早期腹腔镜下射频消融治疗肝细胞癌自发性破裂出血  

Early laparoscopic radiofrequency ablation for spontaneous rupture of hepatocellular carcinoma

作　　者：许力 高君[1] 柯山[1] 丁雪梅[1] 王劭宏[1] 孔健[1] 董淑英 孙文兵[1] Xu Li;Gao Jun;Ke Shah;Ding Xuemei;Wang Shaohong;Kong Jian;Dong Shuying;Sun Wenbing(Department of Hepatobiliary-Pancreatic-Splenic Surgery,West Campus,Beijing Chao-yang Hospital,Capital Medical University,Beijing 100043,China)

机构地区：[1]首都医科大学附属北京朝阳医院西区肝胆胰脾外科,100043

出　　处：《国际外科学杂志》2018年第12期811-815,F0003,共6页International Journal of Surgery

摘　　要：目的评估腹腔镜下射频消融治疗肝细胞癌(HCC)自发性破裂出血的临床价值。方法回顾性分析2005年4月-2018年6月首都医科大学附属北京朝阳医院西区收治的以腹腔镜下射频消融为主要治疗手段的12例HCC自发性破裂出血患者的临床资料。总结射频消融技术成功率、安全性、完全消融率、腹腔转移率和生存率。采用SPSS 21.0统计软件,正态计量资料用均数±标准差描述,非正态计量资料用中位数描述,Kalpan-Meier法估计患者生存曲线。结果12例HCC自发性破裂出血患者,肿瘤最大直径为5.85 cm(4.0~10.1cm)。射频消融成功率为100%(12/12)。首次射频消融治疗时,完全消融率为58.3%(7/12),5例患者为不完全消融,接受重复射频消融后获得了完全消融。术后并发症发生率为33.3%(4/12),均为轻微并发症(Dindo-Clavien分级I级)。术后平均随访时间36.8个月,4例(33.3%)患者生存,8例(66.7%)患者死亡;1年和3年生存率分别为90%和60%。随访期间12例患者均无腹腔转移。结论早期腹腔镜下射频消融治疗HCC自发性破裂出血是微创、安全、有效的,可同时实现止血、消融肿瘤、清除腹腔积血。Objective To evaluate the efficacy and clinical outcomes of early laparoscopic radiofrequency ablation(RFA)forspontaneously ruptured hepatocellular carcinoma (HCC).Methods A retrospective analysis was conducted on 12 patients with spontaneously ruptured HCC treated by laparoscopic RFA from April 2005 to June 2018 in the West Campus of Beijing Chao-yang Hospital,Capital Medical University.The successful rate, safety,peritoneal recurrence rate,complete ablation rate and survival rate of RFA were respectively analyzed. Results The median size of the 12 HCC cases was 5.85 cm (4.0-10.1 cm)in the maximal dimension. Procedures of laparoscopic RFA ablation were performed successfully for all patients.Complete ablation was achieved in 58.3%patients (7/12).Five patients with incompletely ablated tumors received repeated RF ablation to achieve completeablation.Four patients (33.3%)developed minor complications (Dindo-Clavien grade I ). The mean follow-up of 35.8 months,4 patients (33.3%)were alive and 8 (66.7%)died.Of the 12 patients, the 1-and 3-year survival rates were 90.0%and 60.0%,respectively.No patient had peritoneal recurrence. Conclusion Early laparoscopic RFA therapy is an minimally invasive,safety and effective treatment measure for spontaneouslyruptured HCC in selected patients,which presents an advantage of achieving simultaneous hemostasis, tumorelimination,and rinsing of peritoneal cavity to minimize the risk of peritoneal metastasis.

关 键 词：癌 肝细胞 腹腔镜 出血 射频消融 

分 类 号：R735.7[医药卫生—肿瘤]