微波固化联合肝癌根治术治疗肝细胞癌的研究  

Microwave coagulation combined with hepatectomy in treatment of hepatocellular carcinoma

作　　者：李涛[1] 阴继凯[1] 杜锡林[1] 杨林[1] 鲁建国[1] 

机构地区：[1]第四军医大学唐都医院普通外科,陕西西安710038

出　　处：《外科理论与实践》2014年第5期459-463,共5页Journal of Surgery Concepts & Practice

摘　　要：目的：观察微波固化联合肝癌根治术治疗对肝细胞癌病人生存状况的影响,筛选影响病人生存的相关因素。方法：回顾性分析2009年1月至2012年6月诊断为肝细胞癌病人106例,根据肝癌根治术中是否联合微波固化治疗分为研究组（57例,微波固化联合手术切除）和对照组（49例,单纯肝癌根治术）。随访时间为6~42个月,生存分析采用Kaplan-Meier法,Log-Rank试验被用来估计生存曲线的不同;预后相关风险因素分析采用COX比例风险模型。结果：病人总体平均生存时间为（669±73）d。研究组平均生存时间为（901±99）d,累积生存率为65.2%,对照组平均生存时间为（462±64）d,累积生存率为22.2%。生存分析证实,研究组和对照组病人的生存率差异具有统计学意义（χ^2=5.707,P=0.017）。COX比例风险模型分析显示：与单纯肝癌根治术相比较,联合治疗能对病人生存起到保护性作用,而肿瘤最大径〉10 cm、AFP〉800μg/L和CEA〉5.9μg/mL为影响病人生存的危险性因素。结论：肝癌根治术辅以微波固化治疗能延长病人术后生存时间,提高肝细胞癌病人的总生存率。Objective To study the survival rate of the patients with hepatocellular carcinoma, who underwent microwave coagulation combined with hepatectomy, and the prognostic factors of the survival. Methods One hundred six patients with hepatocellular carcinoma who underwent curative hepatectomy from January 2009 to June 2012 were collected retrospectively. There were two groups： the study group （n=57, microwave coagulation therapy combined with hepatectomy） and the control group （n=49, hepatectomy）. Follow-up time ranged from 6 to 42 months. Survival rate was estimated using the Kaplan-Meier method, and the differences between two groups were evaluated with the Log-Rank test. Prognosis risk factors were analyzed by COX proportional hazards model. Results The overall mean survival time of all patients was （669±73） days. The cumulative survival rate of study group was 65.2% with （901±99） days, while 22.2% and （462±64） days for control group. There was statistically significant difference （x2=5.707, P=0.017） in survival rate between two groups with the analysis of survival. It was shown by the analysis of COX proportional hazards model that the treatment of microwave coagulation combined with hepatectomy was more protective factor on the patients with hepatocellular carcinoma compared with hepatectomy. The risk factors of survival of the patients from the analysis, however, were the diameter of tumor （〉10 cm）, AFP （〉800 μg/L） and CEA （〉5.9 μg/mL）. Conclusions Microwave coagulation combined with hepatectomy could prolong survival time of the patients with hepatocellular carcinoma, and improve the overall survival rate when compared with hepatectomy.

关 键 词：肝细胞癌 肝切除术 微波固化治疗 生存分析 

分 类 号：R735.7[医药卫生—肿瘤]