腹腔镜下冷循环射频消融治疗肝癌

Laparoscopic cool-tip radiofrequency ablation for hepatic carcinoma

目的探讨腹腔镜下冷循环射频消融在肝癌治疗中的价值。方法肿瘤位于肝脏脏面不适于在B超引导下进行射频治疗的原发性肝癌12例,转移性肝癌3例,肝癌破裂出血4例,全身麻醉,术中先腹腔镜探查,明确肿瘤位置确定穿刺点,然后在腹腔镜引导下,穿刺肿瘤行射频消融治疗。结果全组未发生手术并发症。4例肝癌破裂出血停止,术后复查肿瘤缩小,血AFP显著下降。术后1个月32个肝癌病灶,完全消融27个,消融不全5个,完全消融率844%(27/32)。3个月后CT示9例肿瘤病灶完全坏死,AFP降至正常;6例病灶部分坏死。随访2～18个月,平均82月,15例生存,4例死亡(3例肝功能衰竭,1例消化道大出血)。结论腹腔镜引导下冷循环射频消融治疗肝癌比B超引导下射频治疗定位更加准确,治疗效果肯定,手术并发症发生率低。

Objective To evaluate the clinical value of laparoscopic cool-tip radiofrequency ablation for hepatic carcinoma.Methods Included into this study were 12 cases of primary liver carcinoma (the tumor was located at the visceral surface, which was not suitable for B-ultrasound guided radiofrequency treatment), 3 cases of metastatic liver cancer and 4 cases of ruptured liver carcinoma. The operations were conducted under general anesthesia. After laparoscopic exploration to understand the location of the tumor and determine the puncture site, laparoscopy guided puncture were carried out to perform the cool-tip radiofrequency ablation.Results No operative complications were seen. In the 4 cases of ruptured liver carcinoma, the bleeding was effectively stopped and postoperative re-examination showed a regression of tumor and a decrease of AFP level. Of the 32 lesions, complete ablation was achieved in 27 lesions and partial ablation in 5, giving a complete ablation rate of 84 4% (27/32). In 9 cases, CT examination 3 months after the treatment showed complete necrosis of tumor, with AFP level having been dropped to normal. In another 6 cases, the lesion was partly ablated. Follow-up for 2～18 months (mean, 8.2 months) found 15 cases survived and 4 died (3 cases of hepatic failure and 1 case of hemorrhage of digestive tract). Conclusions Laparoscopic cool-tip radiofrequency ablation for hepatic carcinoma is an accurate and effective intervention with a relatively low incidence of complications.