Department of interventional radiology, Nouvel Hôpital Civil, 1, place de l'hôpital, 67096, Strasbourg Cedex, France.
UMR 7357, CNRS, INSA Strasbourg, ICube - University of Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg, France.
Abdom Radiol (NY). 2020 Oct;45(10):3352-3360. doi: 10.1007/s00261-020-02463-0.
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.
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.
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.
Hydrodissection of the sub-diaphragmatic bare area of the liver is technically feasible and may potentially optimize safety PTA of sub-cardiac hepatic tumours.
报告肝膈下裸区水分离技术，以保护心脏/膈肌在心脏下肝肿瘤经皮热消融（PTA）期间。
2016 年 1 月至 2018 年 12 月，5 例（4 例女性，1 例男性；平均年龄 56.2 岁）5 例心脏下肝肿瘤（2 例肝细胞癌，3 例转移瘤；平均大小 39mm）紧邻裸区（II/IVA 段），预计消融区域距心肌 ≤ 5mm，采用 PTA 联合辅助水分离治疗。记录水分离时间、水分离前后肝膈和肝心包表面之间的距离、消融效果、并发症和最后影像学随访时的局部肿瘤进展（LTP）。
技术可行性为 100%，水分离量平均为 126ml（范围 80-200ml），中位数为 9 分钟（范围 8-45 分钟）。肝膈和肝心包距离分别从 2.4mm（范围 0-8mm）增加到 10.8mm（范围 6-19mm）和从 4mm（范围 1-10mm）增加到 12.6mm（范围 8-20mm）。所有程序均在最大功率下进行，完全消融肿瘤，无并发症（包括围手术期血流动力学/心电图干扰、心包积液和膈疝）或平均 12.2 个月（范围 1-26 个月）随访时 LTP 证据。
肝膈下裸区水分离技术是可行的，可能有助于优化心脏下肝肿瘤的 PTA 安全性。
