腹腔镜超声引导下射频消融治疗肝脏恶性肿瘤的安全性与疗效分析  

Safety and efficacy of laparoscopic ultrasound-guided radiofrequency ablation for malignant liver tumors

作　　者：邱枫[1] 杨天池 韩威[1] Feng Qiu;Tianchi Yang;Wei Han(Department of General Surgery,Beijing Luhe Hospital,Capital Medical University,Beijing 101100,China)

机构地区：[1]首都医科大学附属北京潞河医院普通外科,北京101100

出　　处：《中华肝脏外科手术学电子杂志》2025年第1期102-106,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：首都卫生发展科研专项(2002-2-7081);通州区卫生发展科研专项(KJ2020CX004-23)。

摘　　要：目的探讨腹腔镜超声(LUS)引导下射频消融(RFA)治疗肝脏恶性肿瘤的安全性与疗效。方法回顾性分析2017年1月至2022年6月在首都医科大学附属北京潞河医院行LUS引导下RFA的47例肝脏恶性肿瘤患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男33例,女14例;年龄37~86岁,中位年龄64岁。肝细胞癌(HCC)14例,结直肠癌肝转移(CRLM)33例。肿瘤直径0.5~3.5 cm,中位直径1.6 cm。观察患者完全消融率、围手术期并发症等。随访患者生存和肿瘤复发情况,生存分析采用Kaplan-Meier法。结果所有手术均顺利完成,无中转开腹。47例患者共72枚病灶行RFA;RFA治疗肝肿瘤数目中位数1.5(1.0~5.0)枚。完全消融率97%(70/72)。术后1 d转氨酶不同程度升高,术后3 d明显下降。术后肝脓肿1例,经穿刺引流后痊愈。围手术期无发生严重并发症和死亡。术后住院时间4.6(1.0~12.0)d。术后1、3年总体生存率分别95.8%、90.3%,术后1、3年无复发生存率分别为82.3%、67.7%。结论LUS引导下RFA治疗肝脏恶性肿瘤操作简便,安全有效,并发症发生率低,肿瘤治疗效果满意,可作为不宜手术切除患者的重要治疗手段。Objective To evaluate the safety and efficacy of laparoscopic ultrasound(LUS)-guided radiofrequency ablation(RFA)in the treatment of malignant liver tumors.Methods Clinical data of 47 patients with malignant liver tumors who underwent LUS-guided RFA in Beijing Luhe Hospital affiliated to Capital Medical University from January 2017 to June 2022 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,33 patients were male and 14 female,aged from 37 to 86 years,with a median age of 64 years.14 patients were diagnosed with hepatocellular carcinoma(HCC)and 33 cases of colorectal cancer liver metastasis(CRLM).The tumor diameter was ranged from 0.5 to 3.5 cm,with a median diameter of 1.6 cm.The complete ablation rate and perioperative complications were observed.The survival and tumor recurrence were recorded during follow-up.Survival analysis was performed by Kaplan-Meier method.Results All procedures were successfully completed without conversion to open surgery.72 lesions from 47 patients were treated with RFA.The median number of liver tumors treated by RFA was 1.5(1.0-5.0).The complete ablation rate reached 97%(70/72).Transaminase levels were increased to different degrees at postoperative 1 d,and then significantly decreased at postoperative 3 d.One case developed postoperative liver abscess,which was cured by puncture and drainage.No severe complications and death occurred during perioperative period.The length of postoperative hospital stay was 4.6(1.0-12.0)d.The postoperative 1-and 3-year overall survival rates were 95.8% and 90.3%,and the 1-and 3-year recurrence-free survival rates were 82.3%and 67.7%,respectively.Conclusions LUS-guided RFA is a simple,safe and efficacious treatment for malignant liver tumors,which yields a low incidence of postoperative complications and satisfactory therapeutic effect.It can be utilized as an important treatment for patients ineligible for surgical resection.

关 键 词：肝肿瘤 癌 肝细胞 结直肠癌肝转移 腹腔镜超声 射频消融 

分 类 号：R735.7[医药卫生—肿瘤]