腹腔镜辅助下原发性肝癌和肝转移癌的射频消融术治疗

目的 :探讨腹腔镜辅助下肝癌射频消融术治疗的优势。方法 :全麻下联合腹腔镜技术对原发性肝癌和多发的肝转移癌灶行射频消融术治疗。结果 :1 0例患者 32个瘤体 ,其中直径 5cm的 2 0个瘤体均一次手术热凝损毁 ,CT和MRI提示肿瘤坏死 ,其中 ,1 5个瘤体完全缓解 (CR)占 75 % ,5个瘤体部分缓解 (PR)占2 5 % ,近期疗效CR +PR为 1 0 0 %。随访 2～ 1 4个月无复发。直径 >5cm的 1 2个瘤体亦予以一次性热凝损毁 ,术后 1～ 8周内AFP、CEA、CA1 9 9肿瘤指标均转阴或下降 ,CT或MRI提示肿瘤热凝损毁 ,近期疗效CR +PR为 83 3%。患者均能耐受射频消融治疗 ,无并发症发生。 1例原发性肝癌术后 1 3个月死于肿瘤扩散。结论 :腹腔镜辅助下肝癌射频消融术治疗直径 5cm的瘤体效果显著 ,对直径 >5cm的瘤体部分有效。此法为腹腔镜辅助下结直肠癌手术中多发肝转移癌灶的处理提供了一种创伤小、时间短、见效快、安全方便的治疗方法。

Laparoscopic radio-frequency ablation in the treatment of hepatocellular carcinoma or liver metastases

Objective:To investigate the potential efficiency of radio frequency(RF) ablation of hepatocellular carcinoma or liver metastases.Methods:Under general anaesthesia,radio frequency electrodes were put into the liver for ablation to treat hepatocellular carcinoma or liver metastases.Results:Among the 32 hepatic cancer lesions in 10 patients,20(62.5%) lesions with diameter 5cm were ablated by one session.The effective rate (CR+PR) was 100%(20/20) with CR 75% (15/20) and PR 25%(5/20).During the 2 14 months follow up of these lesions,no recurrence was found by CT or MRI.12 lesions(37.5%) with 5cm<Φ10cm were also ablated by one session,with CR 25%(3/12),PR 58.3%(7/12),MR 16.6%(2/12) and the effective rate(CR+PR) was 83.3%(10/12)by CT or MRI.Tumor markers such as AFP,CEA,CA19 9 were also become negative or fell down in 1 2 months after treatment.All patients tolerated the procedure well,no complications occurred after the ablation.One patient with the hepatocellular carcinoma died of disseminated disease at the 13 months. Conclusions:Laparoscopic radio frequency(RF) ablation in the treatment of hepatocellular carcinoma or liver metastases is effective on liver tumor with Φ≤5cm,and it's partly effective on lesions with 5cm<Φ<10cm.This procedure especially can be a safe,convenient and effective method to treat those patients of colorectal cancer with the liver metastases during the laparoscopic operations.