胆囊旁肝癌的微创治疗

目的评价腹腔镜下热消融治疗胆囊旁肝癌的安全性及疗效。方法采用腹腔镜胆囊切除术（LC）联合腹腔镜下经皮热消融治疗各类胆囊旁肝癌21例共32个病灶，术后复查肝功能、甲胎蛋白（AFP）、增强CT，观察疗效。结论手术前后Child-pugh评分无统计学差异；本组病例均无严重并发症和死亡病例；腹腔镜下（LUS）超声发现新病灶2例共2个；术前AFP升高的15例患者术后12例显著降低，3例无改变；术后四周复查增强CT，28个病灶完全消融，4个癌灶残留，再次行经皮热消融后达完全消融。随访12个月，2例复发（9．5％）。结论LC联合热消融使胆囊旁肝癌患者获得了安全、有效的微创治疗。

The minimal invasive therapy for the tumors adjacent to the gallbladder

Objective To evaluate the salty and therapeutic effect of the combination of the laparoscop-ic cholesystectomy(LC)and the laparoscope-assisted thermal ablation for bepatecellular carcinoma adjacent to the gallbladder. Methods 32 hepatic tumors adjacent to the gallbladder in 21 patients were treated with LC and thermal ablation. The liver function, alpha fetoprotein(AFP) , contrast enhanced CT(CECT) were followed up for the observation of the therapy effect. Results There was no difference in the child pugh score of the patients before operation. No patients had serious complications or died. 2 of the 32 lesion were detected by the laparo-scope assisted ultrasonagraphy intraoperativly. 12 in 15 with AFP increasing had the AFP decreased after the op-eration, while the other 3 had no AFP changes. 28 complete necrosis lesions ,4 residual lesions were detected by the CECT in 4 weeks after the operation. The residual were detected to be complete necrosis by another percuta-neous thermal ablation. 2 recurrence lesions (9.5%) were found by the 12-month follow up. Conclusion The combination of LC and thermal ablation is a reliable and safe minimal invasive therapy for the tumors adjacent to the gallbladder.