本文選題：肝腫瘤　切入點(diǎn)：導(dǎo)管消融術(shù)　出處：《中國(guó)臨床醫(yī)學(xué)影像雜志》2017年04期

【摘要】：目的:觀察腹腔鏡超聲與經(jīng)皮超聲引導(dǎo)肝癌射頻消融治療的圍手術(shù)期效果。資料與方法:66例肝癌患者共85個(gè)病灶,分為腹腔鏡超聲組與經(jīng)皮超聲組(每組各33例),在腹腔鏡超聲與經(jīng)皮超聲引導(dǎo)下行射頻消融治療,術(shù)后采用超聲觀察治療區(qū)聲像圖及彩色多普勒血流變化,并結(jié)合血生化及術(shù)后并發(fā)癥情況等初步評(píng)價(jià)圍手術(shù)期效果。結(jié)果:兩組患者均成功完成超聲引導(dǎo)射頻消融治療,成功率100%。經(jīng)皮超聲組術(shù)中出血量、手術(shù)時(shí)間、術(shù)后住院時(shí)間及總住院時(shí)間少于腹腔鏡超聲組,一過(guò)性肝功能損傷輕于腹腔鏡超聲組(P0.05)。腹腔鏡超聲組中11.63%(5/43)在術(shù)前未檢出病灶(0.5~1.5 cm),術(shù)中45.45%(15/33)的患者同時(shí)聯(lián)合其它切除術(shù),88.37%(38/43)的病灶毗鄰重要臟器,本組術(shù)后并發(fā)癥少于經(jīng)皮超聲組。兩組術(shù)后1周復(fù)查超聲,經(jīng)皮超聲組10個(gè)腫瘤內(nèi)部或邊緣探及少許血流信號(hào),其余病灶未探及明確血流信號(hào);術(shù)后次日血生化指標(biāo)(轉(zhuǎn)氨酶等)一過(guò)性增高,出院前均恢復(fù)或趨于正常;圍手術(shù)期均未出現(xiàn)嚴(yán)重并發(fā)癥。結(jié)論:腹腔鏡超聲與經(jīng)皮超聲在引導(dǎo)射頻消融治療肝癌中可發(fā)揮精確定位、實(shí)時(shí)監(jiān)測(cè)的作用,不但取得了較為滿(mǎn)意的圍手術(shù)期效果,腹腔鏡超聲的應(yīng)用還拓寬了射頻消融方法的適用范圍,腹腔鏡超聲在今后微創(chuàng)外科發(fā)展中必將成為不可缺少的部分。
[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.
【作者單位】： 中國(guó)人民解放軍火箭軍總醫(yī)院肝膽中心;
【分類(lèi)號(hào)】：R445.1;R735.7

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