微波消融治疗特殊部位肝癌的疗效和并发症分析

目的评价特殊部位肝癌微波消融（MWA）治疗的疗效和并发症。方法回顾性分析24例特殊部位肝癌行微波消融治疗患者,共治疗28个病灶（膈下8个,腹壁旁4个,靠近肠道4个,靠近肾脏2个,胆囊旁6个,直径〈10mm肝内小结节4个,腹腔镜下治疗8个,消融后完全切除瘤灶;CT定位下治疗20个）。治疗后观察瘤灶的坏死程度,并发症、有无复发及患者生存时间。结果8个病灶术后病理提示肿块呈完全凝固性坏死,20个病灶消融后CT提示肿瘤无强化;1例（1／28）病人出现胸腹壁灼伤合并少量胸腔积液,经对症处理后恢复正常,无膈肌、胆囊、肠道损伤、内出血、脓肿、腹膜炎等并发症,并发症发生率为3．57％;治疗后1年内复发3例（3／28）,1年复发率为10．71％;1年生存率为97．7％（22／24）,3年生存率为80％（12／15）,2例生存时间超过5年,至今仍在随访。结论CT定位和腹腔镜下行微波消融是治疗特殊部位肝癌的有效方法,但操作不当可引起严重并发症。

Analysis of the therapeutic effect and potential complication undergone microwave ablation therapy for liver cancer at privileged sites

Objective To evaluate the effect and potential complication of microwave ablation（MWA） in treatment of hepatoma at privileged site. Methods It was analyzed the result of MWA in treatment of hepatoma at privileged sites from 24 patients with 28 lesions under laparoscopy or CT respectively. It included complete necrosis of the lesions, complications, recurrence rate and survival rate. Results There were 8 of 28 lesions, displayed complete coagulative necrosis after resected pathologically, CT displayed complete unenhenced in another 20 lesions; empyrosis in abdominal wall combined with pleural effusion for 1 case, and 3.57% of complication rate, recurrence on 3 patients （10.71%） during one year after MWA, The survival rate of 1,3 year were 91.7% （22/24）and 80% （ 12/15）inspectively. Conclusions MWA under CT localization and peritoneoscope is an effective approach for treatment of hepatoma at privileged site; however, the serious complication would be caused by inadequate-manipulate.