腹腔镜下保留胆囊的毗邻胆囊肝细胞癌一次性完全射频消融治疗

Laparoscopy-assisted and gallbladder-preserved one-off radiofrequency ablation for hepatocellular carcinoma adjoining gallbladder

目的评估腹腔镜下对毗邻胆囊的肝细胞癌进行一次性完全射频消融(RFA)治疗的可行性与安全性。方法选取毗邻胆囊周边不同部位的肝细胞癌患者5例,肿瘤直径2.5～4.2cm,采用腹腔镜辅助射频消融治疗,腹腔镜下对胆囊不作分离与切除,射频消融过程保中持胆囊壁的连续完整。术后通过B超及CT了解肿瘤有无复发,并观察患者生存状况。结果术后3d行B超检查见胆囊壁近消融区处边缘增厚,厚度0.3～0.5cm,CT显示胆囊壁密度增高。术后6个月增强CT显示5例患者肿瘤边缘均无强化,胆囊完整,达到肿瘤一次性完全消融。随访18～36个月,所有患者均生存良好。结论腹腔镜下对毗邻胆囊的肝细胞癌达到一次性完全消融并保持胆囊壁的连续与完整在技术上是安全可行的。

Objective To evaluate the feasibility and safety of laparoscopy-assisted one-off complete radiofrequency ablation （KFA） for hepatocellular carcinoma （HCC） adjoining gallbladder. Methods Five cases of HCC adjacent to different location of gallbladder were involved in present study. The tumor diameter ranged from 2.5 to 4.2cm. Laparoscopy-assisted radiofrequency ablation was performed without isolation or resection of gallbladder so as to maintain its anatomical integrity. The patients were followed up with the aid of ultrasonography and computed tomography postoperatively, at the same time the surviving quality was assessed. Results Three days after the operation, ultrasound examination showed that the gallbladder wall close to the ablated area was increased by 0.3-0.4cm, and the CT images showed that the density of gallbladder wall was increased. Six months after the operation, the contrast enhanced CT images showed that the gallbladder was intact and no high density area was observed in every patient, implying that the tumor was one-off ablated completely. All the patients lived a life with good quality during the follow-up period of 18-36 months. Conclusion Laparoscopy-assisted one stage radiofrequency ablation for hepatocellular carcinoma adjoining gallbladder with maintenance of the anatomical integrity of gallbladder is technically safe and feasible.