腹腔镜下微波消融联合^(125)Ⅰ粒子植入治疗不可切除肝细胞癌  

Combined treatments of laparoscopic microwave ablation and ^(125)Ⅰ seeds implantation for unresectable hepatocellular carcinoma

作　　者：李凯[1,2] 向国安[1,2] 陈开运[1,2] 王汉宁[1,2] 萧金锋 贺轲[1,2] 段小鹏[1,2] 

机构地区：[1]广东医学院教学医院 [2]广东省第二人民医院普外科,广州510317

出　　处：《消化肿瘤杂志（电子版）》2011年第4期233-236,共4页Journal of Digestive Oncology(Electronic Version)

基　　金：国家自然科学基金资助项目(编号81071990);广东省科协基金(编号GDKX201001);广东省科技计划项目(编号2010B08071088;2011B031800184);广州市科技计划项目(编号2011J4100010)

摘　　要：目的对比单纯微波消融,探讨腹腔镜辅助下微波消融联合125Ⅰ粒子植入治疗不可切除肝细胞癌的安全性及有效性。方法对我院2005年3月至2010年5月收治的65例不能手术切除的肝细胞癌患者,随机分为单纯微波消融治疗组(30例)和微波消融治疗联合125Ⅰ粒子植入治疗组(35例),所有患者均行CT增强扫描,并按病灶大小分为A组(最大直径≤5 cm)和B组(最大直径5.0～9.8 cm)。以生存率、局部复发率及治疗相关并发症发生率作为评价标准,比较两种治疗方法的临床治疗效果。结果65例患者未发生治疗相关死亡。单纯微波消融治疗及联合治疗患者的12、18、24个月生存率分别为87.1%、77.8%、70.2%及89.1%、84.1%、77.9%,差异无统计学意义(P=0.6171)。根据肿瘤大小分组分层分析,A组和B组分别单纯微波治疗和联合治疗患者生存率差异无统计学意义。单纯微波消融治疗患者12、18、24个月肿瘤局部复发率分别为9.6%、19.3%、33.0%,联合治疗患者分别为5.7%、11.4%、17.1%,差异无统计学意义(P=0.2530)。根据肿瘤大小分组分层分析,B组联合治疗患者局部复发率低于单纯微波消融治疗患者,差异有统计学意义(P=0.0441)。单纯微波治疗和联合治疗患者总体治疗相关并发症发生率无统计学差异(36.7%vs.34.3%,P<0.05)。结论腹腔镜辅助下微波消融联合125Ⅰ粒子植入治疗晚期不可切除肝癌安全有效,特别是对于肿瘤最大直径>5 cm的单发病灶,能有效降低术后局部复发率。Objective To investigate the safety and efficacy of combined treatments of laparoscopic microwave ablation and 125Ⅰ seeds implantation for unresectable hepatocellular carcinoma(HCC).Methods Sixty-five patients with unresectable HCC treated in our hospital from March 2005 to May 2010 were divided randomly to receive laparoscopic microwave ablation alone(n=30) and combined treatments of laparoscopic microwave ablation and 125Ⅰ seeds implantation(n=35).All patients received enhanced CT scan,and were divided into group A with a maximal diameter no more than 5.0 cm and group B with a maximal diameter more than 5.0 cm and less than 9.8 cm according to the tumor size.The survival rate,local recurrence rate and treatment related complications were compared between the different groups according to treatment method and tumor maximal diameter.Results There was no treatment related death in our study.The overall 12,18,24-month survival rates were 87.1%,77.8%,70.2% respectively in the patients with laparoscopic microwave ablation alone,and 89.1%,84.1%,77.9% respectively in those with combined treatments(P>0.05).Stratification analysis according to tumor diameter revealed that there were no significant difference in survival between the patients with laparoscopic microwave ablation alone and those with combined treatments both in group A and group B respectively(P>0.05).The overall 12,18,24-month local recurrence rates were 9.6%,19.3%,33.0% respectively in the patients with microwave ablation alone,and 5.7%,11.4%,17.1% respectively in those with combined treatments(P>0.05).However in group B,the local recurrence rates of the patients with combined treatments were significantly lower than those with microwave ablation alone(P<0.05).There was no significant difference in treatment related morbidity between the patients with microwave ablation alone and combined treatments(36.7% vs.34.3%,P<0.05).Conclusions Combined treatments of laparoscopic microwave ablation and 125Ⅰ seeds implantation for unresectable HCC is safe and e

关 键 词：腹腔镜 肝细胞癌 微波消融 125I粒子植入 

分 类 号：R735.7[医药卫生—肿瘤]