橫膈膜旁肝癌復發之胸腔鏡切除手術

Thoracoscopic Resection of Recurrent Hepatoma Near the Diaphragm

自2015年10月至2023年5月共有24位橫隔膜附近疑似肝癌復發的病人接受了胸腔鏡切除手術治療。在胸腔鏡切除術之前，病人以接受射頻消融為主（n = 23,95.8%）,有部份病人也經過動脈栓塞（14, 58.3%）等治療。手術方式包括肝切除術合併橫膈切除術（n = 16, 66.7%）和僅肝切除術（n = 8, 33.3%）。在這24位病人的病理報告，10位（41.7%）病人復發性肝癌並侵及橫膈，10位（41.7%）病人復發性肝癌但未侵及橫膈，一位（4.2%）病人僅橫膈有肝癌活性細胞，3位（12.5%）病人切除之組織皆無活性肝癌。有一位病人3年內接受兩次胸腔鏡切除術，皆因肝癌復發侵犯橫膈。沒有手術死亡或併發症。在21位肝癌復發的病人，胸腔鏡切除術後的生存時間為59.2±9.5個月。

Between October 2015 and May 2023, 24 patients with suspected recurrent hepatoma near the diaphragm underwent thoracoscopic resection. Prior to thoracoscopic resections, the patients were mainly treated using radiofrequency ablation (n = 23, 95.8%) or plus trans-arterial embolization (n = 14, 58.3%). Operative procedures consisted of liver resection combined with diaphragm resection (n = 16, 66.7%) and liver resection only (n = 8, 33.3%). Out of these 24 patients, 10 (41.7%) had recurrent hepatoma with invasion of the diaphragm, 10 (41.7%) had recurrent hepatoma without invasion of the diaphragm, one (4.2%) had non-viable hepatoma in the liver but presented viable hepatoma on the diaphragm, and three (12.5%) had non-viable hepatoma in the resected specimens. One patient underwent two thoracoscopic resections in three years for repeated recurrence of hepatoma with invasion of the diaphragm. There was no operative death or significant morbidity. Among these 21 patients with recurrent hepatoma, the survival time was 59.2±9.5 months after thoracic resection.