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.
Note： A. Diaphragmatic surface of right liver and abdominal wall after pneumoperitoneum establishment. B. Diaphragmatic surface of left liver and abdominal wall after pneumoperitoneum establishment. C. Gauze was packed in the bare area of the diaphragmatic roof after the left coronary ligament was severed.
Fig 1
Isolation zone of tumor ablation from laparoscopic perspective
The manuscript was drafted and revised by ZHANG Yin. The surgery was performed by WANG Yi, WU Xian, XIE Bingluan and ZHANG Yin. The manuscript was reviewed by WANG Yi. All the authors have read the last version of paper and consented for submission.
利益冲突声明
所有作者声明不存在利益冲突。
All authors disclose no relevant conflict of interests.
QIU B A, ZHAO W C, XIA N X, et al. Effect of hepatic resection vs. radiofrequency ablation on multiple hepatocellular carcinoma[J]. Academic Journal of Chinese PLA Medical School, 2015, 36(3): 226-229.
LÜ M D, KUANG M, LIANG L J, et al. Surgical resection versus percutaneous thermal ablation for early-stage hepatocellular carcinoma: a randomized clinical trial[J]. Zhonghua Yi Xue Za Zhi, 2006, 86(12): 801-805.
Chinese College of Intraoperative Ultrasound for hepatobiliary Surgery. Expert consensus on laparoscopic ultrasound guided laparoscopic liver surgery (2017)[J]. Journal of Clinical Hepatol, 2018, (3): 486-493.
BIRSEN O, ALIYEV S, AKSOY E, et al. A critical analysis of postoperative morbidity and mortality after laparoscopic radiofrequency ablation of liver tumors[J]. Ann Surg Oncol, 2014, 21(6): 1834-1840.
ZHANG W W, WANG H G, SHI X J. Advances in laparoscopic ultrasound guided radiofrequency ablation for treatment of liver tumor[J]. Academic Journal of Chinese PLA Medical School, 2016, 37(5): 514-517, 521.
SANTAMBROGIO R, OPOCHER E, ZUIN M, et al. Surgical resection versus laparoscopic radiofrequency ablation in patients with hepatocellular carcinoma and child-pugh class A liver cirrhosis[J]. Ann Surg Oncol, 2009, 16(12): 3289-3298.
SALAMA I A, KORAYEM E, ELABD O, et al. Laparoscopic ultrasound with radiofrequency ablation of hepatic tumors in cirrhotic patients[J]. J Laparoendosc Adv Surg Tech A, 2010, 20(1): 39-46.
LAI E C, TANG C N, HA J P, et al. The evolving influence of laparoscopy and laparoscopic ultrasonography on patients with hepatocellular carcinoma[J]. Am J Surg, 2008, 196(5): 736-740.
SOLIMAN H O, GAD Z S, MAHMOUD A M, et al. Laparoscopy with laparoscopic ultrasound for pretreatment staging of hepatic focal lesions: a prospective study[J]. J Egypt Natl Canc Inst, 2011, 23(4): 141-145.
WANG Z, CHI J C, ZHAI B. Ultrasound-guided percutaneous microwave ablation for the treatment of hepatocellular carcinoma adjacent to diaphragmatic dome[J]. Journal of Interventional Radiology, 2020, 29(3): 305-309.
LIU L L, FANG Y, WANG K F, et al. Clinical investigation of CT-guided radiofrequency ablation for liver cancer in hepatic dome area[J]. Tumor, 2014, 34(1): 60-66.
ZHU C D, DING H Y, WANG L X, et al. Clinical observation of CT-guided microwave ablation in 15 cases of recurrent small hepatocellular carcinoma against the diaphragmatic dome [J]. Journal of Modern Oncology, 2018, 26(5): 733-736.
TANG T, GU S Z, LI G W, et al. Ultrasound-guided microwave ablation with artificial pleural effusion for liver tumor adjacent to diaphragmatic dome[J]. Journal of Central South University (Medical Science), 2017, 42(2): 184-188.
HAN Y, ZHANG J, YAN D, et al. CT-guided percutaneous microwave ablation with artificial pneumothorax for liver malignancies in the hepatic dome[J]. Chinese Journal of the Frontiers of Medical Science (Electronic Version), 2017, 9(5): 119-122.
ZHANG Y, ZHAO L L, WU X, et al. Needle insertion and model design of liver tumor ablation guided by laparoscopic ultrasound [J]. Journal of Laparoscopic Surgery, 2022, 27(6): 428-433.
SHUANG J B, WU N, YAN Q M, et al. Ultrasound-guided combined with laparoscopy for the treatment of high risk liver cancer by microwave ablation [J]. Chinese Journal of General Surgery, 2019, 34(5): 449-450.
