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

doi:10.3877/cma.j.issn.1674-6899.2023.01.011

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. 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. 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

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引用本文：

刘虎, 张搏伦, 杨豪, 乐羿, 刁广浩, 崔昭扬, 赵向宁, 安亮, 李海珠, 蔡建强, 张绍庚. 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[J/OL]. 中华腔镜外科杂志(电子版), 2023, 16(01): 44-48.

Hu Liu, Bolun Zhang, Hao Yang, Yi Le, Guanghao Diao, Zhaoyang Cui, Xiangning Zhao, Liang An, Haizhu Li, Jianqiang Cai, Shaogeng Zhang. Research of curved water-cooled microwave ablation of diaphragmatic dome of HCC under laparoscopy[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2023, 16(01): 44-48.

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

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)

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)

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)

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