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（P<0.05）。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 investigate the perioperative effects of radiofrequency ablation in the treatment of hepatic malignancies under the guidance of laparoscopic ultrasound and percutaneous ultrasound. Materials and Methods: A total of 66 patients with 85 lesions were divided into two groups(n=33), and treated with laparoscopic ultrasound-guided and percutaneous ultrasound-guided radiofrequency ablation. To get evaluation of perioperative effects preliminarily, all patients were followed up with ultrasonography and blood tests, etc. Results: Two groups of patients were successfully completed ultrasound-guided radiofrequency ablation. The amount of bleeding, operative time, postoperative hospital stay, total hospital stays and liver injury of the percutaneous ultrasound group were less than those of the laparoscopic ultrasound group(P<0.05). Laparoscopic ultrasound identified 5 new lesions(11.63%) missed at preoperative imaging(0.5~1.5 cm), and intraoperative 45.45%(15/33) of the patients combined with other resection, while 88.37%(38/43) lesions adjacent to the vital organs. Also, the postoperative complications were less than percutaneous ultrasound group. Only a little color signal was shown in ten lesions of percutaneous ultrasound group, while color Doppler flow imaging showed no color signal in other patients of both groups. In the perioperative period, the transaminase was increased transiently, laboratory studies demonstrated that it decreased to normal range finally, and no severe complications occurred. Conclusion: By laparoscopic ultrasound and percutaneous ultrasound, the lesions can be located accurately and the ablation zone can be visualized in real-time. The application of laparoscopic ultrasound could not only get satisfied effects in perioperative period, but also broaden the application scope of radiofrequency ablation. With the development of ultrasound-guided technique, laparoscopic ultrasound will play a significant role in minimally invasive surgery.
关键词
Ｒ735.7 /
Ｒ815 /
Ｒ445.1
Key words
Liver neoplasms /
Catheter ablation /
Laparoscopy /
Ultrasonography, interventional
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