腹腔镜下射频消融术治疗肝癌的临床应用研究

Application of laparoscopic radiofrequency ablation in thetreatment of hepatocellular carcinoma

目的 :探讨腹腔镜下射频消融 (LRFA)在提高肝治疗效果中的作用。 方法 :采用LRFA方法治疗各类肝癌 36例共 5 8个病灶 ,术后 2周内复查肝功能、甲胎蛋白 (AFP)、癌胚抗原 (CEA)及腹部彩色超声、增强CT ,观察近期疗效 ;并于术后 1、3、6个月及随后每 6个月复查上述指标 ,观察远期疗效。 结果 :每次LRFA平均治疗 3.8个病灶 ,治疗时发现新病灶 5例共 11个 ,占总例数的 13.9%。术后部分患者出现右上腹部隐痛不适、发热 ,对症处理后逐步恢复正常。无相关的手术并发症发生。LRFA治疗 2周后 ,术前AFP升高的 2 3例患者中 ,17例明显降低 ,5例无明显变化 ,1例升高 ,术前CEA升高的 3例患者 ,均明显降低。术后 1、2周复查腹部彩色超声、增强CT ,35例病灶完全坏死 ,1例 (2 .9% )残留癌灶 ,再次行LRFA获治。平均随访 19.2个月 ,9例 (2 5 % )复发。 1年存活率 91.7% ,2年存活率 83.3%。 结论 :LRFA融合了射频与腹腔镜二项微创技术的优点 ,扩大了治疗的适应证 ,可有效地提高射频消融治疗肝癌的效果 ,减少并发症的发生。

Objectives:To evaluate the effect of laparoscopic radiofrequency ablation (LRFA) in hepatocellular carcinoma (HCC) treatment. Methods: Altogether 36 HCC patients with 58 lesions were treated with LRFA. Liver function, AFP, CEA and abdominal ultrasound, enhanced CT were reexamined within 2 weeks after LRFA to evaluate the short term effect. These indexes were reexamined in 1 month, 3 months, 6 months and every 6 months after that to evaluate the long term effect. Results: An average of 3.8 lesions were treated in a single LRFA treatment. Five patients (13.8%) with 11 lesions that had not been found before LRFA by abdominal ultrasound and enhanced CT were confirmed in the treatment. Some patients complained discomfort and vague pain in right upper abdomen and low fever after LRFA treatment. They recovered gradually shortly after expectant treatments. There was no treatment correlative complication. Two weeks after LRFA treatment, abnormal high AFP level in 23 patients decreased significantly in 17 patients, unchanged in 5 patients, increased in 1 patient. Abnormal high CEA level in 3 patients decreased significantly. Reexaminations of abdominal ultrasound, enhanced CT in 1 week and 2 weeks after LRFA treatment revealed 35 complete necrotic lesions and 1 residual lesion. The latter were treated with another LRFA. In an average of 19.2 months fellow up period, there were 9(25%) recurrences. The first year survival rate was 91.7%, and the second year survival rate was 83.3%. Conclusions: Combining the advantages of laparoscopy and radiofrequency, LRFA can increase the therapeutic effectiveness, extend the indication and decrease the complication of radiofrequency ablation in HCC treatment.