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目的探讨腹腔镜切除并联合应用射频消融和125I粒子植入治疗晚期直肠癌合并肝转移的临床价值。方法对30例术前确诊为直肠癌,经CT发现肝脏有实性占位的患者术中行腹腔镜下直肠癌切除,经吻合器吻合肠段后,即行腹腔镜下肝转移瘤切除或射频消融,最后将125I粒子植入盆腔及肝脏肿瘤部位。结果术中超声发现新病灶7个,所有患者均顺利行腹腔镜切除手术,无中转开腹及严重并发症。25个转移病灶位于肝脏右叶仅行腹腔镜下射频消融及125I粒子植入,8个转移病灶行离体切除。随访12-25个月(平均22．3个月),有6例转移癌未见液化,行腹腔镜下二次射频。1年生存率为73％(22／30)。结论腹腔镜切除并联合应用RFA和125I粒子植入治疗晚期直肠癌并肝转移癌具有微创、安全、疗效确切、术后恢复快等优点。
Objective To investigate the clinical value of laparoscopic resection combined with radiofrequency ablation and 125I seed implantation in the treatment of advanced rectal cancer with liver metastasis. Methods Thirty patients with preoperative diagnosis of rectal cancer were diagnosed by CT. The patients undergoing laparoscopic resection of the rectal cancer underwent laparoscopic resection of the intestine. The patients underwent laparoscopic resection of liver metastases or radiofrequency ablation , Finally 125I particles implanted pelvic and liver tumor site. Results Intraoperative ultrasound found seven new lesions, all patients underwent laparoscopic surgery without laparotomy, no laparotomy and serious complications. Twenty-five metastatic lesions were located in the right lobe of the liver. Only laparoscopic radiofrequency ablation and 125I seed implantation were performed. Eight metastatic lesions were excised ex vivo. All the patients were followed up for 12-25 months (average 22.3 months). Six cases had no liquefaction in the metastatic carcinoma and laparoscopic radiofrequency was used. The 1-year survival rate was 73% (22/30). Conclusions Laparoscopic resection combined with RFA and 125I seed implantation for the treatment of advanced rectal cancer and liver metastases has the advantages of minimally invasive, safe, effective and rapid postoperative recovery.