射频消融联合断流术治疗肝癌合并门静脉高压症69例分析  

Radiofrequency ablation combined with devascularization in treating primary liver cancer with portal hypertension:An analysis of 69 cases

作　　者：丁振昊[1] 穆毅[1] 蒋力[1] 张珂[1] 黄容海[1] 鲁岩[1] 赫嵘[1] 李勤涛[1] 郭立民[1] 李宝亮[1] 贾哲[1] 

机构地区：[1]首都医科大学附属北京地坛医院肝胆外科,北京100015

出　　处：《中国实用外科杂志》2013年第11期967-969,共3页Chinese Journal of Practical Surgery

基　　金：首都临床特色应用研究(Z121107001012169)

摘　　要：目的总结射频消融联合断流术治疗原发性肝癌合并门静脉高压症的临床经验。方法对2004年6月至2012年6月首都医科大学附属北京地坛医院肝胆外科69例(治疗组)行射频消融联合断流术治疗原发性肝癌合并门静脉高压症的资料进行回顾性分析,并与同期83例(对照组)行肝部分切除联合断流术的病例进行对照研究。观察病人术后肝功能损害程度、术后并发症发生率、术后食管胃底静脉出血复发率、术后总体存活率和术后无瘤存活率等。结果两组均无围手术期死亡。治疗组术后肝功能损害主要为轻中度,损害程度显著低于对照组(P<0.05)。治疗组术后并发症的发生率低于对照组(P<0.05)。两组术后1、3、5年总存活率、无瘤存活率及食管胃底静脉复发出血率差异无统计学意义。结论在严格掌握适应证的前提下,射频消融联合断流术比肝部分切除联合断流术肝功能损伤小、术后并发症少,且射频消融联合断流术可以获得与肝部分切除联合断流术相似的远期存活率。Objective To summarize the clinical experience of radiofrequency ablation combined with devascularization in treating primary liver cancer with portal hypertension. Methods The clinical data of 69 cases of primary liver cancer with portal hypertension treated with radiofrequency ablation combined with devascularization from June 2004 to June 2012 in Department of Hepatobiliary Surgery, Beijing Ditan Hospital of Capital Medical University （the study group） were analyzed retrospectively. At the same time, the clinical data of 83 cases treated with the partial hepatectomy combined with devascularization （the control group） were compared with the data of the study group. Postoperative liver function grade, complications, the hemorrhage recurrence rate of gastroesophageal varices, postoperative overall survival and postoperative tumor-free survival of two groups were observed. Results There was no dead case in two groups. In the study group, liver dysfunction was mainly mild or moderate degree, and the extent of liver function damage was significantly lower than the control group （P〈0.05）. Postoperative complication incidence in study group was lower than that in the control group （P〈0.05）. Two groups had no difference in postoperative 1-, 3-, and 5-year overall survival rate, tumor-free survival rate and gastroesophageal varices hemorrhage recurrence rate. Conclusion Under the conditions of suitable selection of indications, radiofrequency ablation combined with devascularization can get less liver function damage and postoperative complications with similar long-term survival rate compared with partial hepatectomy combined with devascularization.

关 键 词：原发性肝癌 门静脉高压症 射频消融 断流术 

分 类 号：R6[医药卫生—外科学]