摘要
目的探讨局部麻醉下超声引导肝癌射频消融(RFA)术中患者疼痛程度与病灶距肝包膜或肝段以上门静脉分支远近的关系。方法对23例肝癌患者在局部麻醉下实施超声引导经皮射频消融治疗。其中临近肝包膜组15例,肝癌病灶距肝包膜或肝段以上门静脉分支≤5mm;远离肝包膜组8例,肝癌病灶距肝包膜或肝段以上门静脉分支>5mm。射频消融治疗中采用视觉模拟评分法(VAS)对两组患者疼痛程度进行评估,记录基础VAS评分(局部浸润麻醉时VAS评分)、术中VAS评分(射频消融术中最大痛觉评分)和相对VAS评分结果(术中VAS评分减去基础VAS评分),对两组患者射频消融术中疼痛程度和可耐受的最大治疗功率进行比较。结果 23例患者31个肝癌病灶均在超声引导下完成了经皮射频消融治疗并获取了两组患者术中疼痛程度的基础VAS评分、术中VAS评分、相对VAS评分和术中可耐受的最大治疗功率4项中位数数值:(1)超声显示临近肝包膜组15例患者19个肝癌病灶中5个病灶临近门静脉分支,14个临近肝包膜;射频消融时基础VAS评分为3(0～6)分、术中VAS评分为8(2～10)分、相对VAS评分为5(1～7)分;消融治疗时患者可耐受的最大功率为140(70～200)W。(2)远离肝包膜组8例患者12个肝癌病灶射频消融时基础VAS评分为3(1～5)分、术中VAS评分为6(2～8)分、相对VAS评分为3(0～5)分;消融治疗时患者可耐受的最大功率为150(100～200)W。临近肝包膜组患者(肝癌病灶临近肝包膜或肝段以上门静脉分支)射频消融治疗时痛觉更明显,且临近肝包膜组患者相对VAS评分明显高于远离肝包膜组,两组相对VAS评分比较差异有统计学意义(Z=-3.490,P=0.001),而两组射频消融病灶时患者可耐受的最大功率比较差异无统计学意义(Z=-0.505,P=0.639)。结论局部麻醉下超声引导经皮射频消融肝癌病灶时临近肝包膜或门静脉分支的病灶会导致患者更明显的疼痛。
Objective To investigate the relationship between tumor location and intraprocedural pain in ultrasound-guided percutaneous radiofrequency ablation （RFA） of hepatocellular carcinomas （HCC） under local anesthesia. Methods Twenty-three patients with 31 HCCs received ultrasound-guided percutaneous RFA under local anesthesia. According to the distance that tumor was away from liver capsule or branch of the portal vein ,patients were categorized into group 1 （the distance of the tumor from fiver capsule or branch of the portal vein was less than 5 ram） and group 2 （ the distance of the tumor fiom liver capsule or branch of the portal vein was more than 5 ram）. There were fifteen patients in group 1 and eight patients in group 2. Intraprocedural pain in ultrasound-guided percutaneous radiofrequency ablation was valued by using visual analog scale （VAS）. The following data was recorded： basical VAS score （the VAS score during local anesthesia at the puncture site） , intraproccdural VAS score （the highest VAS score during RFA）, and the relative VAS score （intraprocedural VAS minus basical VAS）. The highest RFA power used was also recorded. The difference of relative visual analog scale and highest intraprocedural RFA power between group 1 and group 2 were compared. Results Twenty-three patients with 31 HCCs had received ultrasound-guided percutaneous RFA under local anesthesia,the following data of the patients in two groups had been recorded： basical VAS score, intraprocedural VAS score,the relative VAS score and the highest intraprocedural RFA power. （1）It showed in ultrasonography that five HCCs were close to the branch of the portal vein among 19 HCCs in fifteen patients in group 1, and the others were close to liver capsule. The median of intraprocedural VAS score, the median of basical VAS score,the median of relative VAS score were 3 （0-6） ,8 （2-10） ,5 （1-7） in group 1. The median of the highest RFA power in group 1 was 140 （70-200）W. （2） It showed in ultrasonography that twelve HCCs in eight patients were far from liver capsule in group 2. The median of intraprocedural VAS score,the median of basical VAS score,and the median of relative VAS score were 3 （1-5）,6 （2-8） ,3 （0-5）. The median of the highest RFA power in group 2 was 150 （100-200） W. The results showed that the patients in group 1 （ the distance of the tumor from liver capsule or branch of the portal vein was more than 5 mm） felt more pain than that in group 2 in ultrasound-guided percutaneous radinfrequency ablation of hepatocellular carcinomas under local anesthesia. The relative VAS in group 1 was much higher than that in group 2 （ Z = - 3. 490, P = 0. 001 ）. There was no significant difference in the median of the highest RFA power （ Z = - 0. 505, P = 0. 639） between the two groups. Conelusion HCC adjacent to liver capsule or portal vein would cause more severe pain in ultrasound-guided percutaneous RFA under local anesthesia.
出处
《中华医学超声杂志（电子版）》
2012年第8期19-22,共4页
Chinese Journal of Medical Ultrasound(Electronic Edition)
基金
广东省科技计划项目(2009B060700026)和(2010B031600041)
关键词
超声检查
肝肿瘤
疼痛
射频消融
Ultrasonography
Liver neoplasms
Pain
Radiofrequency ablation
