原发性肝癌术后复发或转移性肝癌微创治疗的指征与临床处理  

Indication and Clinical Treatment of Minimally Invasive Therapy for Postoperative Recurrence of primary Liver Cancer or Metastatic Liver Cancer

作　　者：秦建民[1,2] 顾新刚[2] 王之[2] 吴旸[2] 倪雷[2] 赵威[2] 盖吉钦[2] 陈腾[2] 

机构地区：[1]上海第二军医大学第三附属医院普外科,上海201800 [2]上海中医药大学附属普陀医院普外科

出　　处：《肝胆外科杂志》2016年第5期365-369,共5页Journal of Hepatobiliary Surgery

基　　金：上海市普陀区肝胆胰重点专科基金项目(项目编号:2012-B-162)

摘　　要：目的探讨复发或转移性肝癌微创治疗的指征与治疗方案的选择。方法回顾性分析我们2008年1月-2015年1月原发性肝癌术后复发或转移性肝癌微创治疗112例患者临床资料，肝动脉栓塞化疗（transcatheterarterialchemoembolization，TACE）36例，微波消融治疗（microwavecoagulationtherapy，MCT）34例，B超引导经皮射频消融治疗（percutaneou$radiofrequencyablmion，PRFA）12例，B超导向经皮无水酒精注射治疗（percutaneousethanolinjectiontherapy，PEIT）14例，TACE联合经皮MCT（PMCT）治疗16例。完全缓解（CR）＋部分缓解（PR）为治疗有效。结果胸腔积液发生26例，不同程度发热82例，肝脓肿6例，腹水14例，均经保守治疗治愈，无出血、胆漏、邻近脏器损伤和死亡。每一种微创治疗有效率50％以上，尤其肿瘤热消融治疗达到80％以上，3年生存率达到50％。TACE联合微波消融治疗组3年、5年生存率（50％、31％）显著高于单一TACE治疗组（16．7％、2．8％）（x2=4．676，P=0．031；x2=6．229，P=0．013）。结论严格掌握各种微创治疗指征，依据患者肝功能和肿瘤特点采用个体化的微创治疗方案，适时选择多种微创技术联合治疗，是提高微创治疗复发与转移性肝癌疗效的重要措施。Objective To investigate the indication and minimally invasive therapy for postoperative recurrence of primary liv- er cancer or metastatic liver cancer. Methods 12 clinical records of patients who were performed minimally invasive therapy were ret- rospectively analyzed from January 2008 to September 2015. All patients accepted the minimally invasive therapy including transcathe- ter arterial chemoembolization （TACE） for 36 cases, percutaneous microwave coagulation therapy （PMCT） for 34 cases, percutaneous radiofrequency ablation （PRFA） for 12 cases, percutaneous ethanol injection therapy （PEIT） for 14 cases, TACE plus PMCT for 16 cases. CR plus PR are regarded as effective therapy. Results After treatment, 26 patients occurred pleural effusion, 82 cases were fever, 6 cases occurred liver abscess, 14 cases were ascites. All complications were cured by conservative treatment, there were no bleeding, bile leakage, adjacent viscera injury and death in all cases. The effective rate of every minimally invasive therapy was more than 50%, especially over 80% in thermal ablation. The lifetime of 3 years 3 was 50%. The respective lifetime of 3 years and 5 years （50%, 31% ） in TACE plus MCT ablation were significantly higher than that of TACE therapy （16. 7%, 2. 8% ） （x2 =4. 676, P = 0. 031; x2 = 6. 229, P = 0. 013）. Conclusion It is very important measures to increase the therapeutic effect of minimally invasive therapy on the postoperative recurrence of primary liver cancer or metastatic liver cance by strictly following the indication of minimally invasive therapy, selecting the individualized therapeutic schedule and duly combining variously minimally invasive techniques accord- ing to liver function and tumor charateristics.

关 键 词：肝癌 复发 转移 微创治疗 

分 类 号：R735.7[医药卫生—肿瘤]