射频凝固器在肝切除术中的应用

目的 评价射频凝固器(Habib 4X)在肝切除术中的应用价值.方法 回顾性分析2009年11月至2010年4月天津市第三中心医院应用Habib 4X对21例肝胆疾病患者施行肝切除术的临床效果.结果 成功完成21例肝切除术,其中右半肝切除3例,左半肝切除1例,2个肝段以上切除9例,单一肝段切除7例,肝脏局部切除1例.肿瘤均完整切除.平均切除时间(50±25)min,平均出血量(129±117)ml.术后无患者进入ICU.术后患者发生胆汁漏3例,淋巴液漏1例,胸腔积液4例,均经非手术治疗痊愈.全组患者无术后腹腔内出血、肝功能衰竭、伤口感染和围手术期死亡.术后平均住院时间(19±14)d.结论 肝切除术中应用Habib 4X辅助切肝,其射频能量可使拟切除面肝组织脱水凝固,闭合局部血管及其他管道系统,不阻断入肝血流,无需预先处理将要离断的粗大血管,可明显减少切除过程中的出血甚至不出血,降低术后并发症的发生率,使肝切除过程更安全、快捷.

Abstract：

Objective To investigate the value of Habib 4X in hepatic resection. Methods The clinical outcome of 21 patients with liver disease who received liver resection at the Tianjin Third Central Hospital from November 2009 to April 2010 were retrospectively evaluated. All the operations were carried out by using Habib 4X. Results All patients received hepatectomy, including right hepatectomy in three patients, left hepatectomy in one patient, multiple segmentectomy in nine patients, single segmentectomy in seven patients and partial liver resection in one patient. All tumors were reseeted completely. The mean operation time was (50±25) minutes and the mean blood loss was(129±117)ml. No patient was transferred to ICU. Three patients were complicated with bile leakage, one with lymphatic leakage and four with pleural effusion, and they were cured by non-surgical treatment. There were no patients with postoperative hemorrhage, incision infection or hepatic failure. No mortality was observed. The mean postoperative hospital stay was(19±14)days. Conclusions Radiofrequency energy was applied along the margins of the tumor to create zones of necrosis before resection with a scalpel, offering hepatobiliary surgeons an additional method for performing liver resections with minimal blood loss, low morbidity and mortality rates. As for malignant tumors, minor or major liver resection assisted by Habib 4X is safe, and it can reduce the chance of positive incisal margin.     

肝切除联合射频消融治疗中期肝癌

目的 探讨肝切除联合射频消融在中期肝癌治疗中的应用价值.方法 回顾性分析2008年10月-2011年11月,安徽省立医院肝脏外科采用肝切除联合射频消融治疗的中期肝癌患者19例,术前采用肝功能Child评分标准、吲哚菁绿排泄试验等方法对患者肝功能进行评估,术后7d结合肝功能各项指标对近期并发症进行评价,术后4周以血清甲胎蛋白、增强CT、超声造影检查为标准,对近期疗效进行评价,术后半年内每月行血清甲胎蛋白、增强CT、超声造影等检查1次,以后每2～3个月复诊1次.结果 术后7d全部病例均有不同程度的肝功能损害,但无肝性脑病及死亡病例的发生;术后4周残留病灶占全部病例的10.1％ (2/19),消融不全10.1％ (2/19);术后1年、2年生存率分别为83.2％、46.4％,平均生存时间22.23个月,中位生存时间24.87个月.结论 肝切除联合射频消融在中期肝癌的治疗中有重要的应用价值,适当的扩大了肝癌特别是中期肝癌手术探查的指征,最大限度的杀灭了肉眼可见的病灶.     

