腹腔镜射频消融治疗多病灶肝癌的疗效及安全性

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

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,我院对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(平均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RFA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、肝左外叶或邻近胆囊的病例进行治疗。

Objective ：To evaluate the feasibility,safety and efficiency of laparoseopie radiofrequeney ablation （RFA） therapy for patients with muhifocal hepatoeellular carcinomas（ HCCs）. Methods： From October 2001 to August 2005,15 patients with multifoeal HCCs were treated with laparoseopie RFA under general anesthesia. Among the patients （12 men and 3 women ） , the mean age was （51.5 ±9.0） years. Thirty-six hepatic lesions with a mean diameter of （3.1 ± 1.1 ）em were identified preoperatively by uhrasonography, 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 eholeeystitis. Results：Laparoseopie RFA therapy was performed successfully in all patients. Choleeysteetomy 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 from 12 to 52 months ） , 1 patient had new malignant nodules and 3 patients recurred locally at the RFA sites ,for whom pereutaneous RFA therapy was performed successfully,and 3 patients died of tumor recurrence and liver failure in 24th,28th and 36th months after treatments respectively. Conclusions：Laparoscopie RFA therapy is a feasible, safe,and effective treatment modality for selected patients with multifocal HICCs 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.