探讨腹腔镜射频消融术（LRFA）在治疗复杂肝细胞癌（肝癌）中的应用价值。

回顾性分析2010年10月至2012年6月在佛山市第一人民医院行LRFA的40例复杂肝癌患者临床资料。肝癌病灶多位于特殊部位或患者有出血倾向。其中男32例，女8例；年龄37～79岁，中位年龄57岁。影像学检查提示单发病灶22例，多发病灶18例，病灶直径2.6（1.0～5.0）cm。患者均签署知情同意书，符合医学伦理学规定。患者在腹腔镜超声引导下行LRFA。术后1个月行增强CT检查肿瘤消融情况。术后每3个月行增强CT或MRI检查肿瘤复发情况。

40例患者均顺利完成LRFA，术后发生中量腹腔积液6例，胸腔积液3例，无出血、肝衰竭、胆道损伤、胃肠道损伤病例，术后总体并发症发生率22%（9/40）。无围手术期死亡病例。肿瘤完全消融率90%（36/40），术后肿瘤复发24例，其中原位复发2例，异位复发22例。术后1、2、4年肿瘤复发率分别为35%、50%、60%。

对于特殊部位肝癌或高出血风险的肝癌患者，LRFA安全性高，中短期疗效肯定，是经皮射频消融的重要补充手段。

To investigate the application value of laparoscopic radiofrequency ablation (LRFA) in the treatment of complicated hepatocellular carcinoma (HCC).

Clinical data of 40 patients with complicated HCC undergoing LRFA in the First People's Hospital of Foshan between October 2010 and June 2012 were retrospectively analyzed. Most HCC lesions were located at special sites or the patients had a bleeding tendency. Among the patients, 32 were males and 8 were females, with the age ranging from 39 to 79 years old and the median of 57 years old. Imageological examination indicated that 22 patients were with single lesion and 18 were with multiple lesions. The median diameter of the lesions was 2.6(1.0-5.0) cm. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients underwent LRFA under the guide of laparoscopic ultrasound. Enhanced computed tomography (CT) was performed 1 month after surgery to check the tumor ablation, and enhanced CT or magnetic resonance imaging (MRI) was performed every 3 months after surgery to check the tumor recurrence.

LRFA was performed successfully on all the patients. After surgery, 6 cases developed moderate ascites and 3 developed pleural effusion. No bleeding, liver failure, bile duct injury or gastrointestinal tract damage was observed. The incidence of postoperative complications was 22% (9/40). No perioperative death was observed. The complete ablation rate of the tumors was 90% (36/40), and tumor recurrence was observed in 24 cases after surgery, including 2 of primary recurrence and 22 of ectopic recurrence. The 1-, 2- and 4-year tumor recurrence rate was respectively 35%, 50% and 60%.

For the patients with HCC at special sites or at high risk of bleeding, LRFA is safe and effective in the short and mid-term treatment. It is an important supplement to percutaneous radiofrequency ablation.