• 中國(guó)醫(yī)科大學(xué)附屬第四醫(yī)院肝膽外科(遼寧沈陽(yáng) 110032);

目的  總結(jié)超聲引導(dǎo)下聯(lián)合腹腔鏡行微波消融治療特殊部位肝癌的臨床應(yīng)用價(jià)值和體會(huì)。
方法  回顧性分析我院2008年2月至2010年10月期間在超聲引導(dǎo)下聯(lián)合腹腔鏡行微波消融治療的9例肝臟惡性腫瘤患者的臨床資料。
結(jié)果
  原發(fā)性肝癌6例,轉(zhuǎn)移性肝癌3例;多發(fā)腫瘤8例,單發(fā)腫瘤1例?;颊呔?個(gè)或多個(gè)病灶侵及肝臟被膜,共計(jì)13個(gè)病灶,其中位于膈頂6個(gè),右葉臟面鄰近腸管3個(gè),左葉鄰近胃壁2個(gè),膽囊床1個(gè),肝門(mén)部1個(gè)?;颊咝g(shù)后無(wú)膈肌損傷、胃腸道穿孔、大出血、膽汁漏等嚴(yán)重并發(fā)癥發(fā)生,圍手術(shù)期無(wú)死亡病例?;颊唠S訪(9.2±4.7)個(gè)月(4~18個(gè)月)。術(shù)后1個(gè)月行CT檢查,11個(gè)病灶完全消融,完全消融率為84.6%(11/13);2個(gè)(2例)病灶邊緣部分殘留,其中1例再次行微波消融,1例行無(wú)水乙醇消融。術(shù)后3個(gè)月再次復(fù)查CT,4例患者出現(xiàn)新發(fā)病灶,其中2例再次行微波消融治療,1例行無(wú)水乙醇消融治療,1例因合并肺轉(zhuǎn)移而放棄治療;1例肝功能不佳于術(shù)后6個(gè)月死于肝功能衰竭;1例多發(fā)病灶患者于術(shù)后10個(gè)月死于腫瘤腦轉(zhuǎn)移;其余患者尚存活。
結(jié)論  超聲引導(dǎo)下聯(lián)合腹腔鏡行微波消融治療特殊部位的肝癌安全、有效、療效確切。

引用本文: 孫文郁,姜洪磊,于浩,許東,梁健. 超聲引導(dǎo)聯(lián)合腹腔鏡微波消融治療特殊部位肝癌的臨床體會(huì). 中國(guó)普外基礎(chǔ)與臨床雜志, 2012, 19(2): 188-191. doi: 復(fù)制

1. Lu MD,Xu HX,Xie XY,et al.Percutaneous microwave and radiofrequency ablation for hepatocellular carcinoma:a retrospective comparative study[J].J Gastroenterol,2005,40(11): 1054-1060..
2. Zhou Q,Jin X,Jiao DC,et al.Microwave ablation:results in ex vivo and in vivo porcine livers with 2 450-MHz cooled-shaft antenna[J].Chin Med J (Engl),2011,124(20):3386-3393..
3. Bhardwaj N,Dormer J,Ahmad F,et al.Microwave ablation of the liver:a description of lesion evolution over time and an investigation of the heat sink effect[J].Pathology,2011,43(7):725731..
4. Simo KA,Sereika SE,Newton KN,et al.Laparoscopic-assisted microwave ablation for hepatocellular carcinoma:safety and efficacy in comparison with radiofrequency ablation[J].J Surg Oncol,2011,104(7):822-829..
5. Padma S,Martinie JB,Iannitti DA.Liver tumor ablation:per-cutaneous and open approaches[J].J Surg Oncol,2009,100(8): 619-634..
6. Müller C.Hepatocellular carcinoma-rising incidence,changing therapeutic strategies[J].Wien Med Wochenschr,2006, 156(13-14):404-409..
7. Poon RT,F(xiàn)an ST,Lo CM,et al.Improving survival results after resection of hepatocellular carcinoma:a prospective study of 377 patients over 10 years[J].Ann Surg,2001,234(1):63-70..
