切换至 "中华医学电子期刊资源库"

中华肝脏外科手术学电子杂志 ›› 2026, Vol. 15 ›› Issue (05) : 724 -730. doi: 10.3877/cma.j.issn.2095-3232.2026.05.007

前沿与争鸣

单孔腹腔镜术中超声引导下微波消融在肝脏肿瘤中的应用
罗佳, 韩江, 戴已禾, 晋云()   
  1. 650000 昆明理工大学附属医院(云南省第一人民医院)肝胆胰外科
  • 收稿日期:2026-04-02 出版日期:2026-10-10
  • 通信作者: 晋云
  • 基金资助:
    云南省重大科技专项(202402AA310056); 云南省基础研究专项-重点项目(202201AS070002); 云南省创新团队专项(202505AS350004); 云南省“兴滇英才支持计划”名医专项(XDYC-MY-2022-0032)

Application of ultrasound-guided microwave ablation in single-incision laparoscopic surgery for liver tumors

Jia Luo, Jiang Han, Yihe Dai, Yun Jin()   

  1. Department of Hepatobiliary and Pancreatic Surgery, the Affiliated Hospital of Kunming University of Science and Technology (the First People's Hospital of Yunnan Province), Kunming 650000, China
  • Received:2026-04-02 Published:2026-10-10
  • Corresponding author: Yun Jin
引用本文:

罗佳, 韩江, 戴已禾, 晋云. 单孔腹腔镜术中超声引导下微波消融在肝脏肿瘤中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(05): 724-730.

Jia Luo, Jiang Han, Yihe Dai, Yun Jin. Application of ultrasound-guided microwave ablation in single-incision laparoscopic surgery for liver tumors[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2026, 15(05): 724-730.

单孔腹腔镜(SIL)技术是在微创外科精准治疗的基础上提出的,可减少手术创伤,加速患者的康复,逐渐应用于外科各领域中。消融术是目前公认治疗原发性及继发性肝脏肿瘤的有效方法。目前组织消融技术包括射频消融(RFA)、微波消融(MWA)等,MWA因其操作便捷,消融范围广,消融效率高,受邻近血管影响较小而广泛应用。随着导航设备和精准靶向技术的进步,消融联合辅助设备可能是下一个精准外科治疗的选择。本文就SIL术中超声引导下MWA在肝脏外科中的应用进行阐述,结合本中心临床经验,评价其在肝脏肿瘤中的应用现状及前景。

Single-incision laparoscopy (SIL) is established based on precise treatment of minimally invasive surgery. SIL can reduce surgical trauma and accelerate postoperative recovery. It has been gradually applied in multiple surgical fields. Ablation is an effective treatment for primary and secondary liver tumors. Current tissue ablation technologies include radiofrequency ablation (RFA) and microwave ablation (MWA), etc. MWA is widely applied in clinical practice due to convenient operation, wide range of ablation, high ablation efficiency and slight impact from neighboring vessels. With the development of navigation equipment and precision targeting technology, ablation combined with auxiliary equipment may become an option for precision surgery. In this article, the application of ultrasound-guided MWA during SIL in liver surgery was elucidated, and clinical experience of our center was summarized to evaluate its application status and prospect in liver tumors.

