肝細胞癌に対する全麻下腹腔鏡的局所治療

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In our department, indication of laparoscopic treatment for hepatocellular carcinoma (HCC) was that the long diameter of HCC was 4 cm or less, the number of HCC was 3 or less, the clinical stage was Child-Pugh A or B, and the vascular invasion was absent.The peculiar feature of laparoscopic treatment is that the objects of treatment and both HCCs on the liver surface and HCCs located deep in the liver using laparoscopic ultrasonography (LUS). The puncture methods of the tumor located deep in the liver were guide needle and immersion method using normal saline solution into the abdominal cavity. Recently convex-type LUS was developed in order to puncture the tumor located deep in the liver.From February 1998, until September 2002, 263 tumors of 197 cases underwent laparoscopic treatment. The mean long diameter of tumors was 24.0 (12-60) mm. One hundred and ninety tumors of 141 cases underwent laparoscopic radiofrequency ablation (LRA) and 73 tumors of 56 cases underwent laparoscopic microwave coagulation (LMC). Local recurrence rate was 6.1% and the recurrence rate of the other lesion was 27.4%. The survival rate was 86% in three year, and 71% in four year.