摘要
目的:探讨腹腔镜超声和经皮超声在肝癌射频消融治疗中的联合应用.方法:2007-09/2008-11我院对25例肝癌患者的43个肝内肿瘤在腹腔镜超声和经皮超声引导下行射频消融治疗.肿瘤直径2.7-7.5(平均3.8)cm.本组中,HBV(+)14例,HCV(+)2例,合并有不同程度肝硬化16例,胆囊结石13例.其中1个癌灶14例,2个癌灶3例,3个癌灶4例,4例多发.术后采用超声检查及螺旋CT增强扫描评价RFA疗效.结果:25例患者顺利完成腹腔镜超声引导下射频消融治疗,有4例射频治疗部位复发和3例肝内新发病灶又采取经皮超声引导下射频消融治疗.全部病例中,11例同时行胆囊切除术,在腹腔镜超声引导下,单个肿瘤平均射频治疗时间为39.3±12.1min,平均总手术时间95.5±25.8min,平均总出血量148.5±84.3mL.在经皮超声引导下,单个肿瘤平均射频治疗时间28.3±10.3min,平均总手术时间50.2±11.5min,治疗后超声检查肝周、腹腔未见明确积液.患者术中、后均未出现严重并发症.术后随访,有3例CT提示原发性肝癌复发,外科医生建议行肝移植,其余22例随访至2008-11均存活.结论:腹腔镜超声和经皮超声在肝癌射频消融治疗中的联合应用,使患者的远期疗效比较满意.
AIM： To evaluate combined application oI laparoscopic ultrasonography and percutaneous ultrasonography in radiofrequency ablation foI hepatic cancer.METHODS： Between September 2007 and No- vember 2008, 25 patients with 43 malignant liver nodules were treated with laparoscopic ultrasonography-guided and percutaneous ultrasonography-guided radiofrequency ablation at our hospital. Of 25 patients, there were 18 males and 7 females with a mean age of 42 （28-77） year, with 20 Hepatic cancer 2.7-7.5 cm in diameter with the mean size of 3.8 cm. Hepatitis B positive was diagnosed preoperatively in 14 patients, and hepatitis C positive in 2 patients. There were sixteen patients with liver cirrhosis and thirteen patients with chronic calculous cholecystitis. One lesion was found in 14 patients, two lesions in 3 patients, three lesions in 4 patients, and dotty lesions in 4 patients. All patients were followed up with helical computed tomographie （CT） scan and ultrasonography.RESULTS： Laparoscopic RFA therapy was performed successfully in 25 patients combined with laparoscopic ultrasonography, and 4 patients experienced local recurrence at the ablation site, 3 patients had a new malignant nodule, for whom percutaneous RFA therapy was performed successfully with percutaneous ultrasonography. Of all cases, 11 patients were performed laparoscopie cholecystectomy simultaneously. With laparoscopic ultrasonography guidence, the mean RFA time per lesion was 39.3 ± 12.1 min, the mean total operation time was 95.5 ± 25.8 min, and the mean blood loss was 148.5 ± 84.3 mL. With percutaneous ultrasonography guidance, the mean RFA time per lesion was 28.3 ± 10.3 min, the mean total operation time was 50.2 ± 11.5 min, and no bleeding sign was found by ultrasound after RFA. No specific complications such as bleeding, gallbladder injury, gastrointestinal tract damage, diaphragmatic injury, bile leakage, stricture of bile duct and liver function failure developed during and after RFA therapy. During a followup period of 3-14 months, three of these patients experienced primary liver cancer recurrence, for which surgeons recommended liver transplantation. The remaining cases are alive so far.CONCLUSION： We are relatively satisfied with long curative effect of combined application of laparoscopic ultrasonography and percutaneous ultrasonography in radiofrequency ablation for hepatic cancer
出处
《世界华人消化杂志》
CAS
北大核心
2009年第7期720-723,共4页
World Chinese Journal of Digestology
关键词
肝脏
腹腔镜超声
经皮超声
射频消融
肝癌
Liver
Laparoscopic ultrasonography
Percutaneous ultrasonography
Hepatic cancer