图1 SIL联合术中超声引导下MWA手术操作 注:SIL为单孔腹腔镜,MWA为微波消融术
图2 一例47岁结肠癌肝转移患者SIL联合术中超声引导下MWA前后MRI 注:a为消融前肝脏S5单发小病灶,大小10 mm×9 mm;b为消融后1个月随访MRI,消融完全,肿瘤无复发;SIL为单孔腹腔镜,MWA为微波消融术(红色箭头:肝脏病灶)
图3 一例43岁肝大血管瘤患者SIL联合术中超声引导下MWA前后CT 注:a为消融前肝脏右后叶大血管瘤,大小90 mm×62 mm×61 mm;b为消融后6个月随访CT示血管瘤范围较前明显缩小;SIL为单孔腹腔镜,MWA为微波消融术(红色箭头:肝脏病灶)
[1]
Kalloo AN, Singh VK, Jagannath SB, et al. Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity[J]. Gastrointest Endosc, 2004, 60(1): 114-117.DOI: 10.1016/s0016-5107(04)01309-4.
[2]
Marescaux J. Surgery without scars: report of transluminal cholecystectomy in a human being[J]. Arch Surg, 2007, 142(9): 823.DOI: 10.1001/archsurg.142.9.823.
[3]
Cheng X, Huang C, Jia W, et al. Clinical status and future prospects of single-incision robotic-assisted surgery: a review[J]. Int J Surg, 2023, 109(12): 4221-4237.DOI: 10.1097/js9.0000000000000944.
[4]
Yang S, Li J, Li J, et al. Ultrasound and single-port laparoscopic-guided microwave ablation of abdominal wall endometriosis lesions: a single-center observational study[J]. Acta Obstet Gynecol Scand, 2025, 104(4): 755-762.DOI: 10.1111/aogs.15051.
[5]
Deng X, Wang JJ, Wang ZX, et al. Effectiveness and safety of ultrasound-guided percutaneous microwave ablation for hepatic alveolar echinococcosis[J]. BMC Med Imag, 2022, 22(1): 27.DOI: 10.1186/s12880-022-00752-2.
[6]
Machairas N, Papaconstantinou D, Gaitanidis A, et al. Is single-incision laparoscopic liver surgery safe and efficient for the treatment of malignant hepatic tumors a systematic review[J]. J Gastrointest Cancer, 2020, 51(2): 425-432.DOI: 10.1007/s12029-019-00285-y.
[7]
莫鹏, 郭杏春, 梁秀娟, 等. 超声引导与CT引导射频消融治疗肝细胞癌患者疗效及预后比较[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(2): 151-154.DOI: 10.3877/cma.j.issn.2095-2015.2024.02.010.
[8]
中华人民共和国国家卫生健康委员会医政司. 原发性肝癌诊疗指南(2024年版)[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(4): 407-449.DOI: 10.3877/cma.j.issn.2095-3232.2024.04.001.
[9]
梁萍, 窦健萍, 于杰. 肝肿瘤的微波消融治疗[J]. 中华老年多器官疾病杂志, 2016, 15(7): 481-485, 476.DOI: 10.11915/j.issn.1671-5403.2016.07.114.
[10]
Wang Z, Liu M, Zhang DZ, et al. Microwave ablation versus laparoscopic resection as first-line therapy for solitary 3-5-cm HCC[J]. Hepatology, 2022, 76(1): 66-77.DOI: 10.1002/hep.32323.
[11]
Curto S, Taj-Eldin M, Fairchild D, et al. Microwave ablation at 915 MHz vs 2. 45 GHz: a theoretical and experimental investigation[J]. Med Phys, 2015, 42(11): 6152-6161.DOI: 10.1118/1.4931959.
[12]
Van Dai Vo Chieu, Werncke T, Hensen B, et al. CT-guided microwave ablation of liver tumors in anatomically challenging locations[J]. Cardiovasc Intervent Radiol, 2018, 41(10): 1520-1529.DOI: 10.1007/s00270-018-2007-z.
[13]
Kong J, Gao R, Wu S, et al. Safety and efficacy of microwave versus radiofrequency ablation for large hepatic hemangioma: a multicenter retrospective study with propensity score matching[J]. Eur Radiol, 2022, 32(5): 3309-3318.DOI: 10.1007/s00330-021-08425-4.