8. Topal B,Aerts R,Penninckx F.Laparoscopic radiofrequency ablation of unresectable liver malignancies:feasibility and clinical outcome[J].Surg Laparosc Endosc Percutan Tech,2003, 13(1):11-15..
9. 樊嘉,黃成.原發(fā)性肝癌外科治療的進(jìn)展[ J].中國(guó)普外基礎(chǔ)與臨床雜志,2009,16(4):257-260..
10. 吳孟超.肝癌外科治療的近期進(jìn)展[ J].中國(guó)普外基礎(chǔ)與臨床雜志,2006,13(2):125-128..
11. Stauffer PR,Rossetto F,Prakash M,et al.Phantom and animal tissues for modelling the electrical properties of human liver[J]. Int J Hyperthermia,2003,19(1):89-101..
12. Wright AS,Lee FT Jr,Mahvi DM.Hepatic microwave ablation with multiple antennae results in synergistically larger zones of coagulation necrosis[J].Ann Surg Oncol,2003,10(3):275283..
13. Shock SA,Meredith K,Warner TF,et al.Microwave ablation with loop antenna:in vivo porcine liver model[J].Radiology, 2004,231(1):143-149..
14. Shibata T,Iimuro Y,Yamamoto Y,et al.Small hepatocellular carcinoma:comparison of radio-frequency ablation and percutaneous microwave coagulation therapy[J].Radiology,2002, 223(2):331-337..
15. Bhardwaj N,Strickland AD,Ahmad F,et al.Microwave ablation for unresectable hepatic tumours:clinical results using a novel microwave probe and generator[J].Eur J Surg Oncol, 2010,36(3):264-268..
16. 朱鵬,陳孝平.腹腔鏡在肝臟外科中的應(yīng)用[ J].中國(guó)微創(chuàng)外科雜志,2007,7(6):575-577..
17. 任正剛.原發(fā)性肝癌的射頻毀損治療進(jìn)展[ J].中國(guó)普外基礎(chǔ)與臨床雜志,2007,14(1):5-7..
18. Jagad RB,Koshariya M,Kawamoto J,et al.Laparoscopic microwave ablation of liver tumors:our experience[J].Hepatogastroenterology,2008,55(81):27-32..
19. 宋希林,石學(xué)濤,宋金龍,等.腹腔鏡引導(dǎo)定位肝臟腫瘤射頻消融治療的臨床觀察[ J].中華腫瘤防治雜志, 2009,16(13): 1025-1027..
20. Martin RC,Scoggins CR,McMasters KM.Safety and efficacy of microwave ablation of hepatic tumors:a prospective review of a 5-year experience[J].Ann Surg Oncol,2010,17(1):171178.
21. Santambrogio R,Costa M,Barabino M,et al.Laparoscopic radiofrequency of hepatocellular carcinoma using ultrasound-guided selective intrahepatic vascular occlusion[J].Surg Endosc, 2008,22(9):2051-2055..
22. Abe T,Shinzawa H,Wakabayashi H,et al.Value of laparoscopic microwave coagulation therapy for hepatocellular carcinoma in relation to tumor size and location[J].Endoscopy,2000, 32(8):598-603..
  1. 1. Lu MD,Xu HX,Xie XY,et al.Percutaneous microwave and radiofrequency ablation for hepatocellular carcinoma:a retrospective comparative study[J].J Gastroenterol,2005,40(11): 1054-1060..
  2. 2. Zhou Q,Jin X,Jiao DC,et al.Microwave ablation:results in ex vivo and in vivo porcine livers with 2 450-MHz cooled-shaft antenna[J].Chin Med J (Engl),2011,124(20):3386-3393..
  3. 3. Bhardwaj N,Dormer J,Ahmad F,et al.Microwave ablation of the liver:a description of lesion evolution over time and an investigation of the heat sink effect[J].Pathology,2011,43(7):725731..
