摘要
目的·探讨膈面肝肿瘤腹腔镜超声引导下微波消融治疗的安全性、有效性,以及具体的使用体会。方法·回顾性分析2019年11月—2021年4月于浙江中医药大学附属温州中医院接受腹腔镜超声引导下微波消融治疗的13例膈面肝肿瘤病例。腹腔镜下观察腹腔内有无转移,根据需要离断镰状韧带、冠状韧带、三角韧带,在肝脏膈顶裸区或脏面填塞纱布垫。腹腔镜超声扫查肝脏,确定肿瘤位置及有无新发肿瘤,同时活检后使用超声造影剂对肿瘤多点多角度消融,在退针过程中腹腔镜直视观察有无出血,并行针道消融。消融后再次超声造影,必要予时追加消融。观察围手术期并发症,比较术前、术后的血生化指标、白细胞水平以及术后磁共振成像(magnetic resonance imaging,MRI)表现。结果·13例患者均成功施行腹腔镜超声引导下微波消融治疗,所有患者围手术期均未出现膈肌损伤、心率失常、肺炎、气胸、大出血、胆瘘、肠管损伤等严重并发症;术前白细胞[(4.9±1.0)×10^(9)个/L]和术后第2日白细胞[(8.7±2.5)×10^(9)个/L]的差异具有统计学意义(P=0.000)。术前谷丙转氨酶[15.0 (22.0,77.5) U/L]和术后第2日谷丙转氨酶[69.0 (135.0,371.0) U/L]的差异具有统计学意义(P=0.013);术后1月复查MRI增强证实,病灶完全坏死率达100%。结论·腹腔镜超声引导下肝肿瘤消融,首先是在腹腔镜下进行的手术,通过建立气腹、离断韧带、纱布隔离等方法使肝脏周围形成一个安全的隔离带;然后在腹腔镜超声探头的直视下对膈面肝肿瘤进行消融,以提供一种更加安全、有效的治疗方法。
Objective·To investigate the safety and effectiveness of laparoscopic ultrasound-guided microwave ablation for phrenic surface liver tumors,as well as the specific experience of its use.Methods·A retrospective analysis was performed on 13 cases of diaphragmatic liver tumor who received laparoscopic ultrasound-guided microwave ablation in Zhejiang University of Traditional Chinese Medicine Affiliated Wenzhou Hospital from November 2019 to April 2021.The falciform ligament,coronal ligament and deltoid ligament were severed according to the need,and gauze pads were filled on the diaphragmatic surface or visceral of the liver.Laparoscopic ultrasound scan of the liver was performed to determine the location of the tumor and whether there were new tumors.Meanwhile,ultrasound contrast agent was used to perform multi-point and multi-angle ablation of the tumor after biopsy.During the process of needle withdrawal,laparoscopic direct observation was performed to observe whether there was bleeding,and needle path ablation was performed.After ablation,contrast-enhanced ultrasound was repeated and additional ablation was performed if necessary.Perioperative complications were observed and preoperative and postoperative blood biochemical indexes,white blood cells level and postoperative MRI manifestations were compared.Results·All the 13 patients were successfully treated with laparoscopic ultrasound-guided microwave ablation.There were no serious complications such as diaphragm injury,arrhythmia,pneumonia,pneumothorax,massive bleeding,biliary fistula and intestinal injury.The white blood cells before surgery[(4.9±1.0)×10^(9)/L]and day 2 after surgery[(8.7±2.5)×10^(9)/L]were significantly different(P=0.000).The glutamic-pyruvic transaminase[15.0(22.0,77.5)U/L]before surgery and day 2 after surgery[69.0(135.0,371.0)U/L]were significantly different(P=0.013).One month after the operation,MRI enhancement confirmed that the total necrosis rate of the lesion was 100%.Conclusion·Laparoscopic ultrasound-guided hepatic tumor ablation,which is first performed under laparoscopy,forms a safe isolation zone around the liver through the establishment of pneumoperitoneum,severed ligament,gauze isolation and other methods.Then,under the direct vision of laparoscopic ultrasound probe,the diaphragmatic liver tumors are ablated to achieve a safer and more effective method.
作者
张寅
吴贤
谢炳銮
王奕
ZHANG Yin;WU Xian;XIE Bingluan;WANG Yi(Department of General Surgery,Zhejiang University of Traditional Chinese Medicine Affiliated Wenzhou Hospital,Wenzhou 325000,China;Department of Hepatobiliary Surgery,Shanghai Tongren Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200336,China)
出处
《上海交通大学学报（医学版）》
CAS
CSCD
北大核心
2023年第3期391-396,共6页
Journal of Shanghai Jiao tong University:Medical Science
关键词
肝癌
腹腔镜
腹腔镜超声
消融
微波消融
liver cancer
laparoscope
laparoscopic ultrasound
ablation
microwave ablation
