三维重建辅助腹腔镜超声引导激光消融在肝脏恶性肿瘤的临床应用

Clinical application of three-dimensional reconstruction-assisted laparoscopic ultrasound-guided laser ablation in liver malignancies

背景与目的:激光消融(LA)提高了肝肿瘤消融的精度,从而降低了并发症的可能性,已成为肝脏恶性肿瘤重要的临床治疗方法之一。然而,目前关于应用三维(3D)重建辅助腹腔镜超声技术引导LA治疗肝脏恶性肿瘤的相关报道较少。因此,本研究探讨3D重建辅助腹腔镜超声引导下LA治疗肝脏恶性肿瘤的临床效果与应用价值。方法:回顾性收集2020年9月—2022年3月行3D重建辅助腹腔镜超声引导下LA治疗肝脏恶性肿瘤患者的临床资料,分析手术完成情况、手术时间、术中出血量、术后并发症发生情况、手术前后肝功能指标与肿瘤标志物变化,术后随访期间肿瘤总缓解率(ORR)和复发率。结果:共纳入35例符合纳入标准的患者,其中原发性肝癌25例、结直肠癌肝转移6例、胰腺癌肝转移2例、肺癌肝转移2例。所有患者均顺利完成手术,手术时间为(66.3±2.8)min,术中出血量为(15.9±12.4)mL。3例患者术后出现轻微并发症,包括1例胸腔积液和2例术后发热,未发生围术期严重并发症或死亡。患者术后出现转氨酶与总胆红素升高的情况,经常规保肝治疗后,术后1个月均恢复至术前水平。25例原发性肝癌患者术后3个月AFP较术前明显降低(8.2 ng/mL vs.5.3 ng/mL,Z=-3.269,P=0.001)。所有患者在术后3个月复查增强CT,显示肿瘤ORR为100%。术后6个月再次复查增强CT,治疗的53个癌灶中2个出现局部复发,局部复发率为3.8%(2/53),再次接受LA。结论:有选择性利用3D重建辅助腹腔镜超声引导的LA治疗肝脏恶性肿瘤,具有治疗精准,侵袭性小,疗效满意的优点。尤其,对于肝脏难以定位的较小病灶、靠近重要结构的以及其他复杂情况,选择该治疗方法有利于患者。

Background and Aims:The utilization of laser ablation(LA)has improved the precision of liver tumor ablation,thereby reducing the possibility of complications,and has become an important clinical treatment method for malignant liver tumors.However,there are few reports on the application of threedimensional(3D)reconstruction-assisted laparoscopic ultrasound-guided LA in the treatment of malignant liver tumors.Therefore,this study was performed to evaluate the clinical efficacy and application value of 3D reconstruction-assisted laparoscopic ultrasound-guided LA in the treatment of malignant liver tumors.Methods:The clinical data of patients with malignant liver tumors who underwent 3D reconstructionassisted laparoscopic ultrasound-guided LA from September 2020 to March 2022 were retrospectively collected.The completion of the surgery,operative time,intraoperative blood loss,occurrence of postoperative complications,changes in liver function parameters and tumor markers before and after surgery,as well as the tumor overall response rate(ORR)and recurrence rate during the postoperative follow-up period,were analyzed.Results:A total of 35 patients who met the inclusion criteria were included,including 25 cases of primary liver cancer,6 cases of colorectal cancer liver metastasis,2 cases of pancreatic cancer liver metastasis,and 2 cases of lung cancer liver metastasis.All patients successfully completed the surgery,with an operative time of(66.3±2.8)min and an intraoperative blood loss of(15.9±12.4)mL.Three patients experienced mild postoperative complications,including 1 case of pleural effusion and 2 cases of postoperative fever,without severe perioperative complications or deaths.The patients showed elevated transaminase and total bilirubin levels after surgery,but after routine liver protection treatment,the levels returned to preoperative levels within one month.In the 25 cases of primary liver cancer,the postoperative AFP level was significantly lower than the preoperative level at 3 months(8.2 ng/mL vs.5.3 ng/mL,Z=-3.269,P=0.001).All patients underwent contrast-enhanced CT at 3 months postoperatively,showing a ORR of 100%.At 6 months postoperatively,a repeat contrast-enhanced CT scan revealed that 2 out of 53 treated lesions showed local recurrence,resulting in a local recurrence rate of 3.8%(2/53).These lesions were subsequently treated with repeat LA.Conclusion:Selective use of 3D reconstruction-assisted laparoscopic ultrasound-guided LA for malignant liver tumors has the advantages of precise treatment,minimal invasiveness,and satisfactory efficacy.In particular,for small lesions in the liver that are difficult to locate,those near important structures,and other complex situations,choosing this treatment method is beneficial for patients.