目的

探讨腹腔镜超声（LUS）引导下射频消融（RFA）治疗肝脏恶性肿瘤的安全性与疗效。

方法

回顾性分析2017 年1 月至2022 年6 月在首都医科大学附属北京潞河医院行LUS 引导下RFA 的47 例肝脏恶性肿瘤患者临床资料。患者均签署知情同意书，符合医学伦理学规定。其中男33 例，女14 例；年龄37～86 岁，中位年龄64 岁。肝细胞癌（HCC） 14 例，结直肠癌肝转移（CRLM）33 例。肿瘤直径0.5～3.5 cm，中位直径1.6 cm。观察患者完全消融率、围手术期并发症等。随访患者生存和肿瘤复发情况，生存分析采用Kaplan-Meier 法。

结果

所有手术均顺利完成，无中转开腹。47 例患者共72 枚病灶行RFA；RFA 治疗肝肿瘤数目中位数1.5（1.0～5.0）枚。完全消融率 97%（70/72）。术后1 d 转氨酶不同程度升高，术后3 d 明显下降。术后肝脓肿1 例，经穿刺引流后痊愈。围手术期无发生严重并发症和死亡。术后住院时间4.6（1.0～12.0）d。术后1、3 年总体生存率分别95.8%、90.3%，术后1、3 年无复发生存率分别为82.3%、67.7%。

结论

LUS 引导下RFA 治疗肝脏恶性肿瘤操作简便，安全有效，并发症发生率低，肿瘤治疗效果满意，可作为不宜手术切除患者的重要治疗手段。

Objective

To evaluate the safety and efficacy of laparoscopic ultrasound (LUS)-guided radiofrequency ablation (RFA) in the treatment of malignant liver tumors.

Methods

Clinical data of

47 patients with malignant liver tumors who underwent LUS-guided RFA in Beijing Luhe Hospital affiliated

to Capital Medical University from January 2017 to June 2022 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them, 33 patients were male and 14 female, aged from 37 to 86 years, with a median age of 64 years.14 patients were diagnosed with hepatocellular carcinoma (HCC) and 33 cases of colorectal cancer liver metastasis (CRLM).The tumor diameter was ranged from 0.5 to 3.5 cm, with a median diameter of 1.6 cm.The complete ablation rate and perioperative complications were observed.The survival and tumor recurrence were recorded during follow-up.Survival analysis was performed by Kaplan-Meier method.

Results

All procedures were successfully completed without conversion to open surgery.72 lesions from 47 patients were treated with RFA.The median number of liver tumors treated by RFA was 1.5 (1.0-5.0).The complete ablation rate reached 97%(70/72).Transaminase levels were increased to different degrees at postoperative 1 d, and then significantly decreased at postoperative 3 d.One case developed postoperative liver abscess, which was cured by puncture and drainage.No severe complications and death occurred during perioperative period.The length of postoperative hospital stay was 4.6 (1.0-12.0) d.The postoperative 1- and 3-year overall survival rates were 95.8% and 90.3%, and the 1- and 3-year recurrence-free survival rates were 82.3% and 67.7%,respectively.

Conclusions

LUS-guided RFA is a simple, safe and efficacious treatment for malignant liver tumors, which yields a low incidence of postoperative complications and satisfactory therapeutic effect.It can be utilized as an important treatment for patients ineligible for surgical resection.