癌_肝细胞；腹腔镜技术；射频消融；治疗结果_

腹腔镜射频消融治疗多病灶肝癌的疗效及安全性

http://www.100md.com 《腹腔镜外科杂志》 2006年第6期

癌,肝细胞；腹腔镜技术；射频消融；治疗结果,,癌，肝细胞；腹腔镜技术；射频消融；治疗结果,1资料与方法,2结果,3讨论,参考文献：

     【摘要】目的：探讨腹腔镜射频消融(radiofrequency ablation,RFA)治疗多病灶肝癌的可行性、安全性及疗效。方法：2001年10月~2005年8月，15例多病灶肝癌患者在全麻下进行治疗。其中男12例，女3例，平均(51.5±9.0)岁。术前经超声、螺旋CT或MRI发现瘤体36个，其中2个病灶11例，3个病灶2例，4个病灶2例。肿瘤平均直径(3.1±1.1)cm。乙型肝炎13例，丙型肝炎2例。合并肝硬化13例，胆囊结石2例。结果：15例均顺利完成手术，同时行胆囊切除术2例。单个病灶RFA平均时间 (30.2±13.3)min，平均总手术时间(98.7±28.5)min，平均总出血量(145.3±82.8)ml。未出现腹腔出血、胃肠道损伤、膈肌损伤及肝功能衰竭等严重并发症。术后1个月螺旋CT增强扫描证实，病灶完全坏死率达100%。随访12 ~ 52个月(中位35个月)，1例发现肝内新病灶，3例消融部位复发，均采用经皮射频消融进行治疗。3例分别在术后24、28、36个月死于肝内复发及肝功能衰竭。结论：腹腔镜射频消融治疗多病灶肝癌安全可行，近期疗效肯定，最大程度保存了受损的肝功能。但应选择肿瘤位于肝脏表面、肝左外叶或临近胆囊的病例进行治疗。

    【关键词】癌，肝细胞；腹腔镜技术；射频消融；治疗结果

    Efficacy and safety of laparoscopic radiofrequency ablation therapy for patients with multifocal hepatocellular carcinomas

    FAN Ruifang,CHAI Fulu,HE Guanxian,et al.

    Dept.of Hepatobiliary Surgery,Lanzhou Genteral Hospital of Lanzhou Military Region,Lanzhou 730050,China

    【Abstract】 Objective:To evaluate the feasibility,safety and efficacy of laparoscopic radiofrequency ablation (RFA) therapy for patients with multifocal hepatocellular carcinomas (HCCs).Methods:From October 2001 and August 2005, a total of 15 patients with multifocal HCCs were treated by laparoscopic RFA under general anaesthesia.Among the patients(12 men and 3 women),the mean was (51.5±9.0)years.Thirtysix hepatic lesions with a mean diameter of (3.1±1.1)cm were identified preoperatively by ultrasonography,helical CT and MRI.Two lesions were found in 11 patients,3 lesions in 2 patients,and 4 lesions in 2 patients.Hepatitis B was diagnosed preoperatively in 13 patients, and hepatitis C in 2 patients.Thirteen patients had liver cirrhosis and 2 had chronic calculous cholecystitis.Results:Laparoscopic RFA therapy was performed successfully in all patients.Cholecystectomy was performed simultaneously for gallstones in two patients.The mean RFA time per lesion was (30.2±13.3)min,the mean total operation time was(98.7±28.5)min,and the mean blood loss was (145.3 ± 82.8)ml.No severe complications such as bleeding,gastrointestinal tract damage,diaphragmatic injury and liver function failure developed after operations.A complete tumor necrosis was achieved on the contrastenhanced helical CT scans in all patients in 1 month after the procedures.During a median followup of 35 months (range,1252 months),1 patients had new malignant nodules and 3 patients recurred locally at the RFA sites,for whom percutaneous RFA therapy was performed successfully,and 3 patients died from tumor recurrence and liver failure in 24th,28th and 36th months after treatments respectively.Conclusions:Laparoscopic RFA therapy is a feasible,safe,and effective treatment modality for selected patients with multifocal HCCs located on the surface of the liver,in the left external lobe of the liver,or adjacent to the gallbladder,which appears wellsuited to preserve impaired liver function. ......

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