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中华肝脏外科手术学电子杂志 ›› 2015, Vol. 04 ›› Issue (05) : 293 -296. doi: 10.3877/cma.j.issn.2095-3232.2015.05.009

所属专题: 文献

临床研究

腹腔镜下微波固化联合肝切除治疗肝硬化合并肝细胞癌的疗效
张克林1, 商昌珍1,(), 李闻达1, 张磊1, 张红卫1, 许磊波1, 曹春红1, 陈亚进1   
  1. 1. 510120 广州,中山大学孙逸仙纪念医院肝胆外科
  • 收稿日期:2015-07-24 出版日期:2015-10-10
  • 通信作者: 商昌珍
  • 基金资助:
    广东省自然科学基金博士启动项目(S2013040015045)

Curative effect of laparoscopic microwave coagulation combined with hepatectomy for liver cirrhosis complicated with hepatocellular carcinoma

Kelin Zhang1, Changzhen Shang1,(), Wenda Li1, Lei Zhang1, Hongwei Zhang1, Leibo Xu1, Chunhong Cao1, Yajin Chen1   

  1. 1. Department of Hepatobiliary Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China
  • Received:2015-07-24 Published:2015-10-10
  • Corresponding author: Changzhen Shang
  • About author:
    Corresponding author: Shang Changzhen, Email:
引用本文:

张克林, 商昌珍, 李闻达, 张磊, 张红卫, 许磊波, 曹春红, 陈亚进. 腹腔镜下微波固化联合肝切除治疗肝硬化合并肝细胞癌的疗效[J]. 中华肝脏外科手术学电子杂志, 2015, 04(05): 293-296.

Kelin Zhang, Changzhen Shang, Wenda Li, Lei Zhang, Hongwei Zhang, Leibo Xu, Chunhong Cao, Yajin Chen. Curative effect of laparoscopic microwave coagulation combined with hepatectomy for liver cirrhosis complicated with hepatocellular carcinoma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2015, 04(05): 293-296.

目的

探讨腹腔镜下微波固化联合肝切除治疗肝硬化合并肝细胞癌(肝癌)的安全性和疗效。

方法

回顾性研究2009年1月至2013年11月在中山大学孙逸仙纪念医院接受诊治的58例肝硬化合并肝癌患者临床资料。按治疗方式不同将患者分为微波固化联合肝切除组(联合组)和单纯微波固化组(固化组)。其中联合组37例,男29例,女8例;平均年龄(54±9)岁。固化组21例,男17例,女4例;年龄(58±10)岁。所有患者均签署知情同意书,符合医学伦理学规定。固化组仅于腹腔镜下行微波固化。联合组于微波固化后在距肿瘤边缘1~2 cm标记切割线后行肝切除术。观察两组患者术中出血量、手术时间。患者术中出血量、手术时间比较采用Wilcoxon秩和检验,生存分析采用Log-rank法和Z检验。

结果

联合组术中出血量146 (58~250)ml明显多于固化组的13 (10~25)ml(Z=7.824,P<0.05)。联合组手术时间177 (83~275)min明显长于单纯固化组的93 (36~135)min(Z=8.650,P<0.05)。联合组患者3年累积生存率及1、3年无瘤生存率97%、83%、92%,均明显高于固化组的64%、71%、43%(Z=10.054,9.011,7.112;P<0.05)。

结论

腹腔镜下微波固化联合肝切除术治疗肝硬化合并肝癌安全、有效,其远期疗效优于单纯腹腔镜微波固化。

Objective

To investigate the safety and curative effect of laparoscopic microwave coagulation combined with hepatectomy for liver cirrhosis complicated with hepatocellular carcinoma (HCC).

Methods

Clinical data of 58 patients with liver cirrhosis complicated with HCC diagnosed and treated in Sun Yat-sen Memorial Hospital of Sun Yat-sen University between Janunary 2009 and November 2013 were retrospectively studied. The patients were divided into the microwave coagulation combined with hepatectomy group (the combination group) and the simple microwave coagulation group (the coagulation group) according to different treatment methods. Among the 37 patients in the combination group, 29 were males and 8 were females with average age of (54±9) years old. Among the 21 patients in the combination group, 17 were males and 4 were females with average age of (58±10) years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients in the coagulation group only underwent laparoscopic microwave coagulation, while the patients in the combination group underwent hepatectomy after marking a incision line 1-2 cm from the tumor edge and undergoing microwave coagulation. The intraoperative blood loss and the duration of operation of two groups were observed. The comparison of the intraoperative blood loss and the duration of operation were conducted using Wilcoxon rank-sum test and the survival analysis was conducted using Log-rank test and Z test.

