探讨超声引导下经皮非接触式热消融治疗邻近腹壁肝包膜下肝细胞癌（肝癌）的疗效。

回顾性分析2012年1月至2015年12月在中山大学附属第三医院接受治疗的30例肝癌患者临床资料。其中男24例，女6例；年龄28～72岁，中位年龄56岁。病灶最大径10～40 mm，中位最大径20 mm。患者均签署知情同意书，符合医学伦理学规定。超声引导下经皮经肝穿刺消融，经正常肝组织从肿瘤深面而不直接穿刺肿瘤消融，对于有供瘤动脉的病灶先行消融阻断。观察完全消融率、并发症发生情况。

射频消融19例，微波消融11例，共31个病灶。仅1例1个边缘病灶残留，完全消融率为97%（30/31）。术中采用人工腹腔积液12例，人工胸腔积液1例，人工胸、腹腔积液3例，无辅助手段14例。无发生术中及术后穿刺部位活动性出血，无发生术后并发症。随访过程中17例出现肝内复发，未发现肝周及腹腔肿瘤种植。

对于邻近腹壁肝包膜下肝癌，超声引导下经皮热消融经正常肝组织穿刺，行非接触式消融，并采用人工辅助手段，可以实现安全、有效的治疗目的。

To evaluate the clinical efficacy of ultrasound-guided percutaneous non-contact thermal ablation in the treatment of sub-capsular hepatocellular carcinoma (HCC) adjacent to abdominal wall.

Clinical data of 30 patients with sub-capsular HCC treated in the Third Affiliated Hospital of Sun Yat-sen University from January 2012 to December 2015 were retrospectively analyzed. Among them, 24 patients were male and 6 were female, aged from 28 to 72 years with a median age of 56 years. The maximum diameter of the lesions ranged from 10 to 40 mm, and the median diameter was 20 mm. The informed consents of all patients were obtained and the local ethical committee approval was received. Ultrasound-guided percutaneous trans-hepatic ablation was performed through the normal liver tissues to the deep side of tumor rather than directly puncturing through the tumors. Lesions involving tumor blood supply arteries were ablated primarily. The complete ablation rate and the incidence of postoperative complications were observed.

Radiofrequency ablation was performed in 19 cases and microwave ablation in 11 cases with a total of 31 lesions. The residual margin lesion was found in only 1 case. The complete ablation rate was 97%(30/31). Intraoperatively, artificial abdominal ascites were performed in 12 cases, artificial pleural ascites in 1 case, artificial pleural and abdominal ascites in 3 cases, and no auxiliary interventions in 14 cases. No active bleeding occurred at the puncture site during and after operation. No postoperative complications were observed. During the postoperative follow-up, intra-hepatic recurrence occurred in 17 cases. No tumors were found at the peri-liver area or the abdominal cavity.

For the sub-capsular HCC adjacent to abdominal wall, ultrasound-guided percutaneous thermal ablation through the normal liver tissues in a non-contact way, combined with artificial auxiliary interventions, can achieve a safe and efficacious treatment.