Head Hayden W, Dodd Gerald D, Dalrymple Neal C, Prasad Srinivas R, El-Merhi Fadi M, Freckleton Michael W, Hubbard Linda G
Department of Radiology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, Mail Code 7800, San Antonio, TX 78229, USA.
Radiology. 2007 Jun;243(3):877-84. doi: 10.1148/radiol.2433060157.
To retrospectively determine the frequency of diaphragmatic injury when percutaneous hepatic radiofrequency (RF) ablation is performed adjacent to the diaphragm.
Institutional Review Board approval was obtained for our HIPAA-compliant study. Informed consent for the ablation procedure and for use of related data for future research was obtained from each patient. A retrospective review was conducted of 215 patients undergoing percutaneous RF ablation of hepatic tumors. Twenty-nine patients (21 men and eight women; age, 41-89 years) were identified with tumors abutting the diaphragm. Episodes of right shoulder pain were recorded. A panel of radiologists blinded to the patients' clinical histories reviewed their imaging for evidence of diaphragmatic injury and ablation success. A generalized estimating equation model and the Fisher exact test were used for statistical analysis.
The 29 patients had a total of 33 tumors abutting the diaphragm. Tumor size was 1.3-5.5 cm (mean, 3.2 cm +/- 1.1). After ablation, five (17%) patients reported right shoulder pain. In four, pain was mild or moderate, with symptoms lasting 2-14 days (median, 5.5 days). Three of these showed diaphragmatic thickening on postablation computed tomographic (CT) scans. One patient had severe pain lasting 2 weeks, followed by milder pain for 2 months. This patient's postablation CT images showed focal nodular diaphragmatic thickening. This patient was treated with a multitined device; the other four, with straight-needle devices. Local tumor progression was seen in 14 tumors (42.4%). Tumors 3 cm or smaller had a much lower local progression rate than tumors larger than 3 cm (12.5% vs 70.6%).
Of 29 patients who had ablation of hepatic tumors adjacent to the diaphragm, five (17%) had diaphragmatic injury, which was clinically apparent with right shoulder pain.
回顾性确定在紧邻膈肌进行经皮肝射频（RF）消融时膈肌损伤的发生率。
我们符合健康保险流通与责任法案（HIPAA）的研究获得了机构审查委员会的批准。从每位患者处获得了消融手术及将相关数据用于未来研究的知情同意书。对215例行经皮肝肿瘤射频消融术的患者进行了回顾性研究。确定了29例（21例男性和8例女性；年龄41 - 89岁）肿瘤紧邻膈肌的患者。记录右肩疼痛发作情况。一组对患者临床病史不知情的放射科医生对其影像进行检查，以寻找膈肌损伤及消融成功的证据。采用广义估计方程模型和Fisher精确检验进行统计分析。
29例患者共有33个肿瘤紧邻膈肌。肿瘤大小为1.3 - 5.5 cm（平均3.2 cm±1.1）。消融后，5例（17%）患者报告有右肩疼痛。其中4例疼痛为轻至中度，症状持续2 - 14天（中位数5.5天）。其中3例消融后计算机断层扫描（CT）显示膈肌增厚。1例患者有严重疼痛持续2周，随后较轻疼痛持续2个月。该患者消融后的CT图像显示局灶性结节状膈肌增厚。该患者使用的是多针装置；其他4例使用的是直针装置。14个肿瘤（42.4%）出现局部肿瘤进展。3 cm或更小的肿瘤局部进展率远低于大于3 cm的肿瘤（12.5%对70.6%）。
在29例对紧邻膈肌的肝肿瘤进行消融的患者中，5例（17%）发生了膈肌损伤，临床上表现为右肩疼痛。
