切换至 "中华医学电子期刊资源库"
高级检索
中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2023, Vol. 16 ›› Issue (01): 44 -48. doi: 10.3877/cma.j.issn.1674-6899.2023.01.011

论著

弯曲形水冷微波消融针在腹腔镜下膈顶部肝细胞癌消融中的应用
刘虎1, 张搏伦2, 杨豪1, 乐羿1, 刁广浩3, 崔昭扬1, 赵向宁1, 安亮1, 李海珠1, 蔡建强2, 张绍庚1,†()   
  1. 1. 201805　上海孟超肿瘤医院肿瘤外科
    2. 100021　北京，国家癌症中心　国家肿瘤临床医学研究中心　中国医学科学院北京协和医学院肿瘤医院
    3. 100039　北京，解放军总医院第五医学中心
  • 收稿日期:2022-12-01 出版日期:2023-02-28
  • 通信作者: 张绍庚

Research of curved water-cooled microwave ablation of diaphragmatic dome of HCC under laparoscopy

Hu Liu1, Bolun Zhang2, Hao Yang1, Yi Le1, Guanghao Diao3, Zhaoyang Cui1, Xiangning Zhao1, Liang An1, Haizhu Li1, Jianqiang Cai2, Shaogeng Zhang1,†()   

  1. 1. Shanghai Mengchao Cancer Hospital, Shanghai 201805, China
    2. National Cancer Center, National Cancer Clinical Medical Research Center, Cancer Hospital of Chinese Academy of Medical Sciences, Beijing 100021, China
    3. The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
  • Received:2022-12-01 Published:2023-02-28
  • Corresponding author: Shaogeng Zhang
全文 ( ) 下载PDF ( )
目的

探讨弯曲形水冷微波消融针在膈顶部肝细胞癌治疗的操作优势、安全性、有效性和效果评价。

方法

选取2015年1月至2021年12月上海孟超肿瘤医院与中国医学科学院北京协和医学院肿瘤医院收治的膈顶部肝细胞癌患者作为研究对象，探讨弯曲形水冷微波消融针在腹腔镜下膈顶部肝细胞癌微波消融的操作优势、安全性和有效性。

结果

弯曲形水冷微波消融针在膈顶部肝细胞癌的治疗与直形针相比，操作优势显著，避免了胸腔入路引起的气胸、胸腔感染、膈肌损伤、支气管胆管漏等并发症，安全有效。

结论

弯曲形水冷微波消融针在膈顶部肝细胞癌的治疗中操作优势明显，安全、有效，值得在膈顶部肝细胞癌的操作中大力推广。

关键词: 弯曲形消融针, 腹腔镜, 膈顶部, 肝细胞癌, 肝脏动态流域学说
Objective

To investigate the operation advantages , safety and effectiveness of curved water-cooled microwave ablation in the treatment of liver cancer on diaphragmatic dome.

Methods

To explore the advantages, safety and effectiveness of the curved water-cooled ablation for HCC on diaphragmatic dome admitted to Shanghai Mengchao Cancer Hospital and Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from Jan. 2015 to Dec. 2021.

Results

The curved water-cooled ablation needle has significant advantages in the treatment of HCC on the dome of the diaphragm under laparoscopy. It avoids the complications such as pneumothorax, pleural infection, diaphragmatic injury and bronchial bile duct leakage caused by the thoracic approach. And it is safe and effective.

Conclusions

The curved water-cooled microwave ablation has obvious advantages in the treatment of HCC on the dome of the diaphragm, and it is safe and effective, which is worthy of promotion in the operation of HCC on the dome of the diaphragm.

