腹腔镜超声引导下冷循环射频治疗肝细胞癌的初步应用体会

目的 评估腹腔镜超声引导下射频消融治疗肝细胞癌的可行性、安全性及临床疗效.方法 对9例合并肝硬化的肝细胞癌患者进行腹腔镜超声引导下射频消融治疗.结果 9例患者共13个肿瘤均成功进行了腹腔镜超声引导下射频消融治疗.肿瘤直径0.7～4.2 cm,平均(2.4±1.1)cm.腹腔镜超声发现2个术前影像学未显示的病灶.3例患者同时进行腹腔镜胆囊切除术、粘连松解术以及腹壁转移灶切除术.术中无患者死亡及严重并发症发生.术后1个月增强CT显示12个病灶完全坏死.1例患者术后6个月死于肝功能衰竭,8例患者存活.结论 腹腔镜射频消融是一种安全可行的肝细胞癌治疗方法,腹腔镜超声在此过程中可准确地发现术前影像学漏诊的病灶.

Laparoscopic ultrasound graded radiofrequency ablation for hepatocellular carcinoma:preliminary experience

Objective To assess the feasibility, safety and clinical efficacy of laparoscopic radiofrequency ablation （LRFA） under laparoscopie ultrasound （LUS） guidance in detecting and treatment of hepatocellular carcinoma （HCC）. Methods Nine patients with HCC in liver cirrhosis were treated with LRFA under LUS guidance. Results LRFA procedure was completed in all patients and thermoablation of 13 HCC nodules was achieved. Tumor diameter was 0.7 ± 4.2 cm, mean （2.4±1. 1 ） cm. Laparoscopic ultrasound identified 2 new malignant lesions, in comparison with the results of preoperative imaging. Tumors ranged from 0. 7 to 4. 2 cm in diameter. Three procedures including cholecystectomy, adhesiolysis and metastasis resection were associated in 3 patients. There was no mortality and intraoperative complications. A complete tumor necrosis was observed in 12 of the 13 thermoablated nodules （92.3%） through spiral CT 1 month after treatment. One patient died 6 months after surgery because of liver failure. All other 8 cases were survived. Conclusion Laparoscopie RFA is a safe and feasible treatment to achieve tumor destruction in patients with HCC. Further, LUS can demonstrate great accuracy by detecting new HCC nodules missed by preoperative imaging.