Jiang Kai, Su Ming, Zhao Xiangqian, Chen Yongwei, Zhang Wenzhi, Wang Jing, Dong Jiahong, Huang Zhiqiang
Key Laboratory of Digital Hepatobiliary Surgery of Chinese PLA, Institute & Hospital of Hepatobiliary Surgery , Chinese PLA Medical School, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China,
Cell Biochem Biophys. 2014 Apr;68(3):547-54. doi: 10.1007/s12013-013-9736-z.
The main objective of this study is to assess the feasibility and safety of treating hepatocellular carcinoma (HCC) proximal to the gallbladder using laparoscopic radiofrequency ablation (RFA). Surgical ablation of tumor located adjacent to the gallbladder may damage the gallbladder wall, even with a laparoscope and this ablation method is not precise and incomplete and is frequently combined with alcohol injections with need for further RFA treatment. Four patients were included in this study, with typical HCC where the tumor was present on the left, right, or bed side surrounding the gallbladder. The gallbladder was not separated or removed during larascopic inspection. In the RFA treatment procedure, the tumor lesion was pre-heated for 10 min, and heating was continued for 20 min. The integrity of the gallbladder wall was properly maintained. A follow-up to check for possible local recurrence was carried out 1 year after the RFA. The goal of "one-off" tumor complete RFA is to achieve thorough ablation of the tumor in a single treatment and limiting the possibility of recurrence within 6 months. Seven days after RFA, liver functions of all the patients returned to near-preoperative levels. The patients experienced slight pain in the upper right abdomen, which disappeared in 2-3 days. Results of B ultrasound on days 3-5 showed thickening of the periphery of the ablation area, without significant effusion. Enhanced CT on day 3 showed that RFA low-density area completely covered the lesions. No significant abnormality was observed in the gallbladder and its vicinity. One month after the surgery, B ultrasound and CT examination revealed no significant abnormalities. All patients had an intact gallbladder, and no extrahepatic or intrahepatic bile duct dilatation occurred. There was no evidence of damage to the bile duct or the vessels. Follow-up for 18-32 months found that all patients were in good condition. "One-off" complete RFA can be safely implemented to ablate HCC close to the gallbladder with the assistance of a laparoscope while maintaining integrity and continuity of the gallbladder, and without the need for secondary treatments.
本研究的主要目的是评估使用腹腔镜射频消融（RFA）治疗胆囊附近肝细胞癌（HCC）的可行性和安全性。即使使用腹腔镜，手术切除毗邻胆囊的肿瘤也可能损伤胆囊壁，且这种消融方法不精确、不完全，还常需联合酒精注射并进一步进行RFA治疗。本研究纳入了4例典型HCC患者，肿瘤位于胆囊左侧、右侧或胆囊床周围。腹腔镜检查时未分离或切除胆囊。在RFA治疗过程中，将肿瘤病灶预热10分钟，然后持续加热20分钟。胆囊壁的完整性得到妥善维持。RFA术后1年进行随访以检查是否可能发生局部复发。“一次性”肿瘤完全RFA的目标是在单次治疗中实现肿瘤的彻底消融，并限制6个月内复发的可能性。RFA术后7天，所有患者的肝功能恢复至接近术前水平。患者右上腹有轻微疼痛，2 - 3天内消失。术后3 - 5天的B超检查显示消融区周边增厚，无明显积液。术后3天的增强CT显示RFA低密度区完全覆盖病灶。胆囊及其周围未观察到明显异常。术后1个月，B超和CT检查未发现明显异常。所有患者的胆囊均完整，肝外或肝内胆管未发生扩张。没有证据表明胆管或血管受到损伤。随访18 - 32个月发现所有患者情况良好。在腹腔镜辅助下，“一次性”完全RFA可安全用于消融靠近胆囊的HCC，同时保持胆囊的完整性和连续性，且无需二次治疗。