Key words: Curved ablation, Laparoscope, Diaphragmatic dome, HCC, Liver dynamic watershed theory
表1 膈顶部肝细胞癌腔镜下微波消融80例患者临床资料
项目 男(46例) 女(34例)
年龄(岁，±s) 55.0±1.0 56.2±0.9
单发肿瘤最大直径(例)    
<3 cm 39 28
3～5 cm 7 6
肝病史(例)    
乙型肝炎 33 20
丙型肝炎 4 6
无 9 8
图1 弯曲形水冷微波消融针连接示意注：A、B.蓝色管为进水管，透明管为出水管。
表2 弯曲形水冷微波消融针治疗时间、工作功率与消融范围[cm，短径/(长径＋前冲)]
治疗时间(min) 55 W 60 W 70 W
5 2.6～3.0/(3.5＋0.3) 2.8～3.2/(3.8＋0.5) 3.2～3.4/(4.0＋0.5)
8 3.0～3.5/(3.5＋0.5) 3.2～3.6/(3.8＋0.7) 3.4～3.8/(4.5＋0.7)
10 3.6～3.8/(4.2＋0.7) 3.8～4.0/(4.5＋0.7) 4.0～4.2/(5.0＋0.7)
12 3.8～4.0/(4.4＋0.7) 3.8～4.2/(4.8＋0.7) 4.0～4.5/(5.0＋0.7)
15 3.8～4.2/(4.8＋0.7) 4.0～4.5/(5.0＋0.7) 4.5～5.0/(5.5＋0.7)
图2 肝癌微波消融入路模式注：A.微波消融直针经胸腔入路；B.微波消融直针经腹腔入路；C.微波消融弯针经腹腔入路。
图3 膈顶部肝细胞癌患者行腹腔镜微波消融注：A.术前MR检查示肿瘤位置；B.腹腔镜操作入路；C.腹腔粘连较重，肝脏未完全显露；D.粘连分解后显露肝脏，术中超声定位肿瘤大小边界、深度；E.膈顶部放置纱布，防止损伤膈肌，消融针消融肿瘤；F.微波消融术中超声定位；G.微波消融后超声检查，防止残留；H.术后1个月CT检查示肿瘤，微波消融完全，边缘无残留无复发。
表3 膈顶部肝细胞癌腔镜下微波消融80例患者术后1个月复查消融效率对比
项目 直径<3 cm 直径3～5 cm AFP水平 合计[例(%)]
术后MR显示完全消融(例) 62 13 恢复正常50例、下降25例 75(93.75)
术后MR显示不完全消融(例) 2 3 下降3例、升高2例 5(6.25)
膈肌刺激(例) 2 1 － 3(3.75)
气胸/胸腔感染(例) 0 0 － 0(0.00)
1
Llovet JM, Kelley RK, Villanueva A, et al. Hepatocellular carcinoma[J]. Nat Rev Dis Primers, 2021, 7(1): 6.
2
Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: globocan estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249.
3
Anwanwan D, Singh SK, Singh S, et al. Challenges in liver cancer and possible treatment approaches[J]. Biochim Biophys Acta Rev Cancer, 2020, 1873(1): 188314.
4
Demir T, Lee SS, Kaseb AO. Systemic therapy of liver cancer[J]. Adv Cancer Res, 2021, 149：257-294.
5
Maki H, Hasegawa K. Advances in the surgical treatment of liver cancer[J]. Biosci Trends, 2022, 16(3): 178-188.
6
Izzo F, Granata V, Grassi R, et al. Radiofrequency ablation and microwave ablation in liver tumors: an update[J]. Oncologist, 2019, 24(10): 990-1005.
7
Liu W, Zou R, Wang C, et al. Microwave ablation resection for hepatocellular carcinoma within the milan criteria: a propensity-score analysis[J]. Therapeutic Advances In Medical Oncology, 2019, 11：1758835919874652.
8
Liu Y, Zheng J, Hao J, et al. Global burden of primary liver cancer by five etiologies and global prediction by 2035 based on global burden of disease study 2019[J]. Cancer Med, 2022, 11(5): 1310-1323.
9
Yang J, Pan G, Guan L, et al. The burden of primary liver cancer caused by specific etiologies from 1990 to 2019 at the global, regional, and national levels[J]. Cancer Med, 2022, 11(5): 1357-1370.
10
Soulen MC, Garcia-Monaco R. Closing the gap in curative ablation of liver cancer[J]. Radiology, 2021, 301(1): 237-238.
11
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 (Baltimore, Md), 2022, 76(1): 66-77.
12
Filippiadis DK, Spiliopoulos S, Konstantos C, et al. Computed tomography-guided percutaneous microwave ablation of hepatocellular carcinoma in challenging locations: safety and efficacy of high-power microwave platforms[J]. Int J Hyperthermia, 2018, 34(6): 863-869.
