射频消融在腹腔镜解剖性半肝切除术中的辅助性应用策略  

The auxiliary application strategy of radiofrequency ablation in laparoscopic anatomical hemihepatectomy

作　　者：国士刚 宁纯民 李敖雷 王向涛 孔新亮 柯山[5] 高君[5] 丁雪梅[5] 孙文兵[5] Guo Shigang;Ning Chunming;Li Aolei;Wang Xiangtao;Kong Xinliang;Ke Shan;Gao Jun;Ding Xuemei;Sun Wenbing(Hepatobiliary Department,Chaoyang Central Hospital,Chaoyang 122000,Liaoning Province,China;Hepatobiliary Department,Chaoyang the Second Hospital,Chaoyang 122000,Liaoning Province,China;Hepatobiliary Department,Binzhou the Second Hospital,Binzhou 256800,Shandong Province,China;Rizhao Institute of Hepatobiliary-pancreatic-splenic Surgery,Rizhao 276800,Shandong Province,China;Department of Hepatobiliary-pancreatic-splenic Surgery,West Campus,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100043,China)

机构地区：[1]辽宁省朝阳市中心医院肝胆外科,122000 [2]辽宁省朝阳市第二医院肝胆外科,122000 [3]山东省滨州市第二医院肝胆外科,256800 [4]山东省日照市肝胆胰脾外科研究所,276800 [5]首都医科大学附属北京朝阳医院西院肝胆胰脾外科,北京100043

出　　处：《中华肝胆外科杂志》2020年第6期412-416,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金(81572957);北京市石景山区医学重点学科建设项目(20130001)。

摘　　要：目的总结射频消融(RFA)在腹腔镜解剖性半肝切除术(LAH)中的辅助性应用策略和价值。方法回顾性总结首都医科大学附属北京朝阳医院等5家医院自2016年1月至2020年1月间32例RFA辅助LAH患者的临床资料。结果 32例患者中,男性21例,女性11例;年龄范围32~77岁,中位年龄52岁。肝细胞癌18例,其中,单发病灶16例,两个病灶2例,肿瘤最大直径(5.6±1.2)cm;转移性肝癌12例,其中,单发病灶8例,两个病灶3例,三个病灶1例,肿瘤最大直径(4.7±1.6)cm;原发性肝胆管结石2例。右半肝切除术23例,左半肝切除术9例。无中转开腹。右半肝切除术手术时间(310.0±22.0)min,左半肝切除术(285.0±25.0)min。术中出血(330.0±28.0)ml。无患者术中输注人血红细胞悬液。患者术后发生反应性胸腔积液6例,胆汁瘘3例,伤口感染1例,断面积液1例,均在保守治疗后痊愈;无术后腹腔出血和肝功能不全。术后住院时间(9.5±3.2)d。随访1~42个月,中位随访20个月。随访期间,30例恶性肿瘤患者中,17例(56.7%)出现肿瘤复发,无断面肿瘤复发,无死亡。结论 RFA在LAH中具有多方面的辅助性作用,包括预防和治疗游离肝脏时肝癌破裂、处理肝断面细小血管出血、保证和巩固安全边界。Objective To analyze the auxiliary application strategy and efficacy of radiofrequency ablation(RFA)in laparoscopic anatomical hemihepatectomy(LAH).Method The clinical data of consecutive patients who underwent RFA-assisted LAH from 5 hospitals including Beijing Chaoyang Hospital,Capital Medical University between January 2016 and January 2020 were retrospectively reviewed.Results Among the 32 patients,there were 21 males and 11 females.The age range is 32 to 77 years,with a median age of 52 years.There were 18 cases of hepatocellular carcinoma,including 16 cases of single lesion and 2 cases of two lesions,with the maximum tumor diameter of(5.6±1.2)cm.There were 12 cases of metastatic liver cancer,including 8 cases of single lesion,3 cases of two lesions,1 case of three lesions,and the maximum tumor diameter(4.7±1.6)cm.Primary hepatolithiasis:2 cases.Right hemihepatectomy was performed in 23 cases and left hemihepatectomy in 9 cases.No conversion to laparotomy.The operation time of right hemihepatectomy was(310.0±22.0)min,and left hemihepatectomy was(285.0±25.0)min.Intraoperative hemorrhage(330.0±28.0)ml.No patients received intraoperative infusion of human red blood cell suspension.Postoperative reactive pleural effusion occurred in 6 cases,biliary fistula in 3 cases,wound infection in 1 case,and cross section effusion in 1 case,all of which recovered after conservative treatment.No postoperative abdominal bleeding and liver insufficiency.Postoperative hospital stay(9.5±3.2)d.The follow-up time was 1-42 months,and the median follow-up time was 20 months.During the follow-up period,17(56.7%)of the 30 patients with malignant tumor experienced tumor recurrence,no sectional tumor recurrence,and no death.Conclusions RFA has a variety of auxiliary applications in LAH,including prevention and treatment of liver cancer rupture during mobilization of liver,treatment of small bleeding blood vessels during liver transection,and help in securing safe and adequate resection margins.

关 键 词：腹腔镜 半肝切除术 解剖性 射频消融 应用价值 

分 类 号：R657.3[医药卫生—外科学] R735.7[医药卫生—临床医学]