肝癌根治术后肝内复发再治疗方式效果比较  

Effect comparison among retreatment for intrahepatic recurrence after hepatocellular carcinoma radical resection

作　　者：贺晓斌[1] 贺宝艳[1] 

机构地区：[1]延安大学附属医院普外科,陕西716000

出　　处：《肝脏》2015年第11期851-854,898,共5页Chinese Hepatology

摘　　要：目的比较重复手术切除、射频消融(RFA)及肝动脉栓塞化疗(TACE)对复发性肝癌的治疗价值。方法回顾性分析2008年1月至2013年12月在延安大学附属医院肝胆外科治疗的原发性肝细胞癌(HCC)患者,对肿瘤复发者采用重复手术切除、RFA或TACE单一治疗并进行随访,评价三种技术对复发性肝癌的治疗效果。结果符合入选标准患者83例,其中重复手术切除18例、RFA20例、TACE45例。早期复发(≤12个月)患者中肝内转移(IM)和多中心发生(MO)分别为29例和7例,晚期复发分别为9例和38例(P<0.01);TACE和重复切除/RFA在早期复发和晚期复发分布差异无统计学意义(P=0.83);TACE组与重复切除/RFA组生存率组间比较差异无统计学意义(P=0.191),早期复发与晚期复发患者生存率组间比较差异无统计学意义(P=0.101),早期复发患者中TACE组与重复切除/RFA生存率组间比较差异无统计学意义(P=0.223),而晚期复发患者中重复切除/RFA组生存率高于TACE组(P=0.025)。结论应该根据IM和MO选择HCC肝内复发的治疗方法,对于早期复发者TACE疗效与重复切除和RFA相近,而对于晚期复发者重复切除或RFA疗效优于TACE。Objective To evaluate therapeutic values of retreatment with resection,radiofrequency ablation （RFA） and transcatheter arterial chemoembolization （TACE）for intrahepatic recurrent cancer.Methods Patients administered resection of hepatocellular carcinoma （HCC）from January 2008 to December 2013 in our hospital were retrospectively analyzed.Cases accepted monotherapy as retreatment with resection,RFA or TACE for tumor recurrence were followed up.In addition,efficacy among three different types of therapy were evaluated.Results Eighty-three patients were enrolled,including 18 patients received retreatment with resection,20 received RFA and 45 received TACE.Among those patients,early recurrence （≤12 months）occurred in 36 cases,including 29 cases with intrahepatic metastasis （IM）and 7 cases with multi-centric occurrence （MO）,while late recurrence occurred in 47 cases,including 9 cases with IM and 38 cases with MO （P 〈0.01 ）.There was no significant difference in recurrence phases （P =0.83）and survival rate （P =0.191）between TACE group and retreatment with resection/RFA group.Also no significant difference was found in survival rate between early recurrence group and late recurrence group （P =0.101）.In early recurrence group,there was no significant difference in survival rate between TACE group and retreatment with resection/RFA group （P =0.223）.While in late recurrence group,survival rate of retreatment with resection/RFA group was higher than that in TACE group （P =0.025）.Conclusion Treatment for intrahepatic recurrence of HCC patients should be based on metastasis status,IM or MO.Similar efficacy was observed in TACE and retreatment with resection/RFA in early recurrence,while retreatment with resection/RFA was more effective than TACE in late recurrence.

关 键 词：复发性肝癌 重复手术 射频消融 肝动脉栓塞化疗 

分 类 号：R735.7[医药卫生—肿瘤]