氩超冷刀治疗晚期巨块多灶型肝癌的临床研究

A clinical study on treatment of massive multifocal malignant liver tumor with argon super-cryosurgery

目的 探讨氩超冷刀手术系统（Argon surper-cryosurgery system，ASSS）治疗晚期巨块多灶型肝癌的方法和研究氩超冷手术（ASS）治疗后癌组织细胞的形态学改变。方法 22例“无法外科治疗”的晚期巨块多灶型肝癌病人中单纯ASS治疗9例，减体手术切除癌肿+ASS+门静脉置泵1例，巨块癌肿切除+ASS+门静脉置泵2例，<5.0 cm癌肿切除+ASS+肝动脉置泵1例，ASS治疗+肝动脉置泵3例，ASS治疗+门静脉置泵6例。结果 成功治疗22例，并发症有 ASSS枪穿刺孔出血、胸腔积液、胆汁漏、肝昏迷，但均治愈。所有病例随访均生存，最长已生存11个月。结论 （1）ASSS 为“无法外科治疗”的晚期巨块多灶型肝癌提供新的治疗途径。（2）在ASS治疗中，应注意其治疗的适应症，以及并发症的防治。

Objective To evaluate the efficacy of argon surper-cryosurgery system (ASSS) in the treatment of huge hepatic multi-nidus carcinoma at advanced stage in cases of which conventional surgery is impossible. Methods Twenty-two patients with huge hepatic multi-nidus carcinoma at advanced stage, incurable with conventional surgery, were treated by ASSS in combination with entire or reduced-size excision. In terms of combined treatment, 1 patient received reduced-size operation and portal vein chemotherapeutic pump, 2 with entire excision and portal vein chemotherapeutic pump, 1 with entire excision and liver artery chemotherapeutic pump, 3 with only liver artery chemotherapeutic pump, and 6 with portal vein chemotherapeutic pump. Nine patients were simply treated by ASSS. Results The surgical procedures went smoothly in all cases and the complications, such as bleeding at the puncture aperturae, thorax effusion, bile leakage and liver cataphora, were successfully managed. The follow-up study was performed and all patients surived with the longest survival of 11 months up till now. Conclusions ASSS offers a new treatment method for huge hepatic multi-nidus carcinoma at advanced stage, but the indications must be carefully observed, and the surgical skills and prevention of complication are of great importance.