目的：探讨肝癌病灶距肝包膜或肝段以上门静脉分支远近与局麻下CT引导行微波消融（MWA）术中疼痛的关系。方法：选取先成功实施肝动脉栓塞化疗后行MWA治疗的78例肝癌患者，根据原发病灶位置分为近端组（病灶距离肝包膜或肝段以上门静脉分支距离≤5 cm，32例，37个病灶）和远端组（病灶距离肝包膜或肝段以上门静脉分支距离>5 cm，46例，54个病灶），比较两组治疗效果及术中疼痛程度等指标的差异。结果：近端组的病灶完全消融率与远端组差异无统计学意义（75.86% vs. 81.48%，P>0.05）；两组术后AFP水平均较术前明显降低（均P>0.05），但无组间差异（P>0.05）。按肿瘤大小（≤2 cm和>2 cm）分层比较，近端组与远端组的术前VAS评分、可耐受的最大治疗功率、消融时间比较差异均无统计学意义（均P>0.05），但近端组术中VAS评分、VAS相对值、哌替啶用量均明显的高于远端组（均P<0.05）；近端组和远端组病灶>2 cm的患者的术中VAS评分、消融时间、哌替啶用量均明显高于本组病灶≤2 cm的患者（均P<0.05）。近端组总并发症发生率明显高于远端组（15.63% vs. 2.17%，P<0.05）。结论：肝癌病灶距离肝包膜或肝段以上门静脉分支的位置≤5 cm会增加患者MWA治疗过程中的疼痛感受，尤其是病灶直径>2 cm的患者增加会更加明显。
Relationship between tumor location and intraoperative pain during CT-guided microwave ablation under local anesthesia
Objective: To investigate the relationship between the distance of lesions of liver cancer from the liver capsule or subsegmental portal vein branches and intraoperative pain during CT-guided microwave ablation (MWA) under local anesthesia. Methods: Seventy-eight patients with liver cancer undergoing MWA treatment following successful hepatic arterial chemoembolization were selected. According to the primary location of the lesions, they were divided into proximal group (distance between lesions and the liver capsule or subsegmental portal vein branches less than or equal to 5 cm, 32 cases and 37 lesions), and distal group (distance between lesions and the liver capsule or subsegmental portal vein branches more than 5 cm, 46 cases and 54 lesions). The differences of treatment efficacy, degree of intra-procedural pain and other variables between the two groups were compared. Results: The difference in complete tumor ablation rate between proximal group and distal group had no statistical significance (75.86% vs. 81.48%, P>0.05). The AFP levels in both groups were significantly reduced compared with preoperative values (both P<0.05), but no significant inter-group difference was noted (P>0.05). Stratified comparison according to tumor size (≤2 cm and >2 cm) showed that there was no significant difference in VAS score, maximum tolerable dose, and ablation time between the two groups (all P>0.05), but the intraoperative VAS score, relative VAS value and dose of pethidine requirement in proximal group were significantly higher than those in distal group (all P<0.05); the intraoperative VAS score, ablation time and dose of pethidine requirement of patients with tumor size >2 cm in either proximal group or distal group were significantly higher than those of patients with tumor size ≤2 cm (all P<0.05). Conclusion: Pain perception is increased during MWA treatment in liver cancer patients with distance between lesion and the liver capsule or subsegmental portal vein branches ≤5 cm and is especially more obvious in those with tumor diameter larger than 2 cm.