射频消融技术在胆囊癌肝浸润外科手术中的应用价值

Intraoperative application of radiofrequency ablation in gallbladder cancer with liver infiltration

目的探讨射频消融技术在胆囊癌肝浸润外科手术过程中的应用价值。方法选择2007年9月-2009年8月入院的胆囊癌肝浸润患者34例,分为外科手术组和射频消融组。20例外科手术组患者行胆囊切除术加肝楔形切除术,其中男12例,女8例,年龄53~76岁,平均69.0岁。14例射频消融组患者行外科开腹射频消融术,其中男9例,女5例,年龄64~78岁,平均71.5岁。术后随访,观察并比较两组的生存率及并发症情况。结果外科手术组1年生存率为14/20,射频消融组1年生存为8/14,两组比较差异无统计学意义（P〉0.05）,2年生存率有无差异还在进一步随访观察中。外科手术组术后发热19例,恶心呕吐13例,腹腔出血3例,胆道损伤3例,胆漏2例;射频消融组术后发热11例,轻度恶心呕吐8例,胆囊床周边少量积血2例,无腹腔出血、胆道损伤、胆漏发生。两组在术后发热、恶性呕吐方面差异无统计学意义（P〉0.05）,但在腹腔出血、胆道损伤、胆汁漏方面有统计学差异（P〈0.05）。结论开腹射频消融技术可用于外科治疗胆囊癌伴肝浸润,且在降低术后并发症发生率方面优于单纯外科手术。

Objective To discuss the value of radiofrequency ablation（RFA）technique in intraoperative application of gallbladder cancer with liver infiltration.Methods Thirty-four patients with gallbladder cancer with liver infiltration,admitted from Sep.2007 to Aug.2009,were involved and divided into two groups.Patients in surgery group（n=20,12 males and 8 females,aged 53-76 years with mean of 69.0 years） received cholecystectomy and liver wedge resection,while in RFA group（n=14,9 males and 5 females,aged 64-78 years with mean of 71.5 years） were selected to undergo RFA.The survival rates and complications in the both groups were observed after operation.Results The 1-year survival rate in surgery group was 70.0%（14/20）,and in RFA group was 57.1%（8/14）,showing no significant difference between the two groups（P0.05）.The 2-year survival rates of the both groups were still under investigation.In surgery group,postoperative febricity occurred in 19 cases,nausea and vomiting in 13 cases,abdominal hemorrhage in 3 cases,biliary tract damage in 3 cases,and bile leakage in 2 cases;while in RFA group,postoperative febricity occurred in 11 cases,nausea and vomiting in 8 cases,and gallbladder rim hematocele in 2 cases,and no abdominal hemorrhage,biliary tract damage or bile leakage occurred.There was no significant difference between the two groups in postoperative febricity and vomiting（P0.05）,but significant differences were found between the two groups in abdominal hemorrhage,biliary tract damage and bile leakage（P0.05）.Conclusion RFA technique can be used in the treatment of gallbladder cancer complicated with liver invasion,and it is more advantageous compared with simple surgery in prevention of postoperative complications.