经皮微波消融与手术切除治疗合并肝硬化的单发小肝癌的疗效比较(附250例)  

Therapeutic Outcomes of Surgical Resection versus Percutaneous Microwave Coagulation Therapy for Single Small Hepatocellular Carcinoma with Cirrhosis(250 Cases)

作　　者：杨藩[1] 张二雷[2] 肖震宇[2] 黄志勇[2] 童兵[2] 

机构地区：[1]湖北民族学院附属民大医院普外科,恩施445000 [2]华中科技大学同济医学院附属同济医院肝脏外科,武汉430030

出　　处：《华中科技大学学报（医学版）》2016年第2期185-189,共5页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

摘　　要：目的比较经皮微波消融（percutaneous microwave coagulation therapy,PMCT）和手术切除（surgical resection,SR）治疗原发性单个小肝癌（最大径≤3cm）合并肝硬化患者的生存及预后。方法回顾性收集2004年6月到2013年7月在华中科技大学同济医学院附属同济医院肝脏外科中心接受治疗的单个小肝癌患者共250例,其中SR组152例,PMCT组98例,比较两组患者的近远期治疗效果。采用Cox模型分析影响预后的危险因素。结果两组平均随访40.6个月（9~96个月）,SR与PMCT组1、3、5年无瘤生存率分别为94.7%、68.0%、42.7%和88.8%、60.0%、37.1%（P=0.076）,1、3、5年总体生存率分别为98.7%、94.2%、60.1%和96.9%、88.3%、59.0%（P=0.211）。单因素及多因素分析结果显示高胆红素是影响肝癌外科治疗后复发、生存的独立危险因素,而治疗方式的不同不是其预后危险因素。结论对于单个原发性小肝癌合并肝硬化患者,PMCT治疗安全、有效,能取得与SR相当的近期、远期疗效,操作方便、费用低廉,临床可考虑作为小肝癌合并肝硬化患者的首选治疗手段之一。Objective To compare the therapeutic outcomes between percutaneous microwave coagulation therapy（PMCT） and surgical resection（SR）for patients with single small hepatocellular carcinoma（HCC）and cirrhosis. Methods Clinical data of 250 patients who were diagnosed with single small hepatocellular carcinoma and treated by SR （n = 152） or PMCT （n = 98） be- tween June 2004 and July 2013 at Hepatic Surgery Center of Tongji Hospital were retrospectively analyzed. Short-term and long-term efficacies were compared between the two therapy modalities. Risk factors that affected the prognosis were analyzed by Cox regression modeling. Results The average follow-up time was 40.6 months（9--96 months）. The 1-,3-,and 5-year dis- ease-free survival（DFS）rates were 94.7% ,68.0% ,42.7% in SR group,and 88.8% ,60.0% ,37.1%in PMCT group,respec- tively. The 1-,3-,and 5-year overall survival（OS） rates were 98.7% ,94.2% ,60.1% in SR group,and 96.9% ,88.3%, 59.0% in PMCT group,respectively. There were no significant difference in OS and DFS rates between the two groups（P=0. 076 and P=0. 211,respectively）. Univariate and multivariate analyses showed that only high total bilirubin was a significant risk factor for therapeutic outcomes, rather than surgical modality. Conclusion PMCT is effective for treatment of patients with single small HCC and cirrhosis, yielding similar OS and DFS to SR but more safety and convenience, and less cost. PMCT can be used as the first-line treatment method for patients with single small HCC and cirrhosis.

关 键 词：小肝癌 肝硬化 微波消融 手术切除 

分 类 号：R735.7[医药卫生—肿瘤]