13
Delmas L, Koch G, Cazzato RL, et al. Artificial ascites using the guidewire technique during microwave ablation in the liver dome: technique and analysis of fluid repartition[J]. Abdom Radiol (NY), 2021, 46(9): 4452-4459.
14
Ding H, Su M, Zhu C, et al. CT-guided versus laparoscopic radiofrequency ablation in recurrent small hepatocellular carcinoma against the diaphragmatic dome[J]. Sci Rep, 2017, 7：44583.
15
Long Y, Zeng Q, He X, et al. One-lung ventilation for percutaneous thermal ablation of liver tumors in the hepatic dome[J]. Int J Hyperthermia, 2020, 37(1): 49-54.
16
Vogel A, Meyer T, Sapisochin G, et al. Hepatocellular carcinoma[J]. Lancet (London, England), 2022, 400(10360): 1345-1362.
17
王兆海，王子政，赵国栋. 个体化解剖标志在肝脏肿瘤靶域切除技术中的意义[J/CD]. 中华腔镜外科杂志(电子版), 2022, 15(4)：197-200.
18
刘荣，汪洋. 恶性肿瘤的靶域切除技术[J]. 中华肿瘤杂志，2022, 44(7)：725-727.
19
赵国栋，马奔，刘荣. 肝脏流域学说下的控血新理念：适时分合肝脏控血技术[J]. 中华医学杂志，2021, 101(40)：3261-3265.
20
Xu Z, Xie H, Zhou L, et al. The combination strategy of transarterial chemoembolization and radiofrequency ablation or microwave ablation against hepatocellular carcinoma[J]. Anal Cell Pathol (Amst), 2019, 2019：8619096.
21
Wei J, Cui W, Fan W, et al. Unresectable hepatocellular carcinoma: transcatheter arterial chemoembolization combined with microwave ablation vs. combined with cryoablation[J]. Frontiers In Oncology, 2020, 10：1285.
[1] 张太平, 翁桂湖, 刘悦泽. 不断推进中国腹腔镜胰腺癌手术规范化[J]. 中华普外科手术学杂志(电子版), 2023, 17(02): 120-123.
[2] 田锋, 郭俊超. 中国微创技术在胰腺癌手术中的应用现状和展望[J]. 中华普外科手术学杂志(电子版), 2023, 17(02): 124-128.
[3] 韩显林, 林伯铮, 洪夏飞. 腹腔镜胰腺癌手术研究进展及血管解剖要点[J]. 中华普外科手术学杂志(电子版), 2023, 17(02): 129-132.
[4] 单兴利, 王栋, 邢念增, 肖泽均, 李亚健. 68Ga-PSMA-PET/CT对前列腺癌盆腔淋巴结转移诊断价值的研究[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(03): 214-218.
[5] 赖华健, 钟文文, 郭强, 李俊涛, 张翼飞, 叶雷, 马波, 尧冰, 瞿虎, 邱剑光, 王德娟. 二次腹腔镜肾盂成形术治疗肾盂输尿管连接部梗阻疗效分析[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(03): 228-232.
[6] 王晓利, 李琦, 李春风, 王璟琦, 管晓东. 保留睾丸动脉的腹腔镜精索内静脉高位结扎术对精索静脉曲张致不育的疗效分析[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(03): 261-264.
[7] 叶鉴锋, 王润邦, 张墨. 3D高清腹腔镜保留睾丸动脉的精索静脉高位结扎术的疗效分析[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(03): 265-269.
[8] 陆乔友, 寸冬云, 虞弘, 郭鹏恒, 田大广. ICG荧光胆道造影在胆囊结石合并胆囊炎患者LC术中的应用[J]. 中华肝脏外科手术学电子杂志, 2023, 12(03): 284-288.
[9] 田广磊, 侯梅华, 李智德, 余波锋, 马俊杰, 李婷婷, 王春, 陈伦牮, 陈雄. 胆囊结石合并混合性神经内分泌-非神经内分泌肿瘤一例报告[J]. 中华肝脏外科手术学电子杂志, 2023, 12(03): 342-344.
[10] 刘丹峰, 荚卫东. 基层医院开展腹腔镜肝脏手术的体会与思考[J]. 中华肝脏外科手术学电子杂志, 2023, 12(03): 263-266.
[11] 黄洁. 腹腔镜肝脏手术中一些值得深入思考的问题[J]. 中华肝脏外科手术学电子杂志, 2023, 12(03): 267-271.
[12] 丹增阿旺, 王超, 次仁平措, 曾成龙, 杨振华, 罗鑫, 王宇蔚, 张必翔, 张斌豪. 陈氏绕肝悬吊技术在机器人辅助腹腔镜右半肝切除术中的应用（附视频）[J]. 中华肝脏外科手术学电子杂志, 2023, 12(03): 294-299.
[13] 郭佳胤, 徐杰, 刘作金. 腹腔镜下ALPPS右半肝切除一例（附视频）[J]. 中华肝脏外科手术学电子杂志, 2023, 12(03): 345-347.
[14] 韦翔曦, 晋云, 王峻峰, 胡苹苹, 杨超, 杨豆. 腹腔镜术中超声在肝胆胰外科中的应用进展[J]. 中华肝脏外科手术学电子杂志, 2023, 12(02): 247-249.
[15] 刘中百, 任勇军. 肝细胞癌的介入治疗现状及进展[J]. 中华消化病与影像杂志(电子版), 2023, 13(02): 111-115.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号