Purpose: To evaluate technical and clinical outcomes of intraoperative (laparoscopic/laparotomic) microwave ablation on HCC. Materials and Methods: This is a retrospective single-center study evaluating consecutive patients treated for very early/early-stage HCC with intraoperative microwave ablation from 1 July 2017 to 30 June 2023. In these patients, a percutaneous US-guided approach was excluded due to the nodule’s suboptimal visibility or harmful location and liver resection for a deep position or adherences. Data about the clinical stage, surgical approach, liver pathology and nodules characteristics, technical success, complications, and follow-up were collected. Technical success was intended as the absence of locoregional persistence at follow-up CT/MRI controls. Results: A total of 36 cirrhotic patients (M:F = 30:6, median age 67 years) were enrolled; 18/36 (50%) had a single nodule, 13/36 (36%) had two, 4/36 had three (11%), and 1/36 had four (3%). Among the patients, 24 (67%) were treated with laparoscopy, and 12/36 (33%) with a laparotomic approach. Sixty HCCs of 16.5 mm (6–50 mm) were treated for 7 min (2–30 min) with 100 W of power. A total of 55 nodules (92%) were treated successfully and showed no residual enhancement at the first postoperative follow-up; the other 5/60 (8%) underwent chemo/radioembolization. There was one complication (3%): a biliary fistula treated with percutaneous drainage and glue embolization. The average hospital stay was 3.5 days (1–51 days), and patients were followed up on average for 238 days (13–1792 days). During follow-up, 5/36 patients (14%) underwent liver transplantation, 1/36 (2%) died during hospitalization and 1 after discharge. Conclusions: Laparoscopic/laparotomic intraoperative HCC MW ablation is feasible in patients unsuitable for percutaneous approach or hepatic resection, with rare complications and with good technical and clinical outcomes.
目的：评估术中（腹腔镜/开腹）微波消融治疗肝细胞癌的技术与临床疗效。材料与方法：本研究为回顾性单中心研究，纳入2017年7月1日至2023年6月30日期间接受术中微波消融治疗的极早期/早期肝细胞癌连续病例。入选患者因结节显影不佳、位置高危，或存在深部病灶、组织粘连等因素，均排除经皮超声引导消融及肝切除术可能。收集数据包括临床分期、手术方式、肝脏病理特征、结节特性、技术成功率、并发症及随访情况。技术成功定义为随访CT/MRI检查未见局部残留病灶。结果：共纳入36例肝硬化患者（男:女=30:6，中位年龄67岁），其中单发结节18例（50%），双发13例（36%），三发4例（11%），四发1例（3%）。24例（67%）采用腹腔镜手术，12例（33%）采用开腹手术。共消融60个肝细胞癌结节（直径6-50 mm，中位16.5 mm），消融功率100 W，时间2-30分钟（中位7分钟）。55个结节（92%）消融成功，首次术后随访未见残余强化；其余5个结节（8%）后续接受化疗/放射栓塞治疗。发生1例并发症（3%）：胆瘘经皮引流联合胶栓塞治疗后痊愈。平均住院时间3.5天（1-51天），平均随访238天（13-1792天）。随访期间5例（14%）接受肝移植，1例（2%）住院期间死亡，1例出院后死亡。结论：对于不适合经皮消融或肝切除的患者，腹腔镜/开腹术中微波消融治疗肝细胞癌具有可行性，并发症发生率低，技术与临床疗效良好。
肿瘤(癌症)患者之家