  4. 4. Simo KA,Sereika SE,Newton KN,et al.Laparoscopic-assisted microwave ablation for hepatocellular carcinoma:safety and efficacy in comparison with radiofrequency ablation[J].J Surg Oncol,2011,104(7):822-829..
  5. 5. Padma S,Martinie JB,Iannitti DA.Liver tumor ablation:per-cutaneous and open approaches[J].J Surg Oncol,2009,100(8): 619-634..
  6. 6. Müller C.Hepatocellular carcinoma-rising incidence,changing therapeutic strategies[J].Wien Med Wochenschr,2006, 156(13-14):404-409..
  7. 7. Poon RT,F(xiàn)an ST,Lo CM,et al.Improving survival results after resection of hepatocellular carcinoma:a prospective study of 377 patients over 10 years[J].Ann Surg,2001,234(1):63-70..
  8. 8. Topal B,Aerts R,Penninckx F.Laparoscopic radiofrequency ablation of unresectable liver malignancies:feasibility and clinical outcome[J].Surg Laparosc Endosc Percutan Tech,2003, 13(1):11-15..
  9. 9. 樊嘉,黃成.原發(fā)性肝癌外科治療的進(jìn)展[ J].中國(guó)普外基礎(chǔ)與臨床雜志,2009,16(4):257-260..
  10. 10. 吳孟超.肝癌外科治療的近期進(jìn)展[ J].中國(guó)普外基礎(chǔ)與臨床雜志,2006,13(2):125-128..
  11. 11. Stauffer PR,Rossetto F,Prakash M,et al.Phantom and animal tissues for modelling the electrical properties of human liver[J]. Int J Hyperthermia,2003,19(1):89-101..
  12. 12. Wright AS,Lee FT Jr,Mahvi DM.Hepatic microwave ablation with multiple antennae results in synergistically larger zones of coagulation necrosis[J].Ann Surg Oncol,2003,10(3):275283..
  13. 13. Shock SA,Meredith K,Warner TF,et al.Microwave ablation with loop antenna:in vivo porcine liver model[J].Radiology, 2004,231(1):143-149..
  14. 14. Shibata T,Iimuro Y,Yamamoto Y,et al.Small hepatocellular carcinoma:comparison of radio-frequency ablation and percutaneous microwave coagulation therapy[J].Radiology,2002, 223(2):331-337..
  15. 15. Bhardwaj N,Strickland AD,Ahmad F,et al.Microwave ablation for unresectable hepatic tumours:clinical results using a novel microwave probe and generator[J].Eur J Surg Oncol, 2010,36(3):264-268..
  16. 16. 朱鵬,陳孝平.腹腔鏡在肝臟外科中的應(yīng)用[ J].中國(guó)微創(chuàng)外科雜志,2007,7(6):575-577..
  17. 17. 任正剛.原發(fā)性肝癌的射頻毀損治療進(jìn)展[ J].中國(guó)普外基礎(chǔ)與臨床雜志,2007,14(1):5-7..
  18. 18. Jagad RB,Koshariya M,Kawamoto J,et al.Laparoscopic microwave ablation of liver tumors:our experience[J].Hepatogastroenterology,2008,55(81):27-32..
  19. 19. 宋希林,石學(xué)濤,宋金龍,等.腹腔鏡引導(dǎo)定位肝臟腫瘤射頻消融治療的臨床觀察[ J].中華腫瘤防治雜志, 2009,16(13): 1025-1027..
  20. 20. Martin RC,Scoggins CR,McMasters KM.Safety and efficacy of microwave ablation of hepatic tumors:a prospective review of a 5-year experience[J].Ann Surg Oncol,2010,17(1):171178.
  21. 21. Santambrogio R,Costa M,Barabino M,et al.Laparoscopic radiofrequency of hepatocellular carcinoma using ultrasound-guided selective intrahepatic vascular occlusion[J].Surg Endosc, 2008,22(9):2051-2055..
  22. 22. Abe T,Shinzawa H,Wakabayashi H,et al.Value of laparoscopic microwave coagulation therapy for hepatocellular carcinoma in relation to tumor size and location[J].Endoscopy,2000, 32(8):598-603..