射频消融辅助下前入路右半肝切除术治疗原发性肝细胞癌

Radiofrequency-assisted anterior approach right hepatectomy for hepatocellular carcinoma

目的探讨射频消融辅助下前入路右半肝切除术治疗原发性肝细胞癌的安全性和有效性。方法回顾性分析2010年1月至2011年7月接受射频消融辅助下前入路右半肝切除术治疗的12例原发性肝细胞癌患者的临床资料，对手术方法和治疗结果进行回顾性分析。12例患者均为男性；年龄38～57岁，平均（48±6）岁。其中10例（10／12）有乙肝病史。术中均先行建立肝后下腔静脉前隧道，悬吊肝脏后沿Cantline线进行消融，以手术刀在消融区域中间直接切开肝实质，直至完整离断右半肝。处理右侧肝短静脉、肝右静脉后游离右半肝周围韧带，完整切除右半肝。组间资料比较采用t检验。结果手术时间165～295min，平均（230±55）min；术中出血量150～1500ml，平均（516±378）ml，优于前入路右半肝切除术的（1291±1159）ml和传统右半肝切除术的（2129±2012）ml（t=1．236、3．265，P〈0．05）。术后住院时间8～19d，平均（12±4）d；无医疗并发症，无术后死亡病例，所有患者治愈出院。结论射频消融辅助下的前入路右半肝切除术治疗原发性肝细胞癌可减少术中出血、缩短手术时间，是一种安全、有效的治疗手段。

Objective To investigate the safety and efficacy of radiofrequency-assisted anterior approach right hepatectomy for hepatocellular carcinoma （HCC）. Methods The clinic data of 12 HCC patients who underwent radiofrequency-assisted anterior approach right hepatectomy from January 2010 to July 2011 was analyzed retrospectively. Surgical techniques and treatment response were retrospectively reviewed. All the 12 patients were male, aging from 38 to 57 years with a mean of （48±6） years. Ten of the 12 patients were infected with hepatitis B virus. A retrohepatic tunnel anterior to the surface of the inferior vena cava （IVC） was developed. The liver was hanged away from the IVC and radiofrequency was carried out along the Cantline＇s line. Scalpel was used to cut off the liver parenchyma along the middle of the ablated area until the parenchyma was fully resected. After short hepatic veins and the right hepatic vein were ligated, ligaments of right liver were fully isolated and right liver was resected. The t test was performed between 2 groups. Results The surgical time was 165 to 295 minutes, with a mean of （230± 55） minutes. The bleeding was 150 to 1500 ml, with a mean of （516 ±378） ml, which was better than those of anterior approach right hepatectomy （（ 1291 ±1159） ml） and classical right hepateetomy （（2129 ±2012） ml; t = 1. 236, 3. 265; P 〈 0. 05）. The postoperative hospital stay was 8-19 days, with a mean of （12 ± 4） days. There were no medical complications and no postoperative death. All patients were cured and discharged. Conclusions Radiofrequency-assisted anterior approach right hepatectomy for HCC is safe and effective and could effectively decrease intra-operative bleeding and shorten surgical time.