CAJ | 학술논문

目的探讨微波消融辅助下腹腔镜肝切除术的安全性和临床应用价值.方法回顾性分析我院2011年12月至2014年10月行微波辅助下腹腔镜肝切除的29例患者临床资料.术中先行超声引导下微波消融,肝组织固化止血后行肿瘤局部切除,观察记录术中出血量、手术时间、术后住院时间、术后并发症等.结果全组均顺利完成腹腔镜下肝切除,为不规则性切除,无中转开腹及围手术期死亡病例.术后病理证实肝细胞性肝癌18例,肝胆管细胞2例,直肠转移性腺癌2例,海绵状血管瘤5例,肝局灶性增生结节1例,肝囊腺瘤1例.3例放置腹腔引流,腹腔引流管5～7d拔除.手术时间150(125 ～210) min,术中出血量120(30～250) ml.术后住院时间7(5 ～ 10)d.术后无腹腔出血、胆漏等并发症.22例肝恶性肿瘤切缘均为阴性,随访3 ～36个月,无肿瘤复发及转移.结论微波消融可有效地控制肝断面的出血,能提高腹腔镜下肝切除的安全性,拓展了腹腔镜肝切除适应证.
목적 탐토미파소융보조하복강경간절제술적안전성화림상응용개치.방법 회고성분석아원2011년12월지2014년10월행미파보조하복강경간절제적29례환자림상자료.술중선행초성인도하미파소융,간조직고화지혈후행종류국부절제,관찰기록술중출혈량、수술시간、술후주원시간、술후병발증등.결과 전조균순리완성복강경하간절제,위불규칙성절제,무중전개복급위수술기사망병례.술후병리증실간세포성간암18례,간담관세포2례,직장전이성선암2례,해면상혈관류5례,간국조성증생결절1례,간낭선류1례.3례방치복강인류,복강인류관5～7d발제.수술시간150(125 ～210) min,술중출혈량120(30～250) ml.술후주원시간7(5 ～ 10)d.술후무복강출혈、담루등병발증.22례간악성종류절연균위음성,수방3 ～36개월,무종류복발급전이.결론 미파소융가유효지공제간단면적출혈,능제고복강경하간절제적안전성,탁전료복강경간절제괄응증.
Objective To evaluate the safety and efficacy of microwave tissue coagulation assisted laparoscopic hepatectomy for the treatment of hepatic tumors.Methods 29 patients underwent laparoscopic hepatectomy using microwave liver tissue coagulation from December 2011 to June 2014 in the General Air Force Hospital.All patients underwent intraoperative ultrasound guided microwave coagulation assisted laparoscopic local hepatectomy.Intraoperative blood loss,operation time,postoperative hospital stay and complications were observed.Results All the operations were successfully performed without conversion to open surgery.There were 18 cases of hepatocellular carcinoma (HCC),2 cases of intrahepatic cholangiocarcinoma,2 cases of hepatic metastases from the rectal carcinoma,5 cases of hepatic hemangioma,1 case of hepatic focal nodular hyperplasia and 1 case of hepatic cystadenoma.Drainage tubes were placed in 3 patients and removed 5-7 d after the operation.The operation time was 150 (125-210) miu,the median amount of intraoperative bleeding was 120 (30-250) ml,the postoperative hospital stay was 7 (5-10) d.All patients recovered well after the operation and no complications such as intraabdominal bleeding and bile leakage were observed.The cutting edges of liver cancer of these 22 cases were negative.The postoperative follow-up time of these 22 cases were 3-36 months and no tumor recurrence and metastasis were observed.Conclusions Laparoscopic liver resection using intraoperative ultrasound guided microwave hepatic tissue coagulation can effectively control the bleeding,improve the safety of laparoscopic liver resection,which makes it a safe and effective minimally invasive technique.