腹腔镜超声与经皮超声引导肝癌射频消融治疗的围手术期效果

发布时间：2018-03-24 22:38

本文选题：肝肿瘤　切入点：导管消融术　出处：《中国临床医学影像杂志》2017年04期

【摘要】：目的:观察腹腔镜超声与经皮超声引导肝癌射频消融治疗的围手术期效果。资料与方法:66例肝癌患者共85个病灶,分为腹腔镜超声组与经皮超声组(每组各33例),在腹腔镜超声与经皮超声引导下行射频消融治疗,术后采用超声观察治疗区声像图及彩色多普勒血流变化,并结合血生化及术后并发症情况等初步评价围手术期效果。结果:两组患者均成功完成超声引导射频消融治疗,成功率100%。经皮超声组术中出血量、手术时间、术后住院时间及总住院时间少于腹腔镜超声组,一过性肝功能损伤轻于腹腔镜超声组(P0.05)。腹腔镜超声组中11.63%(5/43)在术前未检出病灶(0.5~1.5 cm),术中45.45%(15/33)的患者同时联合其它切除术,88.37%(38/43)的病灶毗邻重要脏器,本组术后并发症少于经皮超声组。两组术后1周复查超声,经皮超声组10个肿瘤内部或边缘探及少许血流信号,其余病灶未探及明确血流信号;术后次日血生化指标(转氨酶等)一过性增高,出院前均恢复或趋于正常;围手术期均未出现严重并发症。结论:腹腔镜超声与经皮超声在引导射频消融治疗肝癌中可发挥精确定位、实时监测的作用,不但取得了较为满意的围手术期效果,腹腔镜超声的应用还拓宽了射频消融方法的适用范围,腹腔镜超声在今后微创外科发展中必将成为不可缺少的部分。
[Abstract]:Objective: to observe the perioperative effect of laparoscopic ultrasound and percutaneous ultrasound guided radiofrequency ablation of hepatocellular carcinoma. The patients were divided into laparoscopic ultrasound group and percutaneous ultrasound group (33 cases in each group). The radiofrequency ablation was performed under the guidance of laparoscopic ultrasound and percutaneous ultrasound. The changes of sonogram and color Doppler flow in the treated area were observed by ultrasound after operation. Results: two groups of patients were successfully treated with ultrasound guided radiofrequency ablation (RFCA), the success rate was 100%. Postoperative hospitalization time and total hospitalization time were less than those in laparoscopic ultrasound group. Transient liver function injury was less severe than that in the laparoscopic ultrasound group (P 0.05). In the laparoscopic ultrasound group, 11.63% (5 / 43) did not detect the lesion 0.5 ~ 1.5 cm / L before operation, and 45.45% 15 / 33) combined with other excision (88.37% / 3843), the lesions were adjacent to important organs. The postoperative complications in this group were less than those in the percutaneous ultrasound group. One week after operation, ultrasound was reexamined in both groups. A little blood flow signal was detected in 10 tumors in the percutaneous ultrasound group, but no blood flow signal was detected in the other lesions. The serum biochemical indexes (transaminase, etc.) were temporarily increased on the day after operation, and all recovered or tended to be normal before discharge. Conclusion: laparoscopic ultrasound and percutaneous ultrasound can play a role of accurate localization and real-time monitoring in the treatment of liver cancer with radiofrequency ablation. The application of Laparoscopic Ultrasound also widens the scope of radiofrequency ablation, and Laparoscopic Ultrasound will become an indispensable part in the development of minimally invasive surgery in the future.
【作者单位】：中国人民解放军火箭军总医院肝胆中心;
【分类号】：R445.1;R735.7

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