Murawa Dawid, Spychała Arkadiusz, Lewandowski Adam, Nowaczyk Piotr
First Department of Surgical Oncology, Greater Poland Cancer Center, Poznań, Poland.
Contemp Oncol (Pozn). 2012;16(2):179-83. doi: 10.5114/wo.2012.28801. Epub 2012 May 29.
Thermoablation of metastatic lesions in the liver is very commonplace. At present there are 3 essential techniques of access to carry out the procedure: open surgery, percutaneous technique and laparoscopic method. Percutaneous thermoablation is criticised due to the possible lack of radicalism. On the other hand, thermoablation during open surgery is a big perioperative trauma for the patient. The laparoscopic technique seems to be a compromise between the aforementioned techniques. The aim of this study was to present the technique and preliminary results of thermoablation of the liver carried out by means of the laparoscopic technique.
Laparoscopic thermoablation was carried out in 4 patients with colorectal cancer metastases to the liver. In order to precisely locate the tumour and guarantee radicalism of the surgery, laparoscopic probe ultrasonography was carried out during the procedure.
All the patients underwent the procedure without any difficulties. All the patients left the hospital department as soon as 3 or 4 days after the surgery. This was about 7 days earlier in comparison with the open surgery procedure, which had been carried out before. The patients required a supply of analgesics only during the first 48 hours - non-steroid anti-inflammatory drugs, which made a substantial difference between them and the patients treated with the open surgical technique. Thanks to the laparoscopic ultrasound technique one patient had an additional lesion located, which had not been described in preoperative examinations.
In combination with ultrasonography, laparoscopic access, which does not have a very invasive character, seems to be relatively simple and effective to carry out the procedure of thermoablation.
肝脏转移瘤的热消融术十分常见。目前有三种基本的手术入路技术来实施该手术：开放手术、经皮技术和腹腔镜方法。经皮热消融术因可能缺乏根治性而受到批评。另一方面，开放手术中的热消融术对患者来说是较大的围手术期创伤。腹腔镜技术似乎是上述技术之间的一种折衷。本研究的目的是介绍通过腹腔镜技术进行肝脏热消融术的技术及初步结果。
对4例发生肝脏转移的结直肠癌患者实施了腹腔镜热消融术。为了精确确定肿瘤位置并确保手术的根治性，术中进行了腹腔镜探头超声检查。
所有患者手术过程均无困难。所有患者术后3或4天即可出院。这比之前实施的开放手术提前了约7天。患者仅在术后头48小时需要使用镇痛药——非甾体类抗炎药，这使他们与接受开放手术治疗的患者有很大不同。得益于腹腔镜超声技术，有1例患者发现了一个术前检查未提及的额外病灶。
结合超声检查，具有微创特点的腹腔镜入路在实施热消融手术时似乎相对简单且有效。
