The Study On Application Of Laparoscopic Ultrasonography In Treatment Of Primary Liver Cancer

Objective:to investigate the clinical value of laparoscopic ultrasound in diagnosis and treatment of Primary liver cancer. Section one:to investigate the clinical value of laparoscopic ultrasound in locating lesions of primary liver cancer. Section two:to investigate the clinical value of laparoscopic ultrasound-guided RFA in treatment of primary liver cancer.Methods:SECTION ONE:The clinical data of patients who underwent laparoscopic partial hepatectomy using laparoscopic ultrasound technique in Chinese PLA general hospital form August 2015 to February 2016 were retrospectively analyzed. These data include patients'general information, total number of lesions, number of lesions detected by MRI, number of lesions detected by laparoscopic ultrasound, postoperative pathologic diagnosis. Define the postoperative pathologic diagnosis as gold standard, describe separately the diagnostic test of MRI and laparoscopic ultrasound. Compare positive-diagnostic ratio between two approaches.SECTION TWO:(1) The clinical data of 5 patients who underwent laparoscopic ultrasonography-guided liver cancer RFA in segment ? or ? in Chinese PLA general hospital form June 2015 to January 2016 were retrospectively analyzed. These data include patients'general information, total number of lesions, lesion'location, diameter, guidance time, follow-up time, completely inactivation. Analyze the safety and feasibility of elevation paracentesis for laparoscopic ultrasonography-guided RFA when treating liver cancer in segment ? or ?. (2) The clinical data of patients who underwent laparoscopic ultrasound-guided hepatic neoplasms in Chinese PLA general hospital form August 2014 to February 2016 were retrospectively analyzed. These data include patients'general information, total information of lesions, total information of liver neoplasms RFA. Analyze ultrasound-guided time and success stab ratio between different stab guidance groups.Results:SECTION ONE:In this section,32 patients were involved and 40 lesions met inclusion criteria, which the diameter is under 3cm. all the lesions were undergoing liver resection via laparoscope.35 were diagnosed as malignant, while the others were benign. The preoperative MRI detected 30 lesions,29 lesions were malignant, the others were benign. Laparoscopic ultrasound detected 39 lesions,34 lesions were malignant, the others were benign. The pick up rate of laparoscopic ultrasound is higher than MRI(97.14% vs 82.86%,x2=3.968 P=0.046).SECTION TWO:(1) All the 5 operations were successfully finished with no severe complications. The mean guidance time was (4.4±5.7) min,100% lesions were completely necrotized. During a median follow-up period of 5.25 months, no patient recurred at the ablation site.(2) In this study,42 lesions were analyzed,25 were in upper side of right liver lobe(Group A),17 were in lower side of right liver lobe (Group B), the mean diameter is (16.05±5.65) mm,the mean distance form liver surface is (12.76±12.45) mm, the mean guidance time is (181.64±103.94) s. In Group A, there has significant difference between using orient-guidance puncture and using non-orient-guidance puncture(17.57±6.19mm vs 16.39±4.88mm, t=0.506,P=0.618). In Group B, there has significantly positive relevant in depth from liver surface and mean guidance time(?=0.810,P< 0.001). There has significantly positive relevant in tumor diameter and mean guidance time(?=0.746,P=0.001). There has significantly positive relevant in attempt puncture times and distance form liver surface (?=0.715,P=0.001).Conclusions:According to our research outcomes, laparoscopic ultrasound has higher diagnostic accuracy compared to preoperative MRI, thus the technique could improve detection rate of primary liver cancer. As a conclusion for laparoscopic ultrasound-guided hepatic tumor RFA, the nonorient-guidance puncture method is recommended to use in lesions locating on surface of liver and in segment ? or ?. While in segment V or VI, the diameter and depth from liver surface are many factors in puncture procedure. We recommend to use elevation paracentesis method for laparoscopic ultrasonography-guided RFA when treating liver cancer in segment ? or ?.