腹腔镜超声在肝癌射频消融治疗中的临床应用

Combined application of laparoscopic ultrasonography and percutaneous ultrasonography in radiofrequency ablation for hepatic cancer

AIM: To evaluate combined application of laparoscopic ultrasonography and percutaneous ultrasonography in radiofrequency ablation for hepatic cancer.

METHODS: Between September 2007 and November 2008, 25 patients with 43 malignant liver nodules were treated with 1aparoscopic ultrasonography-guided and percutaneous ultrasonography-guided radiofrequency ablation at our hospital. Of 25 patients, there were 18 males and 7 females with a mean age of 42 (28-77) year, with 20 Hepatic cancer 2.7-7.5 cm in diameter with the mean size of 3.8 cm. Hepatitis B positive was diagnosed preoperatively in 14 patients, and hepatitis C positive in 2 patients. There were sixteen patients with liver cirrhosis and thirteen patients with chronic calculous cholecystitis. One lesion was found in 14 patients, two lesions in 3 patients, three lesions in 4 patients, and dotty lesions in 4 patients. A1l patients were followed up with helical computed tomographie (CT) scan and ultrasonography.

RESULTS: Laparoscopic RFA therapy was performed successfully in 25 patients combined with 1aparoscopic ultrasonography, and 4 patients experienced 1oca1 recurrence at the ablation site, 3 patients had a new malignant nodule, for whom percutaneous RFA therapy was performed successfully with percutaneous ultrasonography. Of all cases, 11 patients were performed laparoscopie cholecystectomy simultaneously. With 1aparoscopic ultrasonography guidence, the mean RFA time per lesion was 39.3 ± 12.1 min, the mean total operation time was 95.5 ± 25.8 min, and the mean blood loss was 148.5 ± 84.3 mL. With percutaneous ultrasonography guidance, the mean RFA time per lesion was 28.3 ± 10.3 min, the mean total operation time was 50.2 ± 11.5 min, and no bleeding sign was found by ultrasound after RFA. No specific complications such as bleeding, gallbladder injury, gastrointestinal tract damage, diaphragmatic injury, bile leakage, stricture of bile duct and liver function failure developed during and after RFA therapy. During a follow-up period of 3-14 months, three of these patients experienced primary liver cancer recurrence, for which surgeons recommended liver transplantation. The remaining cases are alive so far.

CONCLUSION: We are relatively satisfied with long curative effect of combined application of 1aparoscopic ultrasonography and percutaneous ultrasonography in radiofrequency ablation for hepatic cancer.