腹腔镜超声引导下肝肿瘤消融术的模型及进针设计  

Needle insertion and model design of liver tumor ablation guided by laparoscopic ultrasound

作　　者：张寅 赵玲玲 吴贤 王奕[2] 苏卫民 谢炳銮 ZHANG Yin;ZHAO Ling-ling;WU Xian(Department of General Surgery,Wenzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang University of Traditional Chinese Medicine,Wenzhou 325000,China)

机构地区：[1]浙江中医药大学附属温州中医院普通外科,浙江温州325000 [2]上海交通大学医学院附属同仁医院肝胆外科

出　　处：《腹腔镜外科杂志》2022年第6期428-433,共6页Journal of Laparoscopic Surgery

摘　　要：目的:探讨腹腔镜超声引导下消融术中多针、多角度消融的必要性。方法:回顾分析2019年11月至2021年8月为24例患者在腹腔镜超声引导下行微波消融术的临床资料,观察消融效果、并发症,总结消融针的进针设计思路。结果:24例患者术后均未发生出血、黄疸、肠道损伤等并发症。术后1个月复查增强MRI,1例未完全消融,23例完全消融。术后第2天血常规白细胞[(7.80±3.14)×10^(9)/L vs.(5.68±1.94)×10^(9)/L]、血生化丙氨酸转氨酶[23.50(18.25,41.00)U/L vs.119.00(79.13,235.18)U/L]较术前升高,差异有统计学意义(P<0.05)。结论:直角楔形模型可很好地帮助确定腹腔镜超声引导下消融的中心点及范围。腹腔镜超声引导下行肝肿瘤消融具有微创、安全、有效的特点,肿瘤病灶消融率高,术后并发症少,值得进一步临床研究与开展。Objective:To investigate the necessity of multi-needle and multi-angle laparoscopic ultrasound-guided ablation.Methods:From Nov.2019 to Aug.2021,the clinical data of 24 patients who underwent laparoscopic ultrasound guided microwave ablation were retrospectively analyzed to observe the ablation effect and complications,and summarize the ideas of ablation needle insertion.Results:None of the 24 patients suffered from any postoperative complications such as hemorrhage,jaundice,or intestinal injury.One month after operation,enhanced MRI showed that 1 case was not completely ablated,and the other 23 cases were completely ablated.On the second day after operation,blood leukocytes[(7.80±3.14)×10^(9)/L vs.(5.68±1.94)×10^(9)/L]and serum alanine aminotransferase[23.50(18.25,41.00)U/L vs.119.00(79.13,235.18)U/L]were higher than those before the operation,the differences were statistically significant(P<0.05).Conclusions:The right-angle wedge model can help determine the ablation center and ablation range under the guidance of laparoscopic ultrasound.Laparoscopic ultrasound-guided liver tumor ablation is minimally invasive,safe and effective,with a high ablation rate of tumor lesions and few postoperative complications,it is worthy of further clinical research and development.

关 键 词：肝肿瘤 腹腔镜超声 消融 进针角度 三维模型 

分 类 号：R735.7[医药卫生—肿瘤]