Effect of laparoscopic microwave ablationin the treatment of liver cancer and itscomplications after operation
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摘要:目的 探讨腹腔镜下微波消融治疗原发性肝癌的疗效和术后常见并发症。方法 回顾性分析行腹腔镜下微波消融治疗的35例肝癌患者的病例资料，对术后并发症、肝功能、肿瘤指标等进行分析，评估腹腔镜下行微波消融治疗肝原发肿瘤的疗效。结果 35例患者全部顺利完成手术，术后完全消融率达95.9%, 术后肝功能(转氨酶指标)逐渐好转。术后1周，肿瘤指标甲胎蛋白(AFP)及异常凝血酶原均进行性下降。35例患者术后穿刺部位有不同程度的疼痛不适，对症治疗后缓解。术后有29例患者出现低热，无需特殊处理自行恢复; 1例患者出现反应性胸腔积液; 2例患者出现膈下包裹性积液。术后复查肝功能, 35例患者的转氨酶水平均不同程度升高，经护肝治疗后，转氨酶水平进行性下降，逐渐恢复至正常水平。本组患者术后未出现肝衰竭、胆汁渗漏、消化道穿孔等与治疗相关的严重并发症。结论 采用腹腔镜下微波消融治疗原发性肝癌可取得与单纯手术切除相似的疗效，并能减少术后严重并发症发生率，具有创伤小、恢复快、安全性高的特点。Abstract:Objective To investigate the effect of laparoscopic microwave ablation in the treatment of liver cancer and its complications after operation.Methods Clinical data of 35 patients undergoing laparoscopic microwave ablation for primary liver cancer was retrospectively analyzed. Postoperative complications after operation, liver function and tumor markers were analyzed. The curative effect of laparoscopic microwave ablation for liver cancer was evaluated.Results All 35 patients successfully completed the operation. The complete ablation rate of the operation was 95.9%. The liver function improved gradually after operation. Tumor markers such as Alpha fetoprotein(AFP) and abnormal prothrombin were gradually decreased at one week after operation. All the patients had different degrees of pain after operation, but was subsided gradually after symptomatic treatment. Low fever occurred in 29 patients, and body temperature recovered to normal after no special treatment. Besides, one patient developed reactive pleural effusions, and diaphragmatic fluid-covered hydrops occurred in two patients. Postoperative routine re-check of liver function showed that transaminase levels increased in all patients, and transaminases progressively declined and gradually restored to normal after active treatment. There were no serious complications after operation, including liver failure, bile leakage and perforation of digestive tract.Conclusion Laparoscopic microwave ablation, with the advantage of less trauma, rapid recovery and high safety, for liver cancer has the same effect as surgical resection, and can reduce the incidence of severe complications.
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Keywords:
- laparoscopy /
- primary hepatocellular carcinoma /
- microwave ablation /
- effect /
- complication /
- transaminase
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表 1 35例患者术后不同时点肝功能指标结果比较(x±s)
IU/L 指标 n 术后1 d 术后3 d 术后6 d 术后1个月 谷丙转氨酶 35 150.2±13.5 80.1±10.5* 65.3±11.4*# 45.1±9.8*#△ 谷草转氨酶 35 160.8±10.3 90.5±11.1* 78.7±11.5*# 55.9±10.2*#△ 与术后1 d比较, *P＜0.05; 与术后3 d比较, #P＜0.05; 与术后6 d比较, △P＜0.05。 
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