Computed tomography-guided percutaneous microwave ablation with artificial ascites for problematic hepatocellular tumors

Figures & data

Table 1. Baseline characteristics of the patients and tumors.

Variables	Datum
Patients	48
Age(years)
Mean	55.4 ± 5.6
Range	33–75
Gender
Male	26 (54.2%)
Female	22 (45.8%)
Etiology of liver disease
Hepatitis B virus	40 (83.2%)
Hepatitis C virus	2 (4.2%)
Other	6 (12.6%)
Underlying liver disease
Liver cirrhosis	48 (100%)
Child-Pugh class A	15 (31.2%)
Child-Pugh class B	33 (68.8%)
Previous history
Liver resection	10 (20.8%)
TACE	40 (83.2%)
Local tumor progression	3 (6.3%)
TACE group	2 (4.2%)
Non-TACE group	1 (2.1%)
Total ablated tumors	61
Tumor size (cm)
<3 cm	40 (65.6%)
≥3 cm	21 (34.4%)
Location
Segment II–III	19 (31.1%)
Segment IV	4 (6.6%)
Segment V–VI	15 (24.6%)
Segment VII–VIII	23 (37.7%)
Adjacent to the colon	22 (36%)
Adjacent to the diaphragm	20 (32.8%)
Adjacent to the stomach	10 (16.4%)
Adjacent to the gallbladder	4 (6.6%)
Adjacent to the heart	4 (6.6%)
Adjacent to the kidney	1 (1.6%)

Figure 1. (a) An 18-gauge sheathed needle was inserted into the peritoneal space between the lesion and the risk organs under computed tomography guidance. (b) The inner stylet of the sheath needle was removed, and a 0.035-inch guidewire was inserted through the sheath. (c) A 5-French sheath was introduced into the peritoneal cavity over the guidewire. (d) Sufficient volume of 0.9% saline solution was injected through the sheath to separate the tumors from the risk organs.

Figure 2. A 65-year-old woman with hepatocellular carcinoma in live segment VI. The patient was treated previously with transcatheter arterial chemoembolization. (a) Contrast-enhanced computed tomography (CT) scan before microwave ablation showed a slightly enhanced lesion with partial lipiodol deposition. The lesion was adjacent to the hepatic flexure of the colon. (b) The electrode needle was inserted into the lesion under CT guidance after the artificial ascites was infused. The lesion was separated from the colon. (c) Contrast-enhanced CT scans obtained immediately after microwave ablation showed complete ablation without enhanced zones in the lesion. (d) No enhancement in the target tumor or peripheral area was observed on the follow-up contrast-enhanced CT 1 month later.

Table 2. Adverse events related to microwave ablation assisted with artificial ascites.

Complications	No. of complications
Mild adverse events	20 (41.7%)
Pain	8 (16.7%)
Fever	12 (25%)
Moderate adverse events	26 (54.1%)
Pain	17 (35.4)
Fever	9 (18.8%)
Severe adverse events	0
Disabling adverse events	0
Deaths	0