射频止血技术在肝切除术中的应用

目的 探讨射频止血技术在肝切除术中的临床应用价值.方法 回顾性总结2009年1月至2011年2月实施肝脏肿瘤切除患者60例.术中应用射频止血技术(raido-frequencyhemostasis,RFH)30例为射频组,传统钳夹法(clamp crushing method,CCM)30例作为对照组,两组患者年龄,性别,术前肝功能指标,病变大小等方面差异无统计学意义(P＞0.05).记录患者手术时间、术中出血量、术后肝功能恢复情况,术后3d引流量,术后第1、7天ALT及T-BIL水平等方面进行对比研究.结果 RFH组术中出血(219±62) ml明显少于CCM组(416 ±96) ml,差异有统计学意义(t =5.241,P＜0.05),RFH组未发生大出血,CCM组5例术中损伤肝静脉,3例出现大出血.术后3d引流量RFH组明显少于CCM组,术后第1、7天ALT及T-BIL比较,RFH组明显小于CCM组(分别t =5.987,16.803,22.264,8.386,8.255,均P＜0.05).术后肝功能恢复RFH组明显快于CCM组.结论 射频止血技术在肝切除术中具备损伤小,出血量少,恢复快、安全性高等优势.     

射频凝血器在原发性肝癌切除术中的应用

目的 探讨射频凝血器在原发性肝癌切除术中的应用价值.方法 回顾性分析2010年1月至2012年2月西安交通大学医学院第一附属医院收治的82例行手术切除的原发性肝癌患者的临床资料,根据其手术方式不同将患者分为射频止血肝切除组(41例)和常规钳夹肝切除组(41例),通过对两组患者的临床资料进行分析,评价射频凝血器的应用价值.计量资料采用t检验,计数资料采用x2检验.结果 射频止血肝切除组平均手术时间(77±28) min,比常规钳夹肝切除组的(129±34) min明显缩短(t=7.432,P＜0.05);射频止血肝切除组肝门阻断4例,较常规钳夹肝切除组的23例明显减少(x2=19.934,P＜0.05);射频止血肝切除组和常规钳夹肝切除组术中出血量分别为(241±214) ml和(751 ±421) ml,术中输血患者比例分别为15％ (6/41)和49％(20/41),两者比较,差异均有统计学意义(t=6.920,x2=11.038,P＜0.05).射频止血肝切除组和常规钳夹肝切除组在术后出血发生率、术后胆汁漏发生率方面比较,差异无统计学意义(x2=0.213,1.822,P＞0.05);射频止血肝切除组术后住院时间为(9±4)d,比常规钳夹组的(12±7)d明显减少(t=2.368,P＜0.05).两组均无围手术期死亡患者.结论 新型手术辅助器械射频凝血器能够有效地控制出血、减少手术时间,缩短术后住院时间,在原发性肝癌手术治疗中有较大的应用价值.     

射频消融在肝癌治疗中的应用及评价

肝癌治疗效果的提高有赖于多学科、多种方法有机结合又各有重点的＂个体化＂综合治疗方案。射频消融技术以其微创、方便、肿瘤灭活效果确切及可重复的优势成为肝癌治疗的有效方法之一。随着设备的改进和技术的成熟,其治疗效果不断提高,对中小肝癌可达到根治性治疗,有替代手术切除的趋势,尤其是对合并肝硬化肝功能不全的患者更表现出其独有的优势;在大肝癌的治疗中,作为姑息治疗或手术的辅助和补充治疗也具有一定的作用。在未来的肝癌治疗方案中,射频消融将占有更高的地位。     

水媒射频切割闭合器在肝切除术中的应用配合

总结12例肝切除术患者术中水媒射频切割闭合器的应用配合经验。提出术前做好充分的各项准备，熟悉闭合器的工作原理及使用方法，术中密切配合是手术成功的保证。     

射频消融在肝肿瘤治疗中的并发症

射频消融(radiofrequency ablation，RFA)治疗是在超声、CT或其他影像学设备的引导下，将射频电极针插入肿瘤内，利用高频交流电对局部组织进行高温热凝固，从而达到杀灭肿瘤的目的。RFA是近年来肝肿瘤局部治疗方法中发展较快的方法之一，可经皮、经腹腔镜或开腹术中进行，具有创伤小、疗效高的特点。目前认为，RFA是一种相对安全有效的方法，尤其对于无法手术切除的肝脏肿瘤有很好的姑息治疗效果。近年来，随着RFA方法的广泛应用和治疗病例的     

