Gruttadauria Salvatore, Pagano Duilio, Tropea Alessandro, Cintorino Davide, Castellana Luisa, Bonsignore Pasquale, Ricotta Calogero, Piccolo Gaetano, Vizzini Giovanni, Luca Angelo
1 Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), University of Pittsburgh Medical Center Italy , Palermo, Italy .
2 Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), University of Pittsburgh Medical Center Italy , Palermo, Italy .
J Laparoendosc Adv Surg Tech A. 2016 Oct;26(10):808-811. doi: 10.1089/lap.2016.0373. Epub 2016 Aug 10.
The surgical therapy of choice for hepatocellular carcinoma (HCC) is liver transplantation (LT) or hepatic resection, although only a small percentage of patients can undergo these procedures. Microwave thermal ablation (MWTA) can be an effective alternative treatment for HCC that complicates a cirrhotic liver disease, either as a final procedure or for downstaging patients on the waiting list for LT, or in combination with resective surgery to achieve oncological radicality.
The purpose of this retrospective study was to evaluate experience with the laparoscopic approach of MWTA at our center.
In a cohort of 35 consecutive patients undergoing MWTA with laparoscopic approach between January, 2013 and May, 2016, we reviewed the demographic data, the Barcelona clinic liver cancer stage, the severity of cirrhotic liver disease, the size of the ablated lesion, the duration of the procedure, and complications occurring within 90 days of surgery.
MWTA was performed by applying one to three hepatic parenchymal insertions (mean 1.8) per patient. The mean duration of surgery was 163 ± 18 minutes. There was no blood loss in any of the procedures. Complete necrosis on CT scan was achieved in 26/35 patients (75%). The mean hospital stay was 4.6 (range 2-7) days; major complications were postablation syndrome in 2/35 (5.7%), peritoneal fluid in 4/35 (11.4%), and transient jaundice in 1/35 (2.8%) patients. There was no mortality.
Laparoscopic MTWA is a safe and effective treatment for unresectable HCC and when a percutaneous procedure is not feasible.
肝细胞癌（HCC）的手术治疗选择是肝移植（LT）或肝切除术，尽管只有一小部分患者能够接受这些手术。微波热消融（MWTA）对于合并肝硬化的HCC患者可以作为一种有效的替代治疗方法，既可以作为最终治疗手段，也可以用于降低等待LT患者的分期，或者与切除手术联合使用以实现肿瘤根治性切除。
本回顾性研究的目的是评估我们中心腹腔镜下MWTA的经验。
在2013年1月至2016年5月期间连续35例接受腹腔镜下MWTA的患者队列中，我们回顾了人口统计学数据、巴塞罗那临床肝癌分期、肝硬化疾病的严重程度、消融病灶的大小、手术持续时间以及术后90天内发生的并发症。
每位患者平均进行1至3次肝实质穿刺（平均1.8次）进行MWTA。平均手术时间为163±18分钟。所有手术均无失血。35例患者中有26例（75%）在CT扫描上实现了完全坏死。平均住院时间为4.6天（范围2 - 7天）；主要并发症为消融后综合征2/35例（5.7%）、腹腔积液4/35例（11.4%）、短暂性黄疸1/35例（2.8%）。无死亡病例。
腹腔镜下MWTA对于不可切除的HCC以及经皮手术不可行时是一种安全有效的治疗方法。
