腹腔镜下一期行结直肠癌切除与多电极射频治疗肝转移癌

Laparoscopic excision and multi-bullet radiofrequency ablation in the treatment of rectosigmoid carcinoma with synchronous hepatic metastasis

目的探讨腹腔镜下行乙状结肠、直肠癌切除,同时多电极射频治疗肝转移癌方法的临床价值。方法对6例术前确诊为乙状结肠、直肠癌,经CT发现肝脏有实性占位的患者,行腹腔镜下乙状结肠、直肠癌切除,吻合器吻合肠段后,再在腹腔镜直视下行肝脏肿瘤穿刺病理学检查,确诊为肝转移癌后,即经皮多电极针穿刺进入肝肿瘤进行射频消融治疗。结果6例患者治疗中未发生严重并发症,术后肠道功能恢复时间24～72h。术后3个月CT复查发现肿瘤明显液化并完全坏死;存活4例,其中1例又再做肝移植至今;2例死于全身衰竭。结论腹腔镜下应用多电极射频消融治疗乙状结肠、直肠癌伴肝转移癌是安全有效的,避免了二期手术的创伤和不良预后。

Objective To evaluate the clinical value of laparoscopic excision and multi bullet radiofrequency ablation(RFA) in the treatment of rectosigmoid adenocarcinoma with synchronous hepatic metastasis. Methods There were 6 patients diagnosed as rectosigmoid adenocarcinoma with synchronous hepatic metastasis detected by CT scan. Hepatic metastases were confirmed by transhepatic biopsy under the laparoscopy. First, laparoscopic radical excision of rectosigmoid carcinoma was performed,then RFA with multi bullet needle was applied to the hepatic metastases later. Results A total of 10 hepatic metastatic lesions were found in these 6 patients.The diameter of the tumors ranged from 2.0 to 6.0 cm. No severe postoperative complications occurred. Bowel function recovered within 24 to 72 hours postoperatively. CT scan 3 months after operation revealed liquefaction and necrosis of metastatic lesions. Hepatic function returned to normal and CEA level decreased obviously. After follow up from 3 to 18 months,4 patients survived including one with later liver transplantation, and 2 died of systemic failure. Conclusions Laparoscopic excision and multi bullet radiofrequency ablation in the treatment of rectosigmoid adenocarcinoma with synchronous hepatic metastasis is safe and effective, which can avoid two staged operation and improve the quality of life and the survival.