射频消融治疗肝癌

射频消融为目前国际上新兴的肝癌治疗手段 ,具有安全、微创、适应证广、并发症少的特点。本文就射频消融技术的基本原理、适应证与禁忌证、临床应用治疗效果及其并发症进行讨论。     

射频消融辅助肝切除控制术中出血的疗效

术中大出血是肝脏手术中最危险的并发症,严重时可引起凝血功能异常,造成出血无法控制,导致患者术中或术后死亡.近年来出现了一种新的RFA辅助技术,可以在极少量出血的情况下完成肝切除术[1].本研究回顾性分析2011年3月至9月我科应用RFA辅助肝切除术和钳夹结扎法肝切除术治疗的45例患者的临床资料,旨在探讨RFA辅助肝切除术的效果.     

单肺通气条件下经皮经肝射频消融治疗肝顶部肝癌

目的探讨单肺通气条件下经皮经肝射频消融（PRFA）治疗肝顶部肝癌（LCHD）的优越性。方法回顾性总结2006年1月至12月间连续应用左侧单肺通气条件下PRFA治疗10例LCHD患者（单肺通气组）的临床资料,按照诊断相同、癌灶大小相近、性别相同、年龄相近的原则,选择2004年1月至2005年12月应用非单肺通气条件下PRFA治疗LCHD的10例患者,与单肺通气组一一配对（对照组）。用配对t检验比较两组患者的年龄和癌灶直径,用,检验比较并发症发生率和不完全消融率。结果两组患者的年龄和癌灶直径无明显差异（P〉0．05）;单肺通气组的平均穿刺针数[（3．4±0．4）次]明显低于对照组[（6．1±0．8）次]（P〈0．01）;两组在治疗时间和射频消融直接产生的费用方面均无明显差异（P〉0．05）;单肺通气组无低氧、肺不张、肺感染等气管插管相关并发症发生,也无血气胸、腹腔内出血、胆瘘等射频针穿刺相关并发症发生,对照组中发生经皮穿刺相关性并发症2例,其中气胸和胸腔积液各1例;两组均无死亡发生;单肺通气组不完全消融率为10％（1／10）,对照组为40％（4／10）,两组差异无统计学意义（P〉0．05）;单肺通气组的医疗不良事件（并发症和不完全消融）发生率（10％）明显低于对照组（60％）（P〈0．05）。结论左侧单肺通气有助于提高PRFA治疗LCHD的效率、疗效和安全性。     

Long-term outcomes after hepatic resection combined with radiofrequency ablation for initially unresectable multiple and bilobar liver malignancies

Background

Hepatic resection (HRE) combined with radiofrequency ablation (RFA) offers a surgical option to a group of patients with multiple and bilobar liver malignancies who are traditionally unresectable for inadequate functional hepatic reserve. The aims of the present study were to assess the perioperative outcomes, recurrence, and long-term survival rates for patients treated with HRE plus RFA in the management of primary hepatocellular carcinoma (HCC) and metastatic liver cancer (MLC).

Methods

Data from all consecutive patients with primary and secondary hepatic malignancies who were treated with HRE combined with RFA between 2007 and 2013 were prospectively collected and retrospectively reviewed.

Results

A total of 112 patients, with 368 hepatic tumors underwent HRE combined with ultrasound-guided RFA, were included in the present study. There were 40 cases of HCC with 117 tumors and 72 cases of MLC with 251 metastases. Most cases of liver metastases originated from the gastrointestinal tract (44, 61.1%). Other uncommon lesions included breast cancer (5, 6.9%), pancreatic cancer (3, 4.2%), lung cancer (4, 5.6%), cholangiocarcinoma (4, 5.6%), and so on. The ablation success rates were 93.3% for HCC and 96.7% for MLC. The 1-, 2-, 3-, 4-, and 5-y overall recurrence rates were 52.5%, 59.5%, 72.3%, 75%, and 80% for the HCC group and 44.4%, 52.7%, 56.1%, 69.4%, and 77.8% for the MLC group, respectively. The 1-, 2-, 3-, 4-, and 5-y overall survival rates for the HCC patients were 67.5%, 50%, 32.5%, 22.5%, and 12.5% and for the MLC patients were 66.5%, 55.5%, 50%, 30.5%, and 19.4%, respectively. The corresponding recurrence-free survival rates for the HCC patients were 52.5%, 35%, 22.5%, 15%, and 10% and for the MLC patients were 58.3%, 41.6%, 23.6%, 16.9%, and 12.5%, respectively.