[14]
Li F, Xing H. Effectiveness of microwave ablation for the treatment of hepatic hemangioma-meta-analysis and meta-regression[J]. Int J Hyperthermia, 2023, 40: 2146214.DOI: 10.1080/02656736.2022.2146214.
[15]
张巍. 术中超声临床应用进展: 创新及发展精准外科[J]. 中国医学影像技术, 2024, 40(2): 168-171.DOI: 10.13929/j.issn.1003-3289.2024.02.002.
[16]
Zheng H, Liu K, Yang Y, et al. Microwave ablation versus radiofrequency ablation for subcapsular hepatocellular carcinoma: a propensity score-matched study[J]. Eur Radiol, 2022, 32(7): 4657-4666.DOI: 10.1007/s00330-022-08537-5.
[17]
Liao M, Zhong X, Zhang J, et al. Radiofrequency ablation using a 10-mm target margin for small hepatocellular carcinoma in patients with liver cirrhosis: a prospective randomized trial[J]. J Surg Oncol, 2017, 115(8): 971-979.DOI: 10.1002/jso.24607.
[18]
Ikeda K, Seki T, Umehara H, et al. Clinicopathologic study of small hepatocellular carcinoma with microscopic satellite nodules to determine the extent of tumor ablation by local therapy[J]. Int J Oncol, 2007, 31(3): 485-491.DOI: 10.3892/ijo.31.3.485.
[19]
House MG, Ito H, Gönen M, et al. Survival after hepatic resection for metastatic colorectal cancer: trends in outcomes for 1, 600 patients during two decades at a single institution[J]. J Am Coll Surg, 2010, 210(5): 744-752.DOI: 10.1016/j.jamcollsurg.2009.12.040.
[20]
Karagkounis G, McIntyre SM, Wang T, et al. Rates and patterns of recurrence after microwave ablation of colorectal liver metastases: a per lesion analysis of 416 tumors in the era of 2.45 GHz generators[J]. Ann Surg Oncol, 2023, 30(11): 6571-6578.DOI: 10.1245/s10434-023-13751-6.
[21]
Vogl TJ, Zitsch M, Albrecht M, et al. Long-term outcomes following percutaneous microwave ablation for colorectal cancer liver metastases[J]. Int J Hyperthermia, 2022, 39(1): 788-795.DOI: 10.1080/02656736.2022.2077991.
[22]
高君, 范瑞芳, 杨家印, 等. 肝血管瘤射频消融治疗(国内)专家共识[J]. 临床肝胆病杂志, 2017, 33(9): 1638-1645.DOI: 10.3969/j.issn.1001-5256.2017.09.004.
[23]
Lee MW, Han S, Gu K, et al. Local ablation therapy for hepatocellular carcinoma: clinical significance of tumor size, location, and biology[J]. Invest Radiol, 2025, 60(1): 53-59.DOI: 10.1097/rli.0000000000001100.
[24]
Ko SE, Lee MW, Ahn S, et al. Laparoscopic hepatic resection versus laparoscopic radiofrequency ablation for subcapsular hepatocellular carcinomas smaller than 3 cm: analysis of treatment outcomes using propensity score matching[J]. Korean J Radiol, 2022, 23(6): 615.DOI: 10.3348/kjr.2021.0786.
[25]
Lu DSK, Raman SS, Limanond P, et al. Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors[J]. J Vasc Interv Radiol, 2003, 14(10): 1267-1274.DOI: 10.1097/01.rvi.0000092666.72261.6b.
[26]
