腹腔镜射频消融术治疗特殊部位肝癌23例

目的探讨腹腔镜射频消融术（1aparoscopic radiofrequency ablation，LRFA）治疗特殊部位肝癌的疗效。方法2008年5月～2011年5月对23例特殊部位肝癌在全麻下行LRFA，其中原发性肝癌19例，转移性肝癌4例，单发肿瘤15例，多发8例，肿瘤直径（3．8±1．1）cm，热辐射损毁范围一般超过肿瘤直径0．5—1cm。结果23例均安全完成LRFA，单个病灶射频消融时间（9．2±4．3）min，手术时间（98．7±21．5）min，出血量（80．6±21．8）ml。术后未发生腹腔出血、胃肠道损伤、膈肌损伤及肝功能衰竭等并发症。术后1个月螺旋cT增强扫描证实，瘤体完全消融率达100％。术后1、2、3年生存率分别为91．3％（21／23）、80．9％（17／21）、76．4％（13／17）。6例术后复发，复发率26．1％（6／23），复发时间术后2～18个月（平均7．5月）；10例死亡：3例死于肝功能衰竭，5例死于消化道出血，2例死于肿瘤复发转移。结论对于特殊部位肝癌LRFA是一种安全、创伤小的方法。

Laparoscopic Radiofrequency Ablation for the Liver Cancer at Special Locations

] Objective To investigate the efficacy of laparoscopic radiofrequency ablation （LRFA） for patients with hepatocellular carcinomas （HCCs） at special sites. Methods Totally 23 patients with special-site HCCs received LRFA under general anesthesia in our hospital from May 2008 to May 2011. Among the patients, 19 were diagnosed with primary liver cancer and 4 with metastatic liver cancer; 15 of them had a single tumor, and the other 8 had multiple tumors. The mean diameter for radiofrequency was （3.8 ± 1.1） cm. Results LRFA was completed successfully in all the patients. The mean operation time was （9.2 ± 4.3） min per lesion, and （98.7 ± 21.5） min in total. The mean total blood loss was （80.6 ± 21.8） ml. No severe complications such as bleeding, gastrointestinal tract damage, diaphragmatic injury or liver function failure were developed after the operation. A complete tumor necrosis was achieved in all the patients, shown by contrast-enhanced helical CT scans in one month after the procedures. The 1-, 2-, and 3-year survival rate was 91.3% （21/23）, 80.9% （17/21）, and 76.4% （13/17）, respectively. Six （26.1%, 6/23） of the patients showed recurrent tumor in a mean of 7.5 months （ ranged from 2 to 18 months）. Ten of the patient died of liver function failure （3 cases）, gastrointestinal tract damage （5 cases）, or tumor metastasis （2 cases） during follow-up. Conclusion LRFA is a safe and minimally invasive for special-site liver cancer.