Department of Anaesthesiology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, 47500, Subang Jaya, Selangor, Malaysia.
Sci Rep. 2021 Jan 27;11(1):2299. doi: 10.1038/s41598-021-81913-1.
Microwave ablation (MWA) is gaining popularity for the treatment of small primary hepatocellular carcinoma and metastatic lesions especially if patients are not candidates for surgical resection. Deep neuromuscular blockade (DMB) is perceived to improve surgical working conditions compared to moderate neuromuscular blockade (MMB) but no studies have examined the same benefits in MWA of liver tumours. This study aimed to compare the clinical outcomes of DMB and MMB in MWA of liver tumours in terms of liver excursion, performance scores by the interventional radiologists and patients, requirements of additional muscle relaxants and complications. 50 patients were recruited and 45 patients (22 in MMB group, 23 in DMB group) completed the study. The mean liver excursion for the MMB group (1.42 ± 1.83 mm) was significantly higher than the DMB group (0.26 ± 0.38 mm) (p = 0.001). The mean Leiden-Surgical Rating Scale (L-SRS) rated by the two interventional radiologists were 4.5 ± 0.59 and 3.6 ± 0.85 for the DMB and MMB groups, respectively (p = 0.01). There was also statistically significant difference on patient satisfaction scores (0-10: Extremely Dissatisfied-Extremely Satisfied) between DMB (8.74 ± 1.1) and MMB (7.86 ± 1.25) groups (p = 0.01). 5 patients from MMB group and none from DMB group required bolus relaxant during the MWA procedure. Adverse events were also noted to be more severe in the MMB group. In conclusion, DMB significantly reduced liver excursion and movement leading to improved accuracy, safety and success in ablating liver tumour.
微波消融 (MWA) 在治疗小肝癌和转移性病变方面越来越受欢迎，尤其是对于不能接受手术切除的患者。与中度神经肌肉阻滞 (MMB) 相比，深度神经肌肉阻滞 (DMB) 被认为可以改善手术操作条件，但尚无研究检查 DMB 在肝脏肿瘤 MWA 中的相同益处。本研究旨在比较 DMB 和 MMB 在肝脏肿瘤 MWA 中的临床效果，包括肝位移、介入放射科医生和患者的绩效评分、对额外肌松剂的需求和并发症。共招募了 50 名患者，其中 45 名患者（MMB 组 22 例，DMB 组 23 例）完成了研究。MMB 组的平均肝位移（1.42±1.83mm）明显高于 DMB 组（0.26±0.38mm）（p=0.001）。两位介入放射科医生使用 Leiden-Surgical Rating Scale（L-SRS）评分，DMB 和 MMB 组的平均评分分别为 4.5±0.59 和 3.6±0.85（p=0.01）。DMB 组（0-10：非常不满意-非常满意）和 MMB 组（7.86±1.25）患者的满意度评分也存在统计学差异（p=0.01）。MMB 组中有 5 名患者，而 DMB 组中没有患者在 MWA 过程中需要使用肌松剂。还注意到 MMB 组的不良事件更为严重。总之，DMB 可显著减少肝位移和运动，从而提高肝肿瘤消融的准确性、安全性和成功率。
