55 s.Conclusions:1.The incidence of pleural effusion after microwave ablation of primary liver cancer in this study was 26.45%,some patients had their pleural effusion absorbed by themselves,the majority of patients had pleural effusion draining less than 500 ml,a few patients had pleural effusion draining of 500-1000 ml,and no patients were found to have pleural effusion draining more than 1000 ml.2.Tumour location,ablation time,and preoperative PT levels were independent correlates of the development of pleural effusion after microwave ablation,with tumour location at specific sites,prolonged ablation time,and high preoperative PT levels increasing the risk of postoperative pleural effusion.3.Tumour location was more specific in predicting pleural effusion after microwave ablation of primary liver cancer compared to ablation time and preoperative PT level. |
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