腹腔镜射频消融治疗第一肝门区肝癌的疗效及安全性  

Efficacy and safety of laparoscopic radiofrequency ablation therapy for hilar hepatocellular carcinoma： A report of 19 cases

作　　者：范瑞芳[1] 柴福录[1] 卫立辛[2] 胡鹏[1] 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,730050 [2]上海第二军医大学东方肝胆外科医院

出　　处：《中华普通外科杂志》2007年第11期813-816,共4页Chinese Journal of General Surgery

摘　　要：目的评价腹腔镜射频消融（radiofrequency ablation,RFA）治疗第一肝门区肝癌的可行性、安全性及疗效。方法本组19例共21个肿瘤采用腹腔镜下RFA治疗,其中19个肿瘤位于第一肝门区。平均肿瘤直径（3.5±0.9）cm。19例均合并肝硬化,其中乙型肝炎17例,丙型肝炎2例。肝功能Child A级13例,B级6例。血清甲胎蛋白（AFP）阳性16例。结果19例均顺利完成腹腔镜RFA治疗,1例因胆囊结石同时行腹腔镜胆囊切除术（laparoscopic eholecystectomy,LC）,另5例因瘤休累及胆囊床并影响RFA操作而行LC。本组患者术后未出现胃肠道损伤、胆漏、胆管狭窄、肝功能衰竭等并发症。术后1个月,螺旋CT增强扫描证实病灶完全坏死率95.2%（20/21）,血清AFP转阴率81.3%（13/16）。术后随访6～56个月（中位15个月）,2例分别于术后5、18个月肝内发现新病灶行经皮RFA治疗,1例于术后25个月死于肝功能衰竭。结论腹腔镜RFA治疗第一肝门区肝癌安全可行,术中超声的应用对RFA治疗的准确引导、提高射频治疗彻底性及减少并发症起到了重要的作用。Objective To evaluate the feasibility, safety and efficacy of laparoscopic radiofrequency ablation （RFA） therapy for hilar hepatocellular carcinoma （HCC）. Methods Nineteen HCC patients with a total of 21 tumors underwent laparoscopic RFA therapy. Of the 21 tumors （mean diameter of 3.5±0.9 cm）, 19 were located in the hepatic portals. According to Child classification there were 13 cases of grade A and 6 cases of grade B. Serum alpha fetoprotein （AFP） was positive in 16 patients. Results Laparoscopic RFA was performed successfully in all patients, and laparoscopic cholecystectomy was performed simultaneously for gallstones in 1 patient and for a better access to the tumors in 5 patients. No severe complications, such as gastrointestinal tract injury, bile leakage, stricture of bile duct and liver function failure developed during and after RFA therapy. One month after the procedure, a complete tumor necrosis was achieved in 95.2% （20/21） lesions according to the contrast-enhanced helical CT scans, and postoperative AFP turned to negative in 81.3% （13/16） cases. During a median follow-up period of 15 months （range, 6 - 56 months）, two patients developed new malignant nodules within the livers and received percutaneous RFA therapy in 5 and 18 months after RFA respectively, and one patient died of liver failure 25 months after the procedure. Conclusions Laparoscopic RFA therapy is a feasible, safe, and effective treatment modality for selected patients with hilar HCC. Intraoperative ultrasonography is a useful guide for RFA improving therapeutic efficacy and reducing RFA-related complications.

关 键 词：癌 肝细胞 腹腔镜 射频消融术 

分 类 号：R686[医药卫生—骨科学]