Conclusions

HRE combined with RFA provides an effective treatment approach for patients with primary and secondary liver malignancies who are initially unsuitable for radical resection, with high local tumor control rates and promising survival data.     

Surgical resection versus radiofrequency ablation for small hepatocellular carcinomas within the Milan criteria

Background/Purpose  It has been reported that hepatic resection may be preferable to other modalities for the treatment of small hepatocellular carcinomas (HCCs), by contributing to improved overall and disease-free survival. Ablation techniques such as radiofrequency ablation (RFA) have also been used as therapy for small HCCs; however, few studies have compared the two treatments based on long-term outcomes. The effectiveness of hepatic resection and RFA for small nodular HCCs within the Milan criteria were compared. Methods  A retrospective cohort study was performed with 278 consecutive patients who underwent curative hepatic resection (n = 123) or initial RFA percutaneously (n = 110) or surgically (thoracoscopic-, laparoscopic-, and open-approaches; n = 45) for HCC. The selection criteria for treatment were based on uniform criteria. Mortality related to therapy and 3- and 5-year overall and disease-free survivals were analyzed. Results  The model for endstage liver disease (MELD) scores for all patients in the series were less than 13. There were no therapy-related mortalities in either the hepatic resection or RFA groups. The incidence of death within 1 year after therapy (1.6 and 1.9%, respectively) was similar in the hepatic resection and RFA groups. The group that underwent hepatic resection showed a trend towards better survival (P = 0.06) and showed significantly better disease-free survival (P = 0.02) compared with the RFA group, although differences in liver functional reserve existed. The advantage of hepatic resection was more evident for patients with single tumors and patients with grade A liver damage. In contrast, patients with multinodular tumors survived longer when treated with RFA, regardless of the grade of liver damage. Further analysis showed that surgical RFA could potentially have survival benefits similar to those of hepatic resection for single tumors, and that surgical RFA had the highest efficacy for treating multinodular tumors. Conclusions  In patients with small HCCs within the Milan criteria, hepatic resection should still be employed for those patients with a single tumor and well-preserved liver function. RFA should be chosen for patients with an unresectable single tumor or those with multinodular tumors, regardless of the grade of liver damage. In order to increase long-term oncological control, surgical RFA seems preferable to percutaneous RFA, if the patient’s condition allows them to tolerate surgery.     

射频辅助肝切除术的可行性、安全性和有效性

目的探讨肝癌病人实施肝脏切除手术中采用射频辅助肝切除的临床应用效果。方法回顾性分析武汉大学人民医院2016年1月至2018年9月128例实施开腹肝脏手术切除病灶的病例资料,根据切除方法分为射频组59例、常规组69例(行常规肝脏切除),对比两种手术方法的相关指标、术后并发症。结果射频组的总出血量、切肝出血量、切肝时间、肝门阻断时间均低于常规组,差异有统计学意义(P<0.05);两组间手术时间、术后住院时间比较差异无统计学意义(P>0.05);术前、术后第1、3、7天,两组病人的血清白蛋白(ALB)、总胆红素(TBIL)、丙氨酸转氨酶(ALT)测定值差异无统计学意义(P>0.05);两组病人术后第1、3天血清ALB较术前均降低(P<0.05),两组病人术后第1、3、7天TBIL、ALT测定值较术前均升高(P<0.05);射频组手术并发症发生率(16.95%)低于常规组病人(23.19%),但差异无统计学意义(P>0.05)。结论肝癌病人实施肝脏切除手术中采用射频辅助肝切除具有减少手术出血量及肝门阻断时间的作用,同时并不会增加手术并发症及肝功能损害。     