Results

The intraoperative blood loss of the combination group was 146 (58-250) ml, which was significantly higher than 13 (10-25) ml of the coagulation group (Z=7.824, P<0.05). The duration of operation of the combination group was 177 (83-275) min, which was significantly longer than 93 (36-135) min of the coagulation group (Z=8.650, P<0.05). The 3-year cumulative survival rate and 1-, 3-year disease free survival of the combination group were respectively 97%, 83%, 92%, which were significantly higher than 64%, 71%, 43% of the coagulation group (Z=10.054, 9.011, 7.112; P<0.05).

Conclusions

Laparoscopic microwave coagulation combined with hepatectomy for liver cirrhosis complicated with HCC is safe and effective. The long-term curative effect is better than that of simple laparoscopic microwave coagulation.

表1 两组肝硬化合并肝癌患者一般资料比较
表2 两组肝硬化合并肝癌患者围手术期情况比较
表3 两组肝硬化合并肝癌患者生存率比较(%)
[1]
唐云强,江鹏,何璐,等.三维重建联合超声引导下射频消融治疗肝癌的疗效分析[J].中华消化外科杂志,2014, 13 (9):678-682.
[2]
何科,王晶,徐丽南,等.TACE联合射频消融治疗结肠癌肝转移患者的临床疗效[J/CD].中华肝脏外科手术学电子杂志,2015,4 (1):31-34.
[3]
Rao A, Rao G, Ahmed I. Laparoscopic vs. open liver resection for malignant liver disease:a systematic review[J]. Surgeon, 2012, 10 (4):194-201.
[4]
Xiong JJ, Altaf K, Javed MA, et al. Meta-analysis of laparoscopic vs open liver resection for hepatocellular carcinoma[J]. World J Gastroenterol, 2012, 18 (45):6657-6668.
[5]
丁强,殷世武,项廷淼.多极射频消融治疗肝癌并发症的临床分析及防治[J].介入放射学杂志,2014, 23 (4):343-345.
[6]
温子龙,薛平,卢海武,等.特殊部位肝癌的腹腔镜下射频消融治疗[J].现代消化及介入诊疗,2012, 17 (3):138-140.
[7]
Cai XJ, Yang J, Yu H, et al. Clinical study of laparoscopic versus open hepatectomy for malignant liver tumors[J]. Surg Endosc, 2008, 22(11):2350-2356.
[8]
赵弘智,韩克强.射频消融治疗肝癌的再认识[J].重庆医学,2011, 40 (7):658-660.
[9]
刘浩润,王观发,李为民,等.经腹腔镜联合腹腔镜超声射频消融治疗多发性肝癌的体会[J].临床消化病杂志,2013, 25 (2):98-100.
[10]
张辉,徐新保,刘承利,等.腹腔镜下射频消融治疗特殊部位肝癌35例疗效观察[J].西部医学,2014, 26 (7):872-873, 875.
[11]
Martin RC, Scoggins CR, Mcmasters KM. Safety and efficacy of microwave ablation of hepatic tumors: a prospective review of a 5-year experience[J]. Ann Surg Oncol, 2010, 17(1):171-178.
[12]
田虎,张阳德.腹腔镜辅助射频消融与经皮射频消融治疗原发性肝癌的临床对照研究[J].中华普通外科杂志,2012, 27 (7):564-567.
[13]
Liu Y, Zheng Y, Li S, et al. Percutaneous microwave ablation of larger hepatocellular carcinoma[J]. Clin Radiol, 2013, 68(1):21-26.
[14]
Guglielmi A, Ruzzenente A, Valdegamberi A, et al. Radiofrequency ablation versus surgical resection for the treatment of hepatocellular carcinoma in cirrhosis[J]. J Gastrointest Surg, 2008, 12(1):192-198.
[15]
Gravante G, Overton J, Sorge R, et al. Radiofrequency ablation versus resection for liver tumours: an evidence-based approach to retrospective comparative studies[J]. J Gastrointest Surg, 2011, 15(2):378-387.
[16]
马仁,王文跃,彭维朝,等.腹腔镜下射频消融治疗肝细胞肝癌[J].中华普通外科杂志,2011, 26 (11):943-946.
[17]
Dong W, Zhang T, Wang ZG, et al. Clinical outcome of small hepatocellular carcinoma after different treatments: a meta-analysis[J]. World J Gastroenterol, 2014, 20(29):10174-10182.
[18]
Li L, Zhang J, Liu X, et al. Clinical outcomes of radiofrequency ablation and surgical resection for small hepatocellular carcinoma: a meta-analysis[J]. J Gastroenterol Hepatol, 2012, 27(1):51-58.
[19]
Peng ZW, Lin XJ, Zhang YJ, et al. Radiofrequency ablation versus hepatic resection for the treatment of hepatocellular carcinomas 2 cm or smaller: a retrospective comparative study[J]. Radiology, 2012, 262(3):1022-1033.
[20]
邱君斓,周铁,孔文韬,等.腹腔镜超声在经皮射频消融术治疗肝肿瘤中的应用价值[J/CD].中华医学超声杂志:电子版,2012, 9 (9):832-835.
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