腹腔镜下人工胸、腹水在特殊部位肝癌热消融中的应用

目的观察腹腔镜下人工胸、腹水在特殊部位肝癌热消融中应用的效果。方法回顾性分析中山大学附属第三医院2003年6月至2007年5月收治的肝癌并进行热消融的患者131例,其中肝癌位于肝脏被膜下有47例,根据是否采用腹腔镜下人工腹水或胸、腹水辅助超声引导将患者分为A、B两组,A组25例,采用腹腔镜下人工腹水或胸、腹水辅助超声引导肝脏被膜下肿瘤消融;B组22例,仅采用超声引导经皮肝脏被膜下肿瘤消融。比较两组患者术后肝被膜下血肿、腹腔内出血、胸腔积液、肝脓肿和肝功能损害等并发症的发生率、肿瘤完全消融率及1年复发率。结果A组出现胸腔积液1例,肝功能损害2例,并发症发生率为12.0%;B组肝被膜下血肿2例,腹腔内出血1例,胸腔积液5例,肝功能损害1例,并发症发生率为40.9%。两组并发症的发生率差异有统计学意义（χ^2=5.144,P=0.023）。A组和B组肿瘤完全消融率分别为96.8%和72.4%,两组肿瘤完全消融率差异有统计学意义（χ^2=5.194,P=0.023）;1年复发率差异无统计学意义（P〉0.05）。结论腹腔镜下人工胸、腹水辅助超声引导肝脏被膜下肿瘤热消融,以人工胸、腹水为媒介,结合了热消融与腹腔镜两项微创技术的优点,有效地提高了热消融治疗肝癌的效果,减少了并发症的发生,扩大了热消融治疗的适应证。

Application of thermal ablation with artificial ascites for liver cancer located in privileged sites

Objective To observe the application effect of thermal ablation with the artificial hydrothorax and ascites for liver cancer in privileged sites.Methods 131 patients with liver cancer,who were performed thermal ablation in our hospital from June 2003 to May 2007,were analyzed retrospectively,including 47 cases with liver cancer located under the liver capsule.According to whether to use laparoscopic ultrasound-guided radiofrequency(RF) ablation assisted by artificial ascites or artificial hydrothorax and ascites,the patients were divided into 2 groups:A(n=25),B(n=22).Patients of group A were given laparoscopic ultrasound-guided RF ablation assisted by artificial hydrothorax or ascites in the treatment of subcapsular tumors;while cases in group B were treated with percutaneous ultrasound-guided RF ablation.The incidence of complications(such as subcapsular hematoma of the liver,intra-abdominal hemorrhage,pleural effusion,liver abscesses and liver functional lesion),the complete ablation rate,and 1-year recurrence rate were compared between the two groups after treatment.Results In group A,there were 1 case of pleural effusion,2 cases of liver functional lesion,with 12.0% complication rate;whereas in group B,The main complications were included 2 case of subcapsular hematoma of the liver,1 case of Intraabdominal hemorrhage,5 cases of pleural effusion,1 case of liver functional lesion,with 40.9% complication rate.The difference of incidence of complications between the 2 groups is statistically significant(χ2=5.144,P=0.023).The complete tumor ablation rate of group A and group B were 96.8% and 72.4% respectively,with a significant difference(χ2=5.194,P=0.023);The difference in 1-year recurrence rate was not significant(P>0.05).Conclusions Laparoscopic ultrasound-guided RF ablation with artificial hydrothorax or ascites for tumors under the liver capsule,which uses artificial hydrothorax or ascites as the media and combines with advantages of two minimally invasive techniques(thermal ablation and laparoscope),has effectively improved the effect of the thermal ablation treatment for liver cancer,reduced the incidence of complications,and expanded the indications of thermal ablation treatment.