Abstract

Objective

To report the technique of hydrodissection of the sub-diaphragmatic bare area of the liver, in order to protect the diaphragm/heart during percutaneous thermal ablation (PTA) of sub-cardiac hepatic tumours.

Materials and methods

Between January 2016 and December 2018, five patients (four female, one male; mean age 56.2 years) with five sub-cardiac liver tumours (two hepatocellular carcinoma, three metastases; mean size 39 mm) abutting the bare area (segments II/IVA) with expected ablation zones ≤ 5 mm from the myocardium were treated with PTA and adjunctive hydrodissection. Time to perform hydrodissection, distance between superior hepatic and diaphragmatic/pericardial surfaces before and after hydrodissection, ablation efficacy, complications, and local tumour progression (LTP) at last imaging follow-up were recorded.

Results

Technical feasibility was 100%, with mean hydrodissection-volume of 126 ml (range 80–200 ml) and median hydrodissection-time of 9 min (range 8–45 min). Liver-diaphragmatic and liver-pericardial distance increased, respectively, from 2.4 mm (range 0–8 mm) to 10.8 mm (range 6–19 mm) and from 4 mm (range 1–10 mm) to 12.6 mm (range 8–20 mm) post-hydrodissection. All procedures were performed at full-power with complete tumour ablation and without complications (including peri-procedural haemodynamic/electrocardiographic disturbances, pericardial effusion and diaphragmatic hernia) or evidence of LTP at mean 12.2-month (range 1–26 month) follow-up.

Conclusion

Hydrodissection of the sub-diaphragmatic bare area of the liver is technically feasible and may potentially optimize safety PTA of sub-cardiac hepatic tumours.

中文翻译：

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心脏下肝肿瘤经皮热消融期间肝脏裸露区域的辅助水分离。

摘要

客观的

报告肝膈下裸露区域的水分离技术，以在心脏下肝肿瘤的经皮热消融 (PTA) 期间保护膈/心脏。

材料和方法

2016 年 1 月至 2018 年 12 月，5 名患者（4 名女性，1 名男性；平均年龄 56.2 岁）患有 5 例心脏下肝肿瘤（2 例肝细胞癌，3 例转移瘤；平均大小 39 mm）毗邻裸露区域（II/IVA 节段） ) 预期消融区距离心肌 ≤ 5 mm，用 PTA 和辅助水分离处理。记录进行水分离的时间、水分离前后肝上表面和膈/心包表面之间的距离、消融效果、并发症和最后一次影像学随访时的局部肿瘤进展（LTP）。

结果

技术可行性为 100%，平均水分离体积为 126 毫升（范围 80-200 毫升），中值水分离时间为 9 分钟（范围 8-45 分钟）。肝膈和肝心包距离分别从 2.4 mm（范围 0-8 mm）增加到 10.8 mm（范围 6-19 mm）和从 4 mm（范围 1-10 mm）增加到 12.6 mm（范围 8- 20 mm) 水分离后。所有手术均以全功率进行，肿瘤完全消融，无并发症（包括围手术期血流动力学/心电图障碍、心包积液和膈疝）或平均 12.2 个月（范围 1-26 个月）随访时的 LTP 证据.

结论

肝膈下裸露区域的水分离在技术上是可行的，并且可能优化心脏下肝肿瘤的安全 PTA。