2008 年 26 巻 p. 67-72
Endoscopic microwave coagulation therapy (MCT) or radio-frequency ablation (RFA) was developed in 1994. 213 endoscopic ablations (37% of 570 ablations) and 40 endoscopic hepatectomies (12% of 328 hepatectomies) were performed in our department. Appropriate selection of thoraco- and laparoscopic approach, marginal pre-ablation method, pre-coagulation method using RFA, and laparoscopic hand-assisted approach are important points. To evaluate the efficacy of endoscopic surgery, the operative outcomes were compared to 86 patients who underwent open non-systematic partial hepatectomy, smaller than 4 cm, and up to three tumors, in the same period. In endoscopic ablation, endoscopic hepatectomy, and open hepatectomy, the percent of liver damage B/C, intraoperative blood loss, operating time, percent requiring blood product, postoperative hospital stay, 5-year cumulative survival rate and complication rate was 49%, 20%, 17%, 23g, 346g, 850g, 3.2 hrs, 5.2 hrs, 6.6 hrs, 1%, 12%, 21%, 8 days, 9 days, 18 days, 54%, 68%, 63%, and 8.2%, 6.7%, 12% respectively. No implantation of malignant cells was encountered in endoscopic surgery. Endoscopic surgery can become a new therapeutic modality in treatment strategy for HCC.
