【摘要】 目的探讨超声引导下微波消融在腹腔镜肝切除术中应用的安全性和疗效。方法回顾性分析2011年9月至2012年9月在中山大学附属第三医院岭南医院行腹腔镜肝切除,且术中应用超声引导下微波消融的4例患者临床资料。其中男3例,女1例;年龄26~49岁,中位年龄41岁;肝细胞肝癌(肝癌)2例,肝血管瘤1例,肝局灶性结节增生1例。患者均签署知情同意书,符合医学伦理学规定。4例患者行腹腔镜下肝切除术,术中超声引导下行微波消融,肝组织固化止血后切除病灶。观察患者术中及术后情况,记录术中出血量、手术时间、术后住院时间、术后并发症和疗效。结果 4例患者腹腔镜下肝切除手术均顺利,无中转开腹。术中出血量中位数90(50~120)ml,手术时间183(145~220)min,术后住院时间9(8~10)d。患者术后恢复顺利,未发生腹腔出血、胆漏等并发症。2例肝癌切缘均为阴性,术后分别随访6、11个月,均未发现肿瘤复发及转移。结论腹腔镜肝切除术中应用超声引导下微波消融可有效地控制肝断面的出血,是一种安全而有效的微创技术。更多还原

【Abstract】 Objective To discuss the safety and efficacy of ultrasound-guided microwave ablation in the laparoscopic hepatectomy.Methods Four patients underwent laparoscopic hepatectomy using microwave ablation guided by ultrasound from September 2011 to September 2012 in Lingnan Hospital,the Third Affiliated Hospital of Sun Yat-sen University were enrolled in this retrospective study.There were 3 males and 1 female with age ranging from 26 to 49 years old and a median age of 41 years old.There were 2 cases with hepatocellular carcinoma(HCC),1 case with hepatic hemangioma and 1 case with hepatic focal nodular hyperplasia.The informed consents of all patients were obtained and the ethical committee approval was received.All the 4 patients underwent laparoscopic hepatectomy,intraoperative ultrasound guided microwave ablation and focal lesions resection after the liver tissue was coagulated and stopped bleeding.Intraoperative and postoperative condition of the patients,amount of intraoperative bleeding,operation time,postoperative hospital stay,complications and curative effect were observed and recorded.Results All the operations were successfully performed without any conversion to open laparotomy.The median amount of intraoperative bleeding was 90(50-120) ml,the operation time was 183(145-220) min,the postoperative hospital stay was 9(8-10) d.All patients recovered well after the operation and no complications such as abdominal bleeding and bile leakage were observed.The cutting edges of liver cancerof these 2 cases were negative.The postoperative follow-up time of these 2 cases were 6,11 months respectively and no tumor recurrence and metastasis were observed.Conclusions Laparoscopic liver resection using microwave ablation guided by intraoperative ultrasound can effectively control the bleeding of resected liver and is a safe and effective minimally invasive technique.更多还原