探讨后腹膜入路腹腔镜微波消融术（MWA）治疗复发性肝细胞癌（肝癌）的安全性和疗效。

回顾性分析2020年1月至2022年12月在昆明理工大学附属医院行后腹膜入路腹腔镜MWA治疗的29例复发性肝癌患者临床资料。其中男16例，女13例；年龄34~72岁，中位年龄45岁。肿瘤均位于肝右叶，累计41个病灶，其中S5 段 9个，S6 段 12个，S7 段 11个，S8 段 9个；单发病灶 18例，2个病灶 10例，3个 病灶 1例；瘤体最大直径 （2.9±0.9） cm。对术前术后肿瘤指标、肝功能、术后并发症等进行分析，评估后腹膜入路腹腔镜MWA治疗复发性肝癌的疗效。

29例患者均顺利完成手术，手术时间（135±30） min；术中出血量（178±46） ml；引流管留置时间（4.1±1.3）d。术后2周所有患者肝功能均恢复正常。术后1例腹腔少量积气影，经保守治疗后，未出现后续并发症；9例肺不张及胸腔积液，经穿刺引流及抗感染治疗后，患者病情稳定，顺利出院。2例少量腹腔积液，未出现发热、腹腔脓肿等后续并发症。余患者无腹腔出血、感染、肝衰竭、胆漏等围手术期并发症发生。术后住院时间（8.3±5.3）d。病灶完全消融率95%（38/41），局部残留率5%（2/41）。术后中位生存期23个月，术后半年、1年、2年累积生存率分别为100%、96.6%、48.5%；术后中位无进展生存期 10个月，半年、1年、2年累积无进展生存率分别为 100%、66.7%、24.0%。

对于复发性肝癌患者，采用后腹膜入路腹腔镜MWA治疗可取得较好的疗效，安全性好，术后并发症发生率较低，具有创伤小、恢复快的特点。

To evaluate the safety and efficacy of laparoscopic microwave ablation (MWA) via retroperitoneal approach in the treatment of recurrent hepatocellular carcinoma (HCC).

Clinical data of 29 patients with recurrent HCC who underwent laparoscopic MWA via retroperitoneal approach in the Affiliated Hospital of Kunming University of Science and Technology from January 2020 to December 2022 were retrospectively analyzed. Among them, 16 patients were male and 13 female, aged from 34 to 72 years, with a median age of 45 years. The tumors were all located in the right lobe, with a total of 41 lesions, including 9 in segment 5, 12 in segment 6, 11 in segment 7 and 9 in segment 8, respectively. 18 patients were diagnosed with a single lesion, 10 cases with 2 lesions and 1 case with 3 lesions. The average maximum diameter of the tumor was (2.9±0.9) cm. Preoperative and postoperative tumor indexes, liver function and postoperative complications were analyzed. Clinical efficacy of laparoscopic MWA through retroperitoneal approach for recurrent HCC was evaluated.

All 29 patients successfully completed MWA. The operation time was (135±30) min. Intraoperative blood loss was (178±46) ml. The indwelling time of drainage tube was (4.1±1.3) d. The liver function of all patients was restored to normal at postoperative 2 weeks. A slight amount of pneumoperitoneum was observed in 1 case. After conservative treatment, the patient did not develop any subsequent complications. 9 cases presented with atelectasis and pleural effusion. Following puncture drainage and anti-infection treatment, these patients were discharged after stable condition. 2 patients experienced a slight amount of ascites, and did not develop subsequent complications such as fever and abdominal abscess. No perioperative complications such as abdominal bleeding, infection, liver failure and bile leakage occurred in the remaining patients. The length of postoperative hospital stay was (8.3±5.3) d. The complete ablation rate was 95%(38/41), and the local residual rate was 5%(2/41). The postoperative median overall survival was 23 months, and the 6-month, 1- and 2-year cumulative overall survival rates were 100%, 96.6% and 48.5%, respectively. The 6-month, 1- and 2-year cumulative progression-free survival rates were 100%, 66.7% and 24.0%, respectively.

For patients with recurrent HCC, laparoscopic MWA through retroperitoneal approach can achieve favorable efficacy, high safety, low incidence of postoperative complications, mild trauma and rapid recovery.