超声引导联合腹腔镜微波消融治疗特殊部位肝癌的临床体会

目的总结超声引导下联合腹腔镜行微波消融治疗特殊部位肝癌的临床应用价值和体会。方法回顾性分析我院2008年2月至2010年10月期间在超声引导下联合腹腔镜行微波消融治疗的9例肝脏恶性肿瘤患者的临床资料。结果原发性肝癌6例,转移性肝癌3例;多发肿瘤8例,单发肿瘤1例。患者均有1个或多个病灶侵及肝脏被膜,共计13个病灶,其中位于膈顶6个,右叶脏面邻近肠管3个,左叶邻近胃壁2个,胆囊床1个,肝门部1个。患者术后无膈肌损伤、胃肠道穿孔、大出血、胆汁漏等严重并发症发生,围手术期无死亡病例。患者随访(9.2±4.7)个月(4～18个月)。术后1个月行CT检查,11个病灶完全消融,完全消融率为84.6%(11/13);2个(2例)病灶边缘部分残留,其中1例再次行微波消融,1例行无水乙醇消融。术后3个月再次复查CT,4例患者出现新发病灶,其中2例再次行微波消融治疗,1例行无水乙醇消融治疗,1例因合并肺转移而放弃治疗;1例肝功能不佳于术后6个月死于肝功能衰竭;1例多发病灶患者于术后10个月死于肿瘤脑转移;其余患者尚存活。结论超声引导下联合腹腔镜行微波消融治疗特殊部位的肝癌安全、有效、疗效确切。

Ultrasound Guided Combined with Laparoscopic Microwave Ablation in Treatment for Special Site Liver Cancer

Objective To explore the clinical value and experience of ultrasound guided combined with laparoscopic microwave ablation in treatment for special site liver cancer.Methods The clinical data of 9 patients with liver cancer treated by ultrasound guided combined with laparoscopic microwave ablation in our hospital from February 2008 to October 2010 were analyzed retrospectively.ResultsThere were 6 cases of primary liver cancer,3 cases of metastatic hepatic carcinoma.Eight cases of multiple tumors,1 case of single tumor.There were one or more lesions invading liver capsular,a total of 13 lesions in all the patients.Among them,6 lesions located in diaphragm,3 closed to bowel,2 neared stomach,1 located in gallbladder bed and 1 in hilar.No serious complications and no death happened during operation.The following-up time was(9.2±4.7) months(4 to 18 months),there were 2 lesions of part residual,including 1 case of microwave ablation again,1 case of percutaneous ethanol ablation,and 11 lesions of complete ablation(84.6%,11/13) 1 month after operation by CT examination.Four cases recurred 3 months after operation by CT examination,including 2 cases of microwave ablation again,1 case of percutaneous ethanol ablation,1 patient with pulmonary metastasis and giving up treatment,1 patient with poor liver function and died of liver failure 6 months after operation;1 patient with multiple lesions died of brain metastases 10 months after operation;the rest were still alive.ConclusionsUltrasound guided combined with laparoscopic microwave ablation is a safe and effective method in the treatment for special site liver cancer,the curative effect is good and worth of spread.