射频消融辅助肝切除在结直肠癌肝转移中的应用

Application of radiofrequency ablation-assisted hepatectomy in colorectal cancer liver metastases

摘要:

目的：探讨射频消融（RFA）辅助肝切除治疗结直肠癌肝转移（CLM）的疗效。 方法：回顾17例CLM行开腹RRFA辅助肝切除患者临床资料，分析手术时间、出血量、有无输血、腹腔引流量及术后并发症发生率，并比较患者手术前后肝功能及凝血功能变化。 结果：所有患者手术均成功完成，手术时间55~237 min，平均（93±19）min；术中出血量235~650 mL，平均（280±40）mL。术中及术后无1例输血，术后3 d内腹腔引流量170~370 mL，1例（5.9%）发生胆瘘。患者术后24、72 h丙氨酸转氨酶（ALT）和天冬氨酸转氨酶（AST）较术前明显增高（均P<0.05），但术后120 h均恢复至术前水平；而手术前后总胆红素（TBIL）水平与凝血酶原时间（PT）未发生明显变化（均P>0.05）。 结论：RFA辅助肝切除治疗CLM安全可行，并可有效降低出血风险。

Abstract:

Objective: To evaluate the efficacy of radiofrequency ablation (RFA)-assisted hepatectomy in treatment of colorectal cancer liver metastases (CLM). Methods: The clinical data of 17 CLM patients undergoing open RFA-assisted hepatectomy were reviewed. The operative time, intraoperative blood loss, blood transfusion, and incidence of postoperative complications as well as the alterations in liver function and coagulation function of the patients before and after operation were analyzed. Results: Operations in all patients were successfully performed. The operative time was 55-237 min with an average of (93±19) min, and the intraoperative blood loss was 235-650 mL with an average of (280±40) mL. No blood transfusion was required in any of the patients during and after operation, and the abdominal drainage volume was 170-370 mL. Bile leakage occurred in one case (5.9%). The alanine transaminase (ALT) and aspartate aminotransferase (AST) levels of the patients were significantly elevated on postoperative 24 h and 72 h compared with their preoperative levels (all P<0.05), but both returned to their preoperative levels on postoperative 120 h, while the total bilirubin (TBIL) level and prothrombin time (PT) of the patients showed no significant alteration before and after operation (all P>0.05). Conclusion: RFA-assisted hepatectomy is safe and feasible for CLM, and it can also decrease the risk of bleeding.