Abstract:

Objective ·To investigate the safety and effectiveness of laparoscopic ultrasound-guided microwave ablation for phrenic surface liver tumors, as well as the specific experience of its use. Methods ·A retrospective analysis was performed on 13 cases of diaphragmatic liver tumor who received laparoscopic ultrasound-guided microwave ablation in Zhejiang University of Traditional Chinese Medicine Affiliated Wenzhou Hospital from November 2019 to April 2021. The falciform ligament, coronal ligament and deltoid ligament were severed according to the need, and gauze pads were filled on the diaphragmatic surface or visceral of the liver. Laparoscopic ultrasound scan of the liver was performed to determine the location of the tumor and whether there were new tumors. Meanwhile, ultrasound contrast agent was used to perform multi-point and multi-angle ablation of the tumor after biopsy. During the process of needle withdrawal, laparoscopic direct observation was performed to observe whether there was bleeding, and needle path ablation was performed. After ablation, contrast-enhanced ultrasound was repeated and additional ablation was performed if necessary. Perioperative complications were observed and preoperative and postoperative blood biochemical indexes, white blood cells level and postoperative MRI manifestations were compared. Results ·All the 13 patients were successfully treated with laparoscopic ultrasound-guided microwave ablation. There were no serious complications such as diaphragm injury, arrhythmia, pneumonia, pneumothorax, massive bleeding, biliary fistula and intestinal injury. The white blood cells before surgery [(4.9±1.0)×10⁹/L] and day 2 after surgery [(8.7±2.5)×10⁹/L] were significantly different (P=0.000). The glutamic-pyruvic transaminase [15.0 (22.0, 77.5) U/L] before surgery and day 2 after surgery [69.0 (135.0, 371.0) U/L] were significantly different (P=0.013). One month after the operation, MRI enhancement confirmed that the total necrosis rate of the lesion was 100%. Conclusion ·Laparoscopic ultrasound-guided hepatic tumor ablation, which is first performed under laparoscopy, forms a safe isolation zone around the liver through the establishment of pneumoperitoneum, severed ligament, gauze isolation and other methods. Then, under the direct vision of laparoscopic ultrasound probe, the diaphragmatic liver tumors are ablated to achieve a safer and more effective method.

Key words: liver cancer, laparoscope, laparoscopic ultrasound, ablation, microwave ablation