本文選題：微波消融 + 肝切除��； 參考：《安徽醫(yī)科大學》2017年碩士論文

【摘要】：目的:探討微波消融(MWA)技術在開腹及腹腔鏡肝切除過程中的臨床應用價值,研究微波輔助肝切除應用中的優(yōu)點及不足之處;觀察微波消融對肝切除手術圍手術期的影響,并隨訪微波技術對肝原發(fā)惡性腫瘤的長期療效的影響,分析微波輔助肝切除的臨床應用價值,為微波消融輔助肝切除技術的臨床推廣提供臨床數(shù)據(jù)。方法:回顧性分析于2009年01月至2015年01月來空軍總醫(yī)院行開腹肝切除的275例肝占位病例,微波組系微波輔助肝切除患者166例,其中包括肝原發(fā)性惡性腫瘤112例,肝良性血管瘤54例;對照組系非微波輔助肝切除患者109例,其中肝原發(fā)性惡性腫瘤66例,肝良性血管瘤43例。行腹腔鏡肝切除手術66例肝占位病例,微波組和對照組病例皆為肝原發(fā)惡性腫瘤,其中微波組38例,對照組28例。最后診斷經(jīng)過術后病理確診。微波組術中采用超聲引導下沿肝預切線行多點連續(xù)微波消融,使肝預切線上肝臟組織形成凝固壞死帶,進而在肝凝固壞死帶上行肝橫斷;對照組術中未使用微波輔助技術,術中部分使用肝門阻斷技術。分別統(tǒng)計開腹手術和腹腔鏡手術兩組患者術前基本情況、術中出血、手術時間、肝門阻斷情況、腹腔引流管拔出時間、術后并發(fā)癥、術后住院時間、術后輸血情況、肝原發(fā)性惡性腫瘤術后生存率等,通過兩組間的比較,分別評估微波消融對肝良性血管瘤及肝原發(fā)性惡性腫瘤肝切除治療效果的不同影響,以及微波消融對開腹手術及腹腔鏡手術治療效果的不同影響,并分析微波消融對肝原發(fā)惡性腫瘤短期生存率的影響。結果:腹腔鏡手術微波組和對照組手術均順利完成,未發(fā)生中轉開腹情況,術后均未發(fā)生明顯膽漏及大量出血等嚴重并發(fā)癥,其中微波組的手術時間少于對照組,出血量也低于對照組,兩者差異皆有統(tǒng)計學意義(P0.05)。另外,微波組的術后住院時間也少于對照組,差異也有統(tǒng)計學意義。開腹手術兩組均較順利的完成手術,圍手術期無死亡病例。肝良性血管瘤微波組手術時間及術中出血都明顯低于對照組,差異有統(tǒng)計學意義(P0.05);微波組在術后引流管拔出時間、術后并發(fā)癥及術后住院時間上與對照組無明顯區(qū)別(P0.05);微波組術后輸血制品的比例為13.0%,對照組術后輸血制品的比例為20.9%,差異有統(tǒng)計學意義(P0.05),微波組術后輸血的人數(shù)比例低于對照組。肝原發(fā)性惡性腫瘤微波組手術時間、術中出血量、引流管拔出時間均低于對照組,差異有統(tǒng)計學意義(P0.05),但是術后住院時間兩者無明顯差異(P0.05),微波組與對照組在切除肝段比例上并無明顯的差異(P0.05),微波組術后輸血制品的比例為15.2%,對照組術后輸血制品的比例為30.3%,差異有統(tǒng)計學意義(P0.05),微波組術后輸血的患者比例低于對照組。開腹手術微波組術后1年、3年總生存率分別為93.7%和82.0%,對照組術后1年、3年總生存率分別為90.8%和75.1%;腹腔鏡手術微波組術后1年、3年總生存率分別約為95.0%和88.0%,對照組術后1年、3年總生存率分別為92.9%和82.1%,兩組數(shù)據(jù)無明顯差異(P0.05)。結論:微波輔助肝切除是一種較為安全的、有效地手術方式,可顯著的減少術中肝橫斷時出血及滲血,縮短手術時間,減少術后輸血的概率,降低肝門阻斷的使用,并未增加術后的風險。因能有效控制肝斷面出血,減少腹腔鏡中轉開腹的可能,同時改善手術視野,降低手術難度,增加了手術安全性。對合并肝硬化的患者,可以降低患者圍手術期的并發(fā)癥,值得臨床推廣及應用。對于肝原發(fā)性惡性腫瘤,微波技術對其短期生存率并無明顯影響,可以減少圍手術期并發(fā)癥,增加圍手術期安全性。對于毗鄰重要管道的肝占位,術者不僅需要有豐富的臨床手術經(jīng)驗,還需要有扎實的解剖學知識及良好的超聲技術。
[Abstract]:Objective: To investigate the clinical value of microwave ablation (MWA) in laparotomy and laparoscopic hepatectomy, to study the advantages and disadvantages of microwave assisted hepatectomy, to observe the effect of microwave ablation on the perioperative period of hepatectomy, and to analyze the effect of microwave on the long-term effect of primary liver cancer and analyze the microwave irradiation. The clinical application value of auxiliary hepatectomy for the clinical application of microwave ablation assisted hepatectomy was provided. Methods: a retrospective analysis was made in 275 cases of liver occupying in the General Hospital of the Air Force PLA from 01 months to 01 months of 2009, and 166 cases of microwave assisted hepatectomy, including primary hepatic malignant swelling. There were 112 cases of tumor, 54 cases of benign hemangioma of the liver, 109 cases of non microwave assisted hepatectomy in the control group, of which 66 cases were primary malignant tumor of the liver, 43 cases of benign hemangioma of the liver, 66 cases of hepatic space occupying with laparoscopic hepatectomy, the microwave group and the control group were all primary malignant tumors of the liver, including 38 cases in microwave group and 28 cases in the control group. Finally, the diagnosis was diagnosed. In the microwave group, multipoint continuous microwave ablation along the liver pretangent line was performed under the guidance of ultrasound in the microwave group, and the liver tissue formed coagulation necrosis zone on the liver precut line, and then the liver transection in the liver coagulation necrosis zone; the control group did not use microwave assisted technique in the operation, and the hepatic portal blocking technique was used in the operation. The preoperative basic conditions, intraoperative hemorrhage, intraoperative bleeding, operation time, hepatic portal blockage, abdominal drainage tube extraction time, postoperative complications, postoperative hospitalization time, postoperative blood transfusion and survival rate of primary liver malignant tumor were evaluated by microwave ablation, and the two groups were compared to evaluate the effect of microwave ablation on the liver benign hemangioma and liver, respectively. Different