摘要目的:探讨超声引导下经皮射频消融治疗心包下肝脏恶性肿瘤的安全性、有效性。方法:回顾性分析2017年1月至2019年10月于郑州大学附属肿瘤医院行超声引导下经皮射频消融治疗的26例（31个肿瘤）心包下肝脏恶性肿瘤患者的临床资料。男性21例，女性5例；年龄55岁（范围：40~77岁）。原发性肝癌14例，转移性肝癌12例。肿瘤最大径（2.3±1.0）cm（范围：1.0~4.2 cm）。通过肿瘤最大径进行1∶1匹配同期收治的27例非心包下患者共36个肝脏恶性肿瘤。心包下肿瘤被定义为在矢状位或冠状位成像中距离心包≤1 cm的肿瘤。记录消融效果及并发症情况，评估其一次性完全消融率、主要技术有效率及并发症情况。收集统计两组患者术前基线特征、消融效果及并发症发生情况。采用单因素分析、多因素Logistic回归分析的方法，分析超声引导下经皮射频治疗心包下肝脏恶性肿瘤消融效果的独立危险因素。结果:心包下组射频消融术后肿瘤一次性完全消融率为80.8%（21/26），非心包下组为92.6%（25/27），两组差异无统计学意义（ P>0.05）。两组患者射频消融术后1个月时随访评估未见肿瘤局部进展的证据，主要技术有效率均为100%。心包下组2例患者出现消融相关并发症。多因素分析结果显示肿瘤边缘至心包距离≤5 mm是影响射频消融效果的独立危险因素（ OR=0.020，95 %CI：0.001~0.454， P=0.014）。 结论:超声引导下经皮射频消融可以安全、有效地治疗心包下肝脏恶性肿瘤。当患者心脏附近（肿瘤边缘距离心包距离≤5 mm）存在肿瘤时，需要特别注意制定详细合理的消融计划以尽量减少肿瘤残留。

abstractsObjective:To examine the safety and effectiveness of ultrasound-guided percutaneous radiofrequency ablation in the treatment of liver malignant tumor under subcardiac.Methods:The clinical data of 26 patients (31 tumors) with subcardiac liver malignant tumors who underwent ultrasound-guided percutaneous radiofrequency ablation from January 2017 to October 2019 at the Affiliated Tumor Hospital of Zhengzhou University were retrospectively analyzed. There were 21 males and 5 females. The age was 55 years old (range: 40 to 77 years old) .There were 14 cases of primary liver cancer and 12 cases of metastatic liver cancer. The maximum diameter of tumor was (2.3±1.0) cm (range: 1.0 to 4.2 cm) .According to the maximum diameter of the tumor, 1∶1 match was made between 27 non-subcardiac patients admitted at the same time and a total of 36 liver malignant tumors. subcardiac tumor is defined as tumor ≤1 cm from pericardium in sagittal or coronal imaging. The ablation effect and complications were recorded, and the one-time complete ablation rate, main technical efficiency and complications were evaluated. The preoperative baseline characteristics, ablation effect and complications of the two groups of patients were collected and counted. Single factor analysis and Logistic regression analysis were used to analyze the independent risk factors that affect the ablation effect of ultrasound-guided percutaneous radiofrequency ablation for liver malignant tumors under subcardiac.Results:The one-time complete ablation rate of tumor after radiofrequency ablation was 80.8% (21/26) in the subcardiac group and 92.6% (25/27) in the non-subcardiac group. There was no significant difference between the two groups ( P>0.05) . No evidence of local tumor progression was found in the follow-up evaluation of the two groups one month after radiofrequency ablation, and the main technical effective rate was 100%.Ablation-related complications occurred in 2 patients in the subcardiac group. Multivariate analysis both showed that the distance between tumor margin and pericardium ≤5 mm was an independent risk factor affecting radiofrequency ablation ( OR=0.020, 95 %CI: 0.001 to 0.454, P=0.014) . Conclusions:Ultrasound-guided percutaneous radiofrequency ablation can safely and effectively treat liver malignant tumor under subcardiac. When there is a tumor near the patient′s heart (the distance between the edge of the tumor and pericardium is ≤5 mm) , special attention should be paid to formulate a detailed and reasonable ablation plan to minimize tumor residue.