手术切除联合射频消融治疗多发性肝癌合并肝硬化  

Surgical resection combined with radiofrequency ablation for multifocal hepatocellular carcinomas in patients with cirrhosis

作　　者：范瑞芳[1] 柴福录[1] 贺冠宪[1] 卫立辛[2] 李红梅[1] 解娅莉[1] 

机构地区：[1]兰州军区兰州总医院肝胆外科,兰州730050 [2]第二军医大学东方肝胆外科医院肝胆外科研究所,上海200438

出　　处：《中国微创外科杂志》2007年第1期17-19,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨手术切除联合射频消融（radiofrequency ablation，RFA）治疗多发性肝癌合并肝硬化的可行性及疗效。方法2003年8月-2006年1月我院收治多发性肝癌合并肝硬化18例，术前经超声、螺旋CT或MRI共发现瘤体46个。其中2个病灶10例，3个病灶6例，4个病灶2例，全麻下距瘤体2cm做包括瘤体的不规则肝段切除、次病灶RFA治疗。结果18例均顺利完成手术切除及RFA治疗。同时行胆囊切除术2例，脾切除及食管胃底周围血管离断术1例。手术切除时间（37．4±8．8）min；单个病灶RFA时间（25．6±8．9）min，总RFA时间（39．8±14．7）min；总手术时间（152．6±30．8）min；总术中出血量（465．6±171．0）ml。未出现腹腔出血、胃肠道损伤、膈肌损伤及肝功能衰竭等严重并发症。术后1个月螺旋CT增强扫描证实，18例手术切除边缘未见残余肿瘤组织，RFA治疗病灶均完全坏死。随访6—31个月，5例发现肝内新病灶。采用经皮RFA进行治疗，其中1例术后15个月死于肝内再复发及肺转移；2例分别于术后7、16个月死于肝功能衰竭。结论手术切除联合RFA治疗多发性肝癌合并肝硬化安全可行，近期治疗效果肯定，最大程度保存受损的肝功能，但应根据病灶的位置及肝功能的状况选择合适的病人进行治疗。Objective To investigate the feasibility and efficacy of surgical resection combined with radiofrequency ablation （RFA） for multifocal hepatocellular carcinomas （HCC） in patients with cirrhosis. Methods A total of 18 patients with multifocal HCCs and liver cirrhosis was treated between August 2003 and January 2006. Forty-six hepatic lesions were identified preoperatively by ultrasonography, helical CT, or MRI. Ten patients were found as having 2 lesions, 6 patients having 3 lesions, and 2 patients, 4 lesions. Under general anesthesia, segmental hepatectomy for major lesions （with a 2cm resection margin） and RFA therapy for minor lesions were performed. Results The combination therapy was performed successfully in all the 18 patients. A cholecystectomy was performed simultaneously for gallstones in 2 patients, and a splenectomy with para-esophagogastric devascularization was performed for portal hypertension in 1 patient. The surgical resection time was 37.4 ± 8.8 min, the RFA time per lesion was 25.6 ± 8.9 min, the total RFA time was 39.8 ± 14.7 min, the total operative time was 152.4 ± 30.8 min, and the intraoperative blood loss was 465.6 ± 171.0 ml. No severe complications, such as intraabdominal hemorrhage, gastrointestinal tract injury, diaphragmatic injury, and liver function failure, developed after operations. No residual tumor was found on the margin of surgical resection and a complete lesion necrosis was achieved in the RFA regions on contrast-enhanced helical CT scanning 1 month after the procedure. During a follow-up period for 6 - 31 months （ mean, 15.5 months）, 5 patients were diagnosed as having new malignant nodules and were given a percutaneous RFA therapy. Out of the 5 patients, one died from tumor recurrence and lung metastases, and two patients died from liver failure at 7 and 16 months after treatment, respectively. Conclusions Surgical resection combined with RFA therapy is a feasible, safe, and effective treatment for proper patients with multifocal HCCs and liver cirrh

关 键 词：肝细胞癌 肝切除术 射频消融 

分 类 号：R735.7[医药卫生—肿瘤] R730.56[医药卫生—临床医学]