手术切除联合术中射频在多发性肝癌患者中的应用  

Combined hepatectomy and radiofrequency ablation for multifocal liver cancer

作　　者：曾新桃[1] 杨培[1] 罗华[1] 张伟[1] 郭道宁[1] 陈熙[1] 

机构地区：[1]绵阳市中心医院肝胆外科,四川绵阳621000

出　　处：《现代肿瘤医学》2017年第1期82-86,共5页Journal of Modern Oncology

摘　　要：目的:探讨手术切除联合术中射频消融(radiofrequency ablation,RFA)治疗多发性肝癌(hepatocellular carcinoma,HCC)的安全性及可行性。方法:2005年1月至2014年1月,我院收治多发性肝癌(≥2个)患者42例,术前通过彩超、增强CT、MRI共发现肿瘤病灶112个,术中超声新发现肿瘤9个。手术方式包括:半肝切除7例,右肝后叶切除2例,左肝外叶切除6例,不规则肝切除27例,共切除肿瘤病灶49个。RFA处理肿瘤病灶72个。术中常规施行超声造影。结果:所有患者均成功完成手术。手术切除肿瘤时间14~45min(25.1±12.8)min。单个肿瘤病灶RFA时间9~37min(17.2±11.9)min,总RFA时间16~61min(36.4±19.2)min。总的手术时间73~189min(138.2±76.6)min。术中出血量80~1 100ml(429.7±226.5)ml。无肝肾功能衰竭、胃肠及膈肌损伤等发生。术后7天开始抗病毒治疗(HBV DNA≥5.00E+2IU/ml),术后1月行TACE。术后失访2例,40例随访时间为6~103月(49.2±31.8)月。对于复发病例采用再次手术切除、RFA、TACE等方法治疗。结论:手术切除联合RFA治疗多发性肝癌能最大限度保存正常肝脏组织,提高肝癌根治性切除率,有选择的实施安全可行。Objective： To discuss the feasibility and safety of hepatectomy combined with radiofrequency ablation（ RFA） for multifocal liver cancers. Methods： There were 42 patients with multifocal hepatocellular carcinomas（ HCCs） were found preoperation by ultrasound,CT or MRI,and 9 focus were found intraoperative. 7 cases undergoing hemihepatectomy,2 patients performed posterior lobes resection and 27 cases undergoing local excision. 49 Lesions were resected. There were 72 focus managed by RFA,We conducted contrast- enhanced ultrasound（ CEUS） routinely intraoperation. Results： All patients undergoing surgical procedure successfully. Excision time was 1 4 - 4 5 min（ 25. 1 ± 12. 8） min. Single lesion RFA time was 9 - 37min（ 17. 2 ± 11. 9） min and total RFA time was 16 - 61min（ 36. 4 ± 19. 2） min. Total operation time was 73 - 189min（ 138. 2 ± 76. 6） min. Blood loss was 80 - 1 100ml（ 429. 7± 226. 5） ml. No liver and kidney function failure or vice- damage happened. When the virus reach 5. 00 E ＋ 2IU / ml,the patients accepted antiviral treatment after operation seven days. All cases need accept transcatheter arterial chemoembolization（ TACE） one month later. There were 2 cases loss to follow- up,follow- up time was 6 - 103months（ 49. 2 ± 31. 8） months. Conclusion： Surgical resection combined with RFA therapy can preserve impaired liver functions,also can improve resectability,it is feasible,safe and effective.

关 键 词：肝癌 射频消融 术中超声 肝切除 

分 类 号：R735.7[医药卫生—肿瘤] R730.5[医药卫生—临床医学]