Feng Y, Wang L, Lv H, et al. Microwave ablation versus radiofrequency ablation for perivascular hepatocellular carcinoma: a propensity score analysis[J]. HPB, 2021, 23(4): 512-519.DOI: 10.1016/j.hpb.2020.08.006.
[27]
Ding WZ, Wei H, Wu JP, et al. Liver cirrhosis and tumor location can affect the range of intrahepatic microwave ablation zone[J]. Int J Hyperthermia, 2023, 40: 2181843.DOI: 10.1080/02656736.2023.2181843.
[28]
Ledoux G, Amroun K, Rhaiem R, et al. Fully laparoscopic thermo-ablation of liver malignancies with or without liver resection: tumor location is an independent local recurrence risk factor[J]. Surg Endosc, 2021, 35(2): 845-853.DOI: 10.1007/s00464-020-07456-0.
[29]
Song Y, Wu M, Zhou R, et al. Application and evaluation of hydrodissection in microwave ablation of liver tumours in difficult locations[J]. Front Oncol, 2023, 13: 1298757.DOI: 10.3389/fonc.2023.1298757.
[30]
程小丽, 宋成利. 单孔腹腔镜手术器械研究的最新进展[J]. 中国组织工程研究与临床康复, 2011, 15(25): 4669-4674.DOI: 10.3969/j.issn.1673-8225.2011.25.027.
[31]
彭子洋, 王志博, 巴赫, 等. 增强现实、虚拟现实与混合现实在腔镜肝脏外科中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(1): 13-17.DOI: 10.3877/cma.j.issn.2095-3232.2025005.
[1] 王博逸, 黄斌, 孙希希, 洪勇强, 吴圣波, 王涵, 亓倩倩. 热平衡术式在经皮子宫肌瘤微波消融治疗中的疗效评价[J/OL]. 中华医学超声杂志(电子版), 2026, 23(04): 307-315.
[2] 马禧圆, 母德安, 曾少杰, 张志远, 张伟. 超微创腹腔镜IV段肝肿瘤切除术[J/OL]. 中华普外科手术学杂志(电子版), 2026, 20(04): 325-325.
[3] 张浩然, 王实现, 王凯, 缪骥. SSLA治疗复发性阑尾炎的疗效与手术时间因素研究[J/OL]. 中华普外科手术学杂志(电子版), 2026, 20(04): 379-383.
[4] 梁前俊, 李昊, 张家龙, 邰胜, 梁朝朝. 国产精锋单孔机器人在中高危前列腺癌患者中的应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2026, 20(04): 413-419.
[5] 何子勤, 李俊涛, 张翼飞, 肖楚天, 赵阳杰, 钟文文, 叶雷, 邱剑光, 王德娟. 机器人辅助单孔腹腔镜肾盂成形术在小儿肾盂输尿管连接部梗阻中的应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2026, 20(03): 279-284.
[6] 贺慷, 杨诚, 刘存东. 经膀胱入路单孔腹腔镜技术在泌尿外科的应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2026, 20(02): 140-146.
[7] 程正武, 李浩然, 奚士航, 王俊峰. 后鞘后入路单孔腹腔镜全腹膜外补片修补术治疗腹股沟疝[J/OL]. 中华疝和腹壁外科杂志(电子版), 2026, 20(04): 394-398.
[8] 冉坤. 单孔腹腔镜完全腹膜外腹股沟疝修补术在特殊解剖条件下的应用与优势[J/OL]. 中华疝和腹壁外科杂志(电子版), 2026, 20(04): 456-460.
[9] 于昆, 司仙科, 郑侃, 陈志升, 李森, 杨佳华, 李炜. 单孔腹腔镜完全腹膜外腹股沟疝修补术的临床应用[J/OL]. 中华疝和腹壁外科杂志(电子版), 2026, 20(02): 168-173.
[10] 郭宏涛, 马怡彤, 姚志强, 毕学汉, 刘畅. 妇科经脐单孔腹腔镜腹膜后入路腹主动脉旁淋巴结切除术的临床应用[J/OL]. 中华腔镜外科杂志(电子版), 2026, 19(03): 135-139.
[11] 李中宇, 杨谨闻, 麻勇. 微创脾部分切除术的发展现状与展望[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(04): 545-550.
[12] 徐荣, 韩伟, 张威. 单孔腹腔镜脾部分切除术的临床应用:微创革新与功能保全[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(04): 551-557.
[13] 王泽宁, 费振浩, 陈业盛, 孙志为. 基于肝癌体积-时间窗的个体化TACE-MWA序贯治疗策略及其机制探讨[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(03): 307-316.
[14] 东小鸽, 樊海宁, 侯立朝, 杜凯豪, 刘海刚, 汪占金, 薛伟伟, 石亚超, 魏六木, 王展. 三维可视化技术、ICG荧光示踪和术中实时超声在肝癌个性化精准诊疗中应用[J/OL]. 中华肝脏外科手术学电子杂志, 2026, 15(02): 181-189.
[15] 中国医师协会结直肠肿瘤专业委员会单孔腹腔镜学组. 单孔腹腔镜结直肠手术专家共识(2025版)[J/OL]. 中华结直肠疾病电子杂志, 2026, 15(02): 97-103.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?