腹腔镜超声引导下微波消融治疗肝细胞性肝癌合并肝硬化的价值

Laparoscopic microwave ablation guided by laparoscopic ultrasound in treating hepatic cellular carcinoma with liver cirrhosis

目的评价肝硬化背景下经腹腔镜超声引导微波消融治疗肝细胞性肝癌的安全性和有效性。方法选取经腹腔镜超声引导下微波消融治疗伴有肝硬化的肝细胞性肝癌患者71例,定期对患者行血清甲胎蛋白(AFP)及影像学检查以评估治疗效果。结果术中腹腔镜超声检查,发现7个术前影像学未检出的肝内病灶(6.9%)。共计101个肝肿瘤病灶,均在腹腔镜超声引导下成功完成肿瘤微波消融治疗,患者血清AFP水平明显降低,与术前比较差异有统计学意义(P<0.01)。术后仅1例患者出现术后严重并发症(1.4%),无死亡情况。术后1个月后复查,超声造影及增强CT均显示肝病灶完全消融,未见残留。术后随访(11.5±10.1)个月,4个病灶发现局部复发,6个病灶出现远处转移,3个病灶同时发生局部复发和远处转移。结论腹腔镜超声引导下的肝癌微波消融治疗具有安全、有效、恢复期短及并发症发生率低等优点。

Objective To evaluate the safety and efficacy of laparoscopic microwave ablation（MWA） guided by laparoscopic ultrasound in treating hepatic cellular carcinoma（HCC） with liver cirrhosis. Methods Seventy-one HCC patients with liver cirrhosis were treated by laparoscopic MWA guided by laparoscopic ultrasound. After treatment, the patients were checked regularly with AFP and various imaging studies to assessing the efficacy of laparoscopic MWA. Results One hundred and one lesions were treated by laparoscopic MWA guided by laparoscopic ultrasound. Laparoscopic ultrasound identified 7 new lesions which not found by preoperative imaging（6.9%）. The level of serum AFP decreased siguificandy after treatment（P〈0.01 ）. There was no mortality. Morbidity occurred in 1 patient（1.4%）. Complete ablation happened in all the lesions. After follow-up, 4 lesions showed local recurrences, 6 lesions showed remote recurrences, 3 lesions showed both local and remote recurrences. Conclusion Laparoscopic MWA guided by laparoscopic ultrasound treating HCC has advantages of safety,efficacy,short recovery time and less complications.