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目的总结超声引导下联合腹腔镜行微波消融治疗特殊部位肝癌的临床应用价值和体会。方法回顾性分析我院2008年2月至2010年10月期间在超声引导下联合腹腔镜行微波消融治疗的9例肝脏恶性肿瘤患者的临床资料。结果原发性肝癌6例,转移性肝癌3例;多发肿瘤8例,单发肿瘤1例。患者均有1个或多个病灶侵及肝脏被膜,共计13个病灶,其中位于膈顶6个,右叶脏面邻近肠管3个,左叶邻近胃壁2个,胆囊床1个,肝门部1个。患者术后无膈肌损伤、胃肠道穿孔、大出血、胆汁漏等严重并发症发生,围手术期无死亡病例。患者随访(9.2±4.7)个月(4～18个月)。术后1个月行CT检查,11个病灶完全消融,完全消融率为84.6%(11/13);2个(2例)病灶边缘部分残留,其中1例再次行微波消融,1例行无水乙醇消融。术后3个月再次复查CT,4例患者出现新发病灶,其中2例再次行微波消融治疗,1例行无水乙醇消融治疗,1例因合并肺转移而放弃治疗;1例肝功能不佳于术后6个月死于肝功能衰竭;1例多发病灶患者于术后10个月死于肿瘤脑转移;其余患者尚存活。结论超声引导下联合腹腔镜行微波消融治疗特殊部位的肝癌安全、有效、疗效确切。
Objective To summarize the clinical value and experience of ultrasound-guided microwave laparoscopic microwave ablation in the treatment of special parts of liver cancer. Methods The clinical data of 9 patients with hepatic malignancies underwent ultrasound-guided microwave ablation combined with microwave ablation in our hospital from February 2008 to October 2010 were retrospectively analyzed. Results Primary liver cancer in 6 cases, metastatic liver cancer in 3 cases; multiple tumors in 8 cases, single tumor in 1 case. Patients had one or more lesions invading the liver capsule, a total of 13 lesions, of which located in the top of the diaphragm 6, the right lobe visceral adjacent to the intestine 3, 2 adjacent to the left gastric wall, a gallbladder bed, hilar 1 No postoperative patients with diaphragmatic injury, gastrointestinal perforation, bleeding, bile leakage and other serious complications, no perioperative deaths. Patients were followed up (9.2 ± 4.7) months (4-18 months). One month after operation, 11 cases were completely ablated by CT, and the complete ablation rate was 84.6% (11/13). The margins of 2 lesions (2 cases) remained, of which 1 case underwent microwave ablation again and 1 case had no ablation Water ethanol ablation. Three months after the operation, CT was reviewed again. Four patients developed new lesions. Two of them underwent microwave ablation, one was treated with absolute ethanol ablation, one was given up for lung metastasis. One patient had no liver function Good died of liver failure 6 months after surgery; 1 case of multiple lesions died of tumor brain metastases 10 months after surgery; the remaining patients still alive. Conclusion Ultrasound-guided combined laparoscopic microwave ablation for the treatment of liver cancer at a specific site is safe, effective and effective.