腹腔镜辅助射频消融术治疗特殊部位肝癌的研究

Clinical application research of laparoscopic radio frequency ablation for the special site of liver cancer

目的:探讨腹腔镜辅助射频消融术治疗特殊部位肝癌的可行性、安全性及优势,并评估其疗效。方法:为35例肝癌患者、42枚特殊部位肝肿瘤行腹腔镜辅助射频消融术(laparoscopic radiofrequency ablation,LRFA)。其中原发性肝癌29例,转移性肝癌6例。32例曾行介入栓塞治疗。单发肿瘤30例,直径1～6.5 cm;多发5例,直径2.5～5.5 cm。热辐射损毁范围一般超过肿瘤直径0.5～1 cm。结果:35例均成功施行LRFA,7例患者术后少量腹水形成,3例反应性右侧胸腔积液,35例转氨酶升高,无围术期死亡及严重并发症发生。术后随访,瘤体完全消融率95.24%(40/42),AFP下降率为96.29%(26/27),CEA下降率100%(6/6)。术后1年、3年生存率分别为94.29%及57.15%。6例术后复发,复发率17.14%(6/35),复发时间5～22个月,死亡原因为肝功能衰竭、消化道出血和肿瘤复发转移。结论:LRFA为特殊部位肝癌的治疗提供了安全、有效、经济、微创的方式,可推广应用。

Objective：To explore the feasibility,security and advantage of laparoscopic radio frequency ablation（LRFA） for the special site liver cancer and to evaluate the curative effect.Methods：35 patients who suffered liver cancer with 42 tumor nodules on special parts,including 29 cases of primary liver cancer and 6 cases of metastatic liver cancer were treated by LRFA.32 patients had transcatheter arterial chemoembolization（TACE）.There were 30 cases of single tumor,1-6.5cm in diameter,5 cases of Multiple tumors 2.5cm-5.5cm in diameter.Thermal radiation damage range was generally more than the tumor of 0.5-1 cm in diameter.Results：35 patients were successfully implemented LRFA,after operation there were 7 cases of a small account of ascites,3 cases of reactive right pleural and 35 cases of transaminase elevation,no perioperative deaths and complications.Through review and follow-up,postoperative tumor ablation completely rate was 95.24%（40/42）.AFP decreased 96.29%（26/27）,CEA decreased 100%（6/6）,respectively.1,3 year overall survival rate was 94.29%,57.15%,respectively.18 patients were recurrence,The recurrence rate was 17.14%（6/35） between 5-22 months,the cause of death were liver function failure,gastrointestinal bleeding and recurrence transfer.Conclusions：LRFA for special parts liver cancer provides a safe,effective,economical,and minimally invasive treatment.