微波消融辅助肝切除的临床应用

发布时间：2018-04-23 14:19

本文选题：微波消融 + 肝切除　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的:探讨微波消融(MWA)技术在开腹及腹腔镜肝切除过程中的临床应用价值,研究微波辅助肝切除应用中的优点及不足之处;观察微波消融对肝切除手术围手术期的影响,并随访微波技术对肝原发恶性肿瘤的长期疗效的影响,分析微波辅助肝切除的临床应用价值,为微波消融辅助肝切除技术的临床推广提供临床数据。方法:回顾性分析于2009年01月至2015年01月来空军总医院行开腹肝切除的275例肝占位病例,微波组系微波辅助肝切除患者166例,其中包括肝原发性恶性肿瘤112例,肝良性血管瘤54例;对照组系非微波辅助肝切除患者109例,其中肝原发性恶性肿瘤66例,肝良性血管瘤43例。行腹腔镜肝切除手术66例肝占位病例,微波组和对照组病例皆为肝原发恶性肿瘤,其中微波组38例,对照组28例。最后诊断经过术后病理确诊。微波组术中采用超声引导下沿肝预切线行多点连续微波消融,使肝预切线上肝脏组织形成凝固坏死带,进而在肝凝固坏死带上行肝横断;对照组术中未使用微波辅助技术,术中部分使用肝门阻断技术。分别统计开腹手术和腹腔镜手术两组患者术前基本情况、术中出血、手术时间、肝门阻断情况、腹腔引流管拔出时间、术后并发症、术后住院时间、术后输血情况、肝原发性恶性肿瘤术后生存率等,通过两组间的比较,分别评估微波消融对肝良性血管瘤及肝原发性恶性肿瘤肝切除治疗效果的不同影响,以及微波消融对开腹手术及腹腔镜手术治疗效果的不同影响,并分析微波消融对肝原发恶性肿瘤短期生存率的影响。结果:腹腔镜手术微波组和对照组手术均顺利完成,未发生中转开腹情况,术后均未发生明显胆漏及大量出血等严重并发症,其中微波组的手术时间少于对照组,出血量也低于对照组,两者差异皆有统计学意义(P0.05)。另外,微波组的术后住院时间也少于对照组,差异也有统计学意义。开腹手术两组均较顺利的完成手术,围手术期无死亡病例。肝良性血管瘤微波组手术时间及术中出血都明显低于对照组,差异有统计学意义(P0.05);微波组在术后引流管拔出时间、术后并发症及术后住院时间上与对照组无明显区别(P0.05);微波组术后输血制品的比例为13.0%,对照组术后输血制品的比例为20.9%,差异有统计学意义(P0.05),微波组术后输血的人数比例低于对照组。肝原发性恶性肿瘤微波组手术时间、术中出血量、引流管拔出时间均低于对照组,差异有统计学意义(P0.05),但是术后住院时间两者无明显差异(P0.05),微波组与对照组在切除肝段比例上并无明显的差异(P0.05),微波组术后输血制品的比例为15.2%,对照组术后输血制品的比例为30.3%,差异有统计学意义(P0.05),微波组术后输血的患者比例低于对照组。开腹手术微波组术后1年、3年总生存率分别为93.7%和82.0%,对照组术后1年、3年总生存率分别为90.8%和75.1%;腹腔镜手术微波组术后1年、3年总生存率分别约为95.0%和88.0%,对照组术后1年、3年总生存率分别为92.9%和82.1%,两组数据无明显差异(P0.05)。结论:微波辅助肝切除是一种较为安全的、有效地手术方式,可显著的减少术中肝横断时出血及渗血,缩短手术时间,减少术后输血的概率,降低肝门阻断的使用,并未增加术后的风险。因能有效控制肝断面出血,减少腹腔镜中转开腹的可能,同时改善手术视野,降低手术难度,增加了手术安全性。对合并肝硬化的患者,可以降低患者围手术期的并发症,值得临床推广及应用。对于肝原发性恶性肿瘤,微波技术对其短期生存率并无明显影响,可以减少围手术期并发症,增加围手术期安全性。对于毗邻重要管道的肝占位,术者不仅需要有丰富的临床手术经验,还需要有扎实的解剖学知识及良好的超声技术。
[Abstract]:Objective: To investigate the clinical value of microwave ablation (MWA) in laparotomy and laparoscopic hepatectomy, to study the advantages and disadvantages of microwave assisted hepatectomy, to observe the effect of microwave ablation on the perioperative period of hepatectomy, and to analyze the effect of microwave on the long-term effect of primary liver cancer and analyze the microwave irradiation. The clinical application value of auxiliary hepatectomy for the clinical application of microwave ablation assisted hepatectomy was provided. Methods: a retrospective analysis was made in 275 cases of liver occupying in the General Hospital of the Air Force PLA from 01 months to 01 months of 2009, and 166 cases of microwave assisted hepatectomy, including primary hepatic malignant swelling. There were 112 cases of tumor, 54 cases of benign hemangioma of the liver, 109 cases of non microwave assisted hepatectomy in the control group, of which 66 cases were primary malignant tumor of the liver, 43 cases of benign hemangioma of the liver, 66 cases of hepatic space occupying with laparoscopic hepatectomy, the microwave group and the control group were all primary malignant tumors of the liver, including 38 cases in microwave group and 28 cases in the control group. Finally, the diagnosis was diagnosed. In the microwave group, multipoint continuous microwave ablation along the liver pretangent line was performed under the guidance of ultrasound in the microwave group, and the liver tissue formed coagulation necrosis zone on the liver precut line, and then the liver transection in the liver coagulation necrosis zone; the control group did not use microwave assisted technique in the operation, and the hepatic portal blocking technique was used in the operation. The preoperative basic conditions, intraoperative hemorrhage, intraoperative bleeding, operation time, hepatic portal blockage, abdominal drainage tube extraction time, postoperative complications, postoperative hospitalization time, postoperative blood transfusion and survival rate of primary liver malignant tumor were evaluated by microwave ablation, and the two groups were compared to evaluate the effect of microwave ablation on the liver benign hemangioma and liver, respectively. Different effects of hepatectomy for primary malignant