肝脏肿瘤的腹腔镜超声检查和活检术:310例经验

目的 探讨腹腔镜超声肝脏检查及在其引导下肝脏肿瘤穿刺活检术的价值。 方法 10mm 7 5MHz线性超声探头检查肝脏。18G穿刺针进行穿刺。在腹腔镜和超声波共同引导下,穿刺针经皮刺入肿瘤组织。穿刺时,穿刺针要与超声波的平面平行。 结果 310例发现肝脏原发或转移性肿瘤 1 080个。穿刺无一例假阴性,无出血性并发症及其他脏器损伤。310例随访 6年,穿刺点无肿瘤种植。 结论 腹腔镜超声波检查能较准确对肝脏进行全面评估。

Laparoscopic liver resection for malignancy:A review of the literature

AIM: To review the published literature about laparoscopic liver resection for malignancy.METHODS: A PubMed search was performed for original published studies until June 2013 and original series containing at least 30 patients were reviewed.RESULTS: All forms of hepatic resections have been described ranging from simple wedge resections to extended right or left hepatectomies. The usual approach is pure laparoscopic, but hand-assisted, as well as robotic approaches have been described. Most studies showed comparable results to open resection in terms of operative blood loss, postoperative morbidity and mortality.Many of them showed decreased postoperative pain,shorter hospital stays, and even lower costs. Oncological results including resection margin status and long-term survival were not inferior to open resection. CONCLUSION: In the hands of experienced surgeons,laparoscopic liver resection for malignant lesions is safe and offers some short-term advantages over open resection. Oncologically, similar survival rates have been observed in patients treated with the laparoscopic approach when compared to their open resection counterparts.

Role of thermal ablation in the management of colorectal liver metastasis

With a recent randomized prospective trial revealing that thermal ablative therapy as local tumor control improved overall survival (OS) in patients with unresectable colorectal cancer liver metastases (CRLM), thermal ablation continues to remain as an important treatment option in this patient population. Our aim of this article is to review the current role of the ablative therapy in the management of CRLM patients. Main indications for thermal ablation include (Ⅰ) unresectable liver lesions;(Ⅱ) in combination with hepatectomy;(Ⅲ) in patients with significant medical comorbidities or poor performance status (PS);(Ⅳ) a small (<3 cm) solitary lesion, which would otherwise necessitate a major liver resection;and (Ⅴ) patient preference. There are several approaches and modalities for ablative therapy, including open, percutaneous, and laparoscopic approaches, as well as radiofrequency ablation (RFA) and microwave ablation (MWA). Each approach and ablation modality have its own pros and cons. Percutaneous and laparoscopic approaches are preferred due to minimally invasive nature, yet laparoscopic approach has more benefits from thorough intraoperative ultrasound (US) exam as well as complete peritoneal staging with laparoscopy. Similarly, whereas high local tumor failure rate has been a major concern with RFA, MWA or microwave thermosphere ablation (MTA) have demonstrated significantly improved local tumor control due to homogenous tissue heating, ability to reach higher tissue temperatures, and less susceptible to the "heat-sink" effect. Although liver resection is the standard of care for CRLM, there have been some retrospective studies demonstrating similar oncological outcome between ablative therapy and surgical resection in very selected populations with small (<3 cm) solitary CRLM. Lastly, ablative therapy and liver resection should not be mutually exclusive, especially in the management of bilobar liver metastases. Concomitant ablative therapy with hepatectomy may spare the patients from having two-stage hepatectomy with less morbidity. The role of the thermal ablation will continue to evolve in patients with resectable and ablatable lesions owing to newly emerging technology, in addition to new systemic treatment options, including immunotherapy for metastatic colorectal cancer (CRC). Keywords: Thermal ablation;radiofrequency ablation (RFA);microwave ablation (MWA);colorectal cancer liver metastasis (CRLM)