effects of hepatectomy for primary malignant tumor, and the effect of microwave ablation on the effect of laparotomy and laparoscopy, and the effect of microwave ablation on the short-term survival rate of primary liver cancer. Results: the operation of the microwave group and the control group in the laparoscopy were all successfully completed without the conversion of the laparotomy. There were no significant complications such as bile leakage and massive bleeding after operation. The operation time of microwave group was less than that of the control group, and the amount of bleeding was also lower than that of the control group. The difference was statistically significant (P0.05). In addition, the time of hospitalization in the microwave group was also less than that of the control group, and the difference was also statistically significant. The two groups in the laparotomy group were all more smooth. There was no death case in the perioperative period. The operation time and intraoperative bleeding were significantly lower in the microwave group of the benign hepatic hemangioma than in the control group. The difference was statistically significant (P0.05). There was no significant difference between the microwave group after the drainage tube extraction, postoperative complications and the postoperative hospital stay (P0.05); the ratio of the blood transfusion products after the microwave group was compared. The proportion of the blood transfusion products in the control group was 20.9%, the difference was statistically significant (P0.05). The proportion of blood transfusion in the microwave group was lower than that of the control group. The operation time, the amount of bleeding and the extraction time of the drainage tube were lower than the control group in the microwave group of the primary liver cancer. The difference was statistically significant (P0.05), but the time of postoperative hospitalization was not significant (P0.05). There was no significant difference between the two groups (P0.05). There was no significant difference between the microwave group and the control group (P0.05), the proportion of blood transfusion products in the microwave group was 15.2%, the proportion of the blood transfusion products in the control group was 30.3%, the difference was statistically significant (P0.05). The proportion of the patients in the microwave group was lower than that of the control group. The microwave group of the laparotomy group was lower than the control group. The total survival rate of 3 years after 1 years was 93.7% and 82% respectively. The total survival rate of the control group was 90.8% and 75.1%, and the total survival rate was 90.8% and 75.1% respectively. The total survival rate of 3 years after the laparoscope operation microwave group was about 95% and 88%, respectively. The total survival rate of the control group was not significant (P0.05). Hepatectomy is a safer and more effective way of operation, which can significantly reduce bleeding and bleeding during intraoperative liver transection, shorten the operation time, reduce the probability of postoperative blood transfusion, reduce the use of hepatic portal blocking, and do not increase the risk of postoperative surgery. Visual field can reduce the difficulty of the operation and increase the safety of the operation. It can reduce the perioperative complications for patients with liver cirrhosis, which is worthy of clinical popularization and application. For the primary malignant tumor of the liver, microwave technology has no obvious influence on its short-term survival rate, which can reduce the perioperative complications and increase the safety of perioperative period. For liver occupying adjacent important pipes, surgeons need not only rich experience in clinical operation, but also solid anatomy knowledge and good ultrasound techniques.

【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.7

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