To explore the value of ultrasound-guided percutaneous microwave ablation (MWA) with artificial ascites in the treatment of liver cancer adjacent to the diaphragm.

Eighty-three patients with 96 lesions of primary liver cancer adjacent to the diaphragm treated by percutaneous MWA from January 2016 to October 2019 at Xixi Hospital Affiliated to Zhejiang Chinese Medical University were selected. According to whether artificial ascites was used during ablation, the patients was divided into either an artificial ascites group (group A, 40 cases) or a non-artificial ascites group (group B, 43 cases). The lesions were scored according to the clarity and completeness on images. The quality of sonogram was compared between the two groups. Contrast-enhanced MRI or contrast-enhanced CT was performed one month after ablation to evaluate the short-term efficacy, and then every 3-6 months to evaluate local tumor progression. The adverse reactions, complications, and postoperative efficacy of the two groups were compared.

The score of clarity and completeness was 4.81±0.35 in group A and 3.54±0.48 in group B, and the difference between the two groups was statistically significant (t=15.352, P<0.05). The statistics of adverse reactions and complications are as follows: 19 cases with fever in group A (19/40, 47.5%) and 20 cases in group B (20/43, 46.5%), with no significant difference between the two groups (P=0.928);16 cases with upper abdominal dull pain in group A (16/40, 40.0%) and 19 cases in group B (19/43, 44.2%) , with no significant difference between the two groups (P=0.700); 1 case with pleural effusion in group A (1/40, 2.5%) and 12 cases in group B (12/43, 27.9%), with a significant difference between the two groups (χ²=8.295, P=0.004); 0 cases with diaphragmatic injury in group A and 6 cases in group B (6/43, 14.0%) with a significant difference between the two groups (Fisher's exact test, P=0.026). One month after ablation, the complete ablation rate was 97.5% (39/40) in group A and 95.3% (41/43) in group B; there was no significant difference between the two groups (P=0.600). The median follow-up time for the 83 patients was 21 months. The rate of local tumor progression was 5.0% (2/40) in group A and 7.0% (3/43) in group B, and there was no significant difference between the two groups (P=0.705).

Artificial ascites assisted ultrasound-guided percutaneous MWA can improve the quality of sonogram and the safety of ablation in the treatment of liver cancer adjacent to the diaphragm.