挽救性肝切除治疗肝癌射频消融术后复发

doi:10.3877/cma.j.issn.2095-3232.2019.04.013

目的

探讨挽救性肝切除治疗肝细胞癌（肝癌）射频消融（RFA）术后复发的安全性和疗效。

方法

回顾性分析2011年1月至2017年12月佛山市第一人民医院行挽救性肝切除的6例肝癌RFA术后复发患者临床资料。患者均签署知情同意书，符合医学伦理学规定。6例患者均为男性；年龄40～62岁，中位年龄48岁。AFP阳性5例，阴性1例。肝功能Child-Pugh分级为A级5例，B级1例。吲哚氰绿15 min滞留率（ICGR15）中位数为0.06（0.03～0.08）。肿瘤位于肝左叶1例，肝右叶5例。患者行开腹挽救性肝切除。

结果

所有患者均顺利完成手术。手术时间270（240～300）min，术中出血量312（100～550）ml。术后出现胸腔积液4例，其中2例经胸腔穿刺抽液治愈；食管胃底静脉曲张破裂出血1例，经胃镜套扎止血好转。无发生围手术期死亡。病理学检查结果示，肿瘤直径4.5（2.0～8.3）cm，肿瘤边缘有活性5例，肿瘤中心有活性1例，微血管侵犯5例。随访时间1～6年，中位随访时间3年，随访期间1例患者6年后肝内复发，行TACE治疗，其余患者未见肿瘤复发。

结论

在肝功能储备条件良好的情况下，挽救性肝切除对于治疗肝癌RFA术后复发仍能取得较好的疗效，是一种有效、安全的治疗方法。

关键词: 肝切除术, 癌，肝细胞, 复发, 导管消融术

Objective

To investigate the safety and efficacy of salvage hepatectomy for recurrent hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA).

Methods

Clinical data of 6 patients with recurrent HCC after RFA undergoing salvage hepatectomy from January 2011 to December 2017 in the First People's Hospital of Foshan were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. All 6 patients were male, aged 40-62 years with a median age of 48 years. AFP was positive in 5 cases and negative in 1 case. Five patients were classified as Child-Pugh grade A and 1 case as grade B. The median indocyanine green retention rate at 15 min (ICGR15) was 0.06(0.03-0.08). The tumors were located in the left liver lobe in 1 case and in the right liver lobe in 5 cases. All patients underwent open salvage hepatectomy.

Results

All patients completed the operation successfully. The operation time was 270(240-300) min. The intraoperative blood loss was 312(100-550) ml. 4 patients presented with postoperative pleural effusion, and 2 of them were healed by pleural puncture and aspiration. 1 case suffering from esophageal and gastric varices rupture and bleeding was cured by endoscopic ligation. No perioperative death occurred. Pathological examination demonstrated that the tumor diameter was 4.5(2.0-8.3) cm. The tumor margin were observed active in 5 cases, the tumor center was active in 1 and microvascular invasion in 5. The follow-up time was 1-6 years with a median follow-up of 3 years. During the follow-up, 1 patient recurred after 6 years and underwent transarterial chemoembolisation (TACE). No tumor recurrence was found in other patients.

Conclusion

Salvage hepatectomy is an effective and safe treatment for recurrent HCC after RFA in patients with a good liver function reserve.

Key words: Hepatectomy, Carcinoma, hepatocellular, Recurrence, Catheter ablation

图1 一例肝癌RFA术后复发患者CT

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Salvage hepatectomy for recurrence of hepatocellular carcinoma after radiofrequency ablation

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Salvage hepatectomy for recurrence of hepatocellular carcinoma after radiofrequency ablation