目的 评价近大血管的肝细胞癌(HCC)进行高功率微波消融治疗的疗效和安全性.方法 对 33例新发单发HCC的患者经皮肝穿刺微波消融治疗,该33病灶均为距离直径大于3 mm的血管0.5 cm以内,其中近门静脉支17例,近肝静脉12例,同时靠近的4例.所有患者均在B超引导下,采用单针或双针100 W的高功率微波热凝2 ～ 4 min.并作短期随访,观察肿瘤消融疗效及并发症情况.结果 所有患者均安全完成微创消融手术.2例(6.1%)出现局部肿瘤进展,7例(21.2%)出现新病灶(7/33),5例复查CT可见局部血供异常,5例消融灶远端出现胆管轻度扩张,另1例术后6个月出现肝门部胆管狭窄伴肝内胆管扩张.结论 高功率微波治疗近血管的肿瘤疗效肯定,但有造成胆管损伤的风险.%Objective To evaluate the safety and efficacy of microwave ablation by using high power output in treating hepatocellular carcinoma (HCC) located next to the large vessels. Methods A total of 33 patients with newly-developed solitary HCC lesion were enrolled in this study. All patients received percutaneous microwave ablation therapy. All the 33 lesions were < 0.5 cm apart from the vessels which had a diameter larger than 3mm. Of the 33 lesions , 17 were adjacent to the portal vein , 12 adjacent to the hepatic vein and 4 adjacent to both. Under B-ultrasound guidance , 100 W output microwave ablation with single needle or two needles, lasting for 2-4 minutes, was carried out in all patients. A short-term follow-up was conducted. The patients were kept under observation for the changes of tumor and the occurrence of complications. The clinical efficacy was evaluated. Results The minimally invasive ablation therapy was safely and successfully completed in all patients. During the follow-up period , exacerbation of the tumor was seen in 2 cases (6.1%), new lesions were detected in 7 cases (21.2% ) and no vital tumor was found in the remaining 24 cases. On the follow-up CT scans , local abnormal blood supply was noted in 5 cases, mild cholangiectasis distal to the ablated lesions was found in 5 cases , and bile duct stenosis at hilar region associated with intrahepatic bile duct dilatation was revealed in one case at six months after the procedure. Conclusion For the treatment of HCC located close to the large vessels , high-power microwave ablation is very effective, although it carries some risk to cause bile duct injury in some patients. (J Intervent Radiol, 2012, 21: 391-394)
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