肝细胞癌合并肝硬化病人的腹腔镜射频消融治疗  

Laparoscopic radiofrequency ablation therapy in patients with hepatocellular carcinoma and liver cirrhosis

作　　者：范瑞芳[1] 柴福录[1] 贺冠宪[1] 李荣梓[1] 李红梅[1] 史建华[1] 曹敏丽[1] 

机构地区：[1]兰州军区兰州总医院肝胆外科,兰州市730050

出　　处：《中华肝胆外科杂志》2005年第8期518-520,共3页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨肝细胞癌合并肝硬化病人行腹腔镜射频消融(LRFA)治疗的可行性、安全性及疗效.方法 2001年8月至2003年12月,25例肝细胞癌合并肝硬化病人在全麻下进行了LRFA治疗.男19例,女6例,平均年龄(52.2±11.9)岁.术前经超声、螺旋CT或MRI等检查共发现瘤体38个,平均肿瘤直径(3.8±1.1)cm.肿瘤均位于肝脏表面、肝左外叶或邻近胆囊等空腔脏器.肝功能均为Child A或B级.合并慢性结石性胆囊炎3例,糖尿病2例,凝血功能障碍5例.术中行腹腔镜超声检查及病理活检.结果 25例病人腹腔镜及术中超声检查共发现瘤体41个.所有病例均顺利完成LRFA治疗,同时行胆囊切除术5例.平均手术时间(72.5±27.6)min.未出现出血、胆道、胃肠道及膈肌损伤等并发症.术后1个月螺旋CT扫描证实,肿瘤完全坏死率达100%.随访6～32个月(平均18个月),1例发现肝内新病灶,3例射频治疗部位复发,l例死于肿瘤复发及肝功能衰竭.结论肝细胞癌合并肝硬化病人行LRFA治疗是安全可行的,可提高肝细胞癌射频消融治疗效果,减少并发症.Objective To evaluate the feasibility, safety and effectiveness of laparoscopic radiofrequency ablation （LRFA） therapy in patients with hepatocellular carcinoma （HCC） and liver cirrhosis. Methods From August 2001 to December 2003, 25 patients with HCC and liver cirrhosis received LRFA therapy under general anesthesia in our hospital. Of the 25 patients with a mean age of 52.2±11.9 years old, 19 were male and 6 female. Thirty-eight hepatic tumors with a mean diameter of 3.8±1.1 cm were identified preoperatively in the 25 patients by ultrasonography, helical CT or MRI. All the tumors were not suitable for percutaneous radiofrequency ablation therapy. All patients were of Child A or B liver function. Three patients had chronic calculous cholecystitis, 2 diabetes and 5 coagulation disorders. Laparoscopic ultrasound examination and biopsy of liver nodules were routinely performed during the operation. Results I.aparoscopic ultrasound examination identified 41 malignant lesions in the 25 patients （3 new lesions not detected preoperatively in 3 patients）. LRFA therapy was successfully performed in all the patients and laparoscopic cholecystectomy was also performed in 5 patients at the same time, with a mean total operative duration of 72.5±27.6 min. Intraoperative and postoperative complications such as bleeding, biliary tract damage, gastrointestinal tract damage and diaphragmatic burn etc. were not observed in all the patients. The complete tumor necrosis was seen in all the patients via dualphase helical CT 1 month after the treatment. During a mean follow up period of 18 months （6-32 months）, 1 patient had a new malignant nodule, 3 local recurrence at the ablation site and 1 died from tumor recurrence and liver failure. Conclusions In the patients with HCC and liver cirrhosis, LRFA therapy is a feasible and safe treatment modality. Meanwhile, it may improve the efficiency of radiofrequency ablation therapy for HCC and reduce the complications related to the procedure.

关 键 词：癌 肝细胞 肝硬化 射频消融治疗 腹腔镜 腹腔镜超声检查 肝硬化病人 肝细胞癌 慢性结石性胆囊炎 术中超声检查 螺旋CT扫描 

分 类 号：R735.7[医药卫生—肿瘤]