腹腔镜射频消融术治疗肝血管瘤

目的 :探讨腹腔镜射频消融治疗肝血管瘤的可行性及实用性。方法 :2 5例肝血管瘤患者全麻气管插管后 ,腹腔镜下行射频消融治疗 ,其中 5例同时行胆囊切除术。结果 :患者经治疗均获满意效果 ,术后无残留病灶 ,无明显并发症。结论 :腹腔镜射频消融治疗肝血管瘤安全可行 ,治疗彻底 ,是治疗肝血管瘤的微创新技术。     

射频止血系统在肝切除术中的应用(附65例报告)

目的介绍一种新的射频止血系统在肝切除术中的应用情况并评估其安全性及有效性。方法 2015年6月至2016年6月间11例病人单独使用射频止血系统行肝切除术,54例病例采用射频止血系统与其他肝切除设备[超声刀、双极电凝钳和超声吸引刀(cavitron ultrasonic surgical aspirator,CUSA)]配合使用行肝切除术。使用射频止血系统解剖第一肝门、离断肝周韧带,使用其他切肝设备离断肝脏实质,肝断面出血点采用射频止血系统止血。结果 11例单独使用射频止血切肝的病人中,有9例没有行肝脏血流阻断,1例左半肝切除病人预先结扎患侧入肝血流,1例左半肝切除术中行陈氏肝血流阻断(第一肝门阻断联合肝下下腔静脉阻断);中位出血量为150 ml(30~300 ml),中位手术时间为200 min(90~250 min)。射频止血系统配合使用其他切肝设备54例病例中:腹腔镜肝切除术33例,开腹手术21例;33例未采用任何血流阻断方法(59.3%),第一肝门联合下腔静脉阻断3例,第一肝门阻断5例,10例半肝切除及3例扩大左半肝切除均预先处理患侧血管;54例中有1例活体肝移植供肝手术未采用任何血流阻断技术;腹腔镜手术无中转开腹;中位出血量为230 ml(50~500 ml),中位手术时间为240 min(90~360 min)。所有病例均未输血,均恢复顺利,无严重术后并发症,无围手术期死亡。结论在肝切除术中使用射频止血系统可减少术中出血量,避免肝血流阻断带来的缺血再灌注损伤,操作简单,值得推广。     

Segmental liver resection in a child using intraoperative ultrasound-guided radiofrequency energy

Segmental surgical liver resection is still considered the only potentially curative option for patients with resectable liver tumors. Intraoperative bleeding may be a dangerous complication even in an expert's hands. A bloodless technique of radiofrequency (RF)-assisted segmental liver resection was performed in a 9-year-old girl with a mycobacterial spindle cell pseudotumor of the liver. Under intraoperative ultrasound guidance, the liver parenchyma was coagulated along the marked resection plane by a single “cooled-tip” RF electrode and then divided with a surgical knife. A nearly bloodless resection of the parenchyma was achieved within 25 minutes. The patient was discharged on the fifth postoperative day without complications. My early experience shows that RF-assisted liver resection offers a valuable additional option for bloodless removal of liver tumors in pediatric age.     

超声造影在肝癌射频消融治疗中的作用

目的：探讨超声造影（CEUS）在肝癌冷循环射频消融（RFA）治疗中的应用价值。方法：选取肝癌患者20例25个病灶为观察对象,RFA治疗前行CEUS确定肿瘤的性质、数目和大小,治疗后1个月内和随访10个月后行CEUS与增强CT对比疗效评价。结果：治疗后1个月内CEUS复查,20个消融病灶各期均无异常增强区,提示肿瘤完全灭活;4个边缘局部有早期增强,提示肿瘤残留,增强区经增强CT及穿刺活组织检查证实为肿瘤残留,当即补充RFA治疗;1个CEUS图像模糊,未能作出诊断。随访10个月,1个消融病灶有残留复发,4例患者行CEUS发现新生病灶11个,直径0.6-3.8 cm,其中2例4个直径〈1.0 cm的病灶增强CT未能发现。结论：CEUS可以在RFA治疗前为治疗方案提供依据,在治疗后判断RFA疗效,是一种有效方法,并有助于发现微小新病灶。