Laparoscopy-Guided Transthoracic Transdiaphragmatic Radiofrequency Ablation for Hepatic Tumors Located Beneath the Diaphragm
Laparoscopy-Guided Transthoracic Transdiaphragmatic Radiofrequency Ablation for Hepatic Tumors Located Beneath the Diaphragm
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DOI：
10.1089/lap.2015.0380
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发表时间：
2016-03-01
影响因子：
1.3
通讯作者：
Hirano, Satoshi
中科院分区：
文献类型：
--
作者：
Tanaka, Kimitaka;Kojima, Tetsufumi;Hirano, Satoshi
背景：对膈下肝肿瘤进行经皮射频消融（RFA）通常是困难的。膈肌热损伤是经皮穿刺射频消融术的致命性晚期并发症之一。我们的经验，腹腔镜经胸经皮术中射频消融术（LTTI-RFA）治疗膈下肝肿瘤reported.Methods：10例患者谁接受LTTI-RFA从2009年至2012年进行了评价。2例同时行部分肝切除术，1例同时行RFA治疗2个肿瘤。诊断为肝细胞癌8例，转移性肝肿瘤2例。11个肿瘤中有9个位于第7和第8节段。9例肿瘤直径小于20 mm。患者采用左半卧位单腔插管。在放置四个腹部输液港后，将一个12 mm输液港插入第四或第五肋间隙进入膈肌。通过射频消融针通过端口消融肿瘤。常规随访包括实验室检查和腹部影像学检查，每3-6个月一次。结果：单肿瘤手术时间中位数为137分钟（范围，105-187分钟）。消融的中位次数为3次。1例（右上肢瘫痪）观察到严重术后并发症（>Clavien-Dindo IIIa）。中位随访期为35个月（范围：11-43个月）。没有局部肿瘤进展。复发性肝肿瘤外观发生在其他部分的肝脏在11 patients.Conclusions：腹腔镜经胸经皮射频消融术是一个可以接受的程序，局部复发率低。
Background: It is often difficult to perform percutaneous radiofrequency ablation (RFA) for hepatic tumors beneath the diaphragm. Diaphragmatic thermal damage is one of the fatal late complications of percutaneous transdiaphragmatic RFA. Our experience with laparoscopic transthoracic transdiaphragmatic intraoperative RFA (LTTI-RFA) for hepatic tumors beneath the diaphragm is reported.Methods: Ten patients who underwent LTTI-RFA from 2009 to 2012 were evaluated. Two cases had concomitant partial hepatectomy, and one underwent RFA for two tumors at the same time. The diagnosis was hepatocellular carcinoma in eight cases and metastatic hepatic tumors in two cases. Nine of eleven tumors were located at segments 7 and 8. Nine tumors were less than 20 mm in diameter. The patients were placed in the half left lateral decubitus position with single-lumen tube intubation. After placement of four abdominal ports, a 12-mm port was inserted in the fourth or fifth intercostal space into the diaphragm. The tumor was ablated by an RFA needle through the port. The routine follow-up consisted of laboratory tests and abdominal imaging every 3-6 months.Results: The median operation time for only one tumor was 137 minutes (range, 105-187 minutes). The median number of times for ablation was three. Severe postoperative complications (>Clavien-Dindo IIIa) were observed in one case (right upper limb paralysis). The median follow-up period was 35 months (range, 11-43 months). There was no local tumor progression. Recurrent hepatic tumor appearance occurred in other parts of the liver in 6 of the 11 patients.Conclusions: Laparoscopic transthoracic transdiaphragmatic RFA is an acceptable procedure with a low rate of local recurrence.