腹腔镜超声在经皮射频消融术治疗肝肿瘤中的应用价值

目的 探讨腹腔镜超声在经皮射频消融术治疗肝肿瘤中的应用价值.方法 31例不能耐受开腹手术的肝癌患者,常规超声均无法经皮定位病灶,行经皮射频消融术时术中均在腹腔镜超声下引导穿刺,并动态观察手术进程.结果 31例肝癌患者均在腹腔镜超声引导下完成经皮射频消融术.其中7例为术前CT或MRI发现而常规超声无法扫查的膈顶部病灶,3例为术前未发现小病灶,1例排除术前MRI诊断的假阳性病灶.31例肝癌患者腹腔镜手术顺利,无术中死亡,术后未出现出血、感染等并发症,5例出现一过性发热,4例出现恶心,3例出现轻微腹痛.术后随访6个月内无1例复发.结论 腹腔镜超声可检出术前影像学检查遗漏的肝癌小病灶、定位常规超声盲区处肝癌病灶并引导经皮射频消融术.腹腔镜超声可以辅助完成不能耐受开腹手术、常规经皮超声又无法定位治疗的肝癌患者的经皮射频消融治疗.

Application of intraoperative laparoscopic ultrasonography in the cool-tip radiofrequency ablation of hepatic carcinoma

Objective To evaluate the feasibility and efficacy of intraoperative laparoscopic ultrasonography （ ILU ） in the radiofrequeney ablation （ RFA ） of hepatic carcinoma. Methods Thirty-one patients with hepatie carcinoma were enrolled in this study. In the process of RFA, ILU was applied to guide the RFA needle and to monitor the process of RFA in real-time. Results Under the guidance of ILU,the percutaneous RFA in all patients proceed smoothly. Seven additional masses at the liver diaphragmatic that were missed in preoperative ultrasound but reported by preoperative CT or MHI top were detected. Three small lesions were not detected in preoperative imaging. A false positive local lesion was ruled out accurately. Thirty-one cases of liver cancer patients underwent laparoseopic surgeru without intraoperative death, postoperative infection, haemorrhage or other complications. Five cases had transient fever, four had nausea and three had mild abdominal pain. Patients were followed up for six months with no recurrence. Conclusions ILU has certain advantages to routine ultrasound in observing conventional blind area and detecting missed lesions preoperatively. ILU is also helpful for assisting the pereutaneous RFA treatment in patients that are unable to detect or locate by preoperative ultrasound and intolerant to routine surgery.