tumor, and the effect of microwave ablation on the effect of laparotomy and laparoscopy, and the effect of microwave ablation on the short-term survival rate of primary liver cancer. Results: the operation of the microwave group and the control group in the laparoscopy were all successfully completed without the conversion of the laparotomy. There were no significant complications such as bile leakage and massive bleeding after operation. The operation time of microwave group was less than that of the control group, and the amount of bleeding was also lower than that of the control group. The difference was statistically significant (P0.05). In addition, the time of hospitalization in the microwave group was also less than that of the control group, and the difference was also statistically significant. The two groups in the laparotomy group were all more smooth. There was no death case in the perioperative period. The operation time and intraoperative bleeding were significantly lower in the microwave group of the benign hepatic hemangioma than in the control group. The difference was statistically significant (P0.05). There was no significant difference between the microwave group after the drainage tube extraction, postoperative complications and the postoperative hospital stay (P0.05); the ratio of the blood transfusion products after the microwave group was compared. The proportion of the blood transfusion products in the control group was 20.9%, the difference was statistically significant (P0.05). The proportion of blood transfusion in the microwave group was lower than that of the control group. The operation time, the amount of bleeding and the extraction time of the drainage tube were lower than the control group in the microwave group of the primary liver cancer. The difference was statistically significant (P0.05), but the time of postoperative hospitalization was not significant (P0.05). There was no significant difference between the two groups (P0.05). There was no significant difference between the microwave group and the control group (P0.05), the proportion of blood transfusion products in the microwave group was 15.2%, the proportion of the blood transfusion products in the control group was 30.3%, the difference was statistically significant (P0.05). The proportion of the patients in the microwave group was lower than that of the control group. The microwave group of the laparotomy group was lower than the control group. The total survival rate of 3 years after 1 years was 93.7% and 82% respectively. The total survival rate of the control group was 90.8% and 75.1%, and the total survival rate was 90.8% and 75.1% respectively. The total survival rate of 3 years after the laparoscope operation microwave group was about 95% and 88%, respectively. The total survival rate of the control group was not significant (P0.05). Hepatectomy is a safer and more effective way of operation, which can significantly reduce bleeding and bleeding during intraoperative liver transection, shorten the operation time, reduce the probability of postoperative blood transfusion, reduce the use of hepatic portal blocking, and do not increase the risk of postoperative surgery. Visual field can reduce the difficulty of the operation and increase the safety of the operation. It can reduce the perioperative complications for patients with liver cirrhosis, which is worthy of clinical popularization and application. For the primary malignant tumor of the liver, microwave technology has no obvious influence on its short-term survival rate, which can reduce the perioperative complications and increase the safety of perioperative period. For liver occupying adjacent important pipes, surgeons need not only rich experience in clinical operation, but also solid anatomy knowledge and good ultrasound techniques.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

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