微波处理肝癌切除断面对术后肿瘤复发的影响  

Curative effect of microwave ablation in treating residual liver after hepatectomy for hepatocellular carcinoma

作　　者：吴钧 陈瑞 殷凯 许建伟 陶立德[2] 张立洪 Wu Jun;Chen Rui;Yin Kai;Xu Jianwei;Tao Lide;Zhang Lihong(Department of Hepatobiliary,Surgery,the People's Hospital of Taixing city,Yangzhou University,Jiangsu 225400,China;Department of Hepatobiliary,Surgery,the Afliated Hospital of Yangzhou University,Jiangsu 225012,China)

机构地区：[1]扬州大学附属泰兴市人民医院肝胆外科,江苏泰兴225400 [2]扬州大学附属医院肝胆外科,江苏扬州225012

出　　处：《中华普外科手术学杂志（电子版）》2020年第2期144-147,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：国家自然科学基金(81702377)。

摘　　要：目的探讨微波处理肝癌切除断面对患者术后肝功能恢复和术后肿瘤复发和生存率的影响。方法回顾性分析2012年1月至2016年12月86例肝癌行肝切除肿瘤切缘<1 cm患者的临床资料,其中42例患者在肝切除创面常规处理后加用微波烧灼(微波组),另44例肝切除断面仅常规处理(常规组)。应用SPSS 18.0软件进行分析,两组术中术后各相关指标用(x±s)表示,采用独立t检验;并发症发生率采用四格表χ^2检验;生存曲线采用Kaplan-Meier法绘制,组间比较采用Log-rank检验。P<0.05为差异有统计学意义。结果两组患者术中平均失血量,输红细胞的量,肿瘤是否有包膜,侵犯血管的情况,手术方式,术后肝功能恢复以及术后并发症等方面均无明显差异(P>0.05);微波组与常规组患者1、3和5年总生存率分别为88.0%、61.4%、23.9%和86.1%、45.9%、19.2%(χ^2=1.27,P=0.26);微波组与常规组患者1、3和5年无瘤生存率分别为68.4%、35.6%、18.5%和50.4%、22.4%、7.6%(χ^2=5.13,P=0.02);微波组与常规组术后6个月、1年和3年累积复发率分别为6.2%、28.1%、56.2和11.4%、34.6%、83.3%(χ^2=4.14,P=0.04)。结论肝癌术中应用微波处理<1 cm的肿瘤切缘不影响术后肝功能恢复,可以降低术后肿瘤复发率及提高患者无瘤生存率等方面有积极的临床意义,具有临床应用价值。Objective To explore the postoperative recovery of liver function,recurrence and metastasis of patients with hepatocellular carcinoma(HCC),who received microwave ablation after hepatectomy.Methods Retrospective analysis of clinical data were performed in 86 patients with HCC from January 2012 to December 2016,who underwent hepatectomy with resection margin of<1 cm.There were 42 cases in MWA group,who received microwave ablation after hepatectomy,while 44 cases in conventional group without microwave ablation.Statistical analysis were performed by using SPSS 18.0 software package.Measurement data such as intraoperative and postoperative indicators were expressed as (x±s) and examined by using independent t-test.The complication rate were compared by usingχ^2 test.Survival were analyzed by using Kaplan Meier method,and were examined by using log rank test.A P value of<0.05 was considered as statistically significant difference.Results There was no significant difference between the two groups in terms of average intraoperative blood loss,amount of infusion of red blood cells,invasion of tumor capsules or vessels,the surgical procedures,the recovery of postoperative liver function and postoperative complications(P>0.05).The overall survive rate of 1,3 and 5-year were 88.0%,61.4%and 23.9%in the MWA group,and 86.1%,45.9%and 19.2%in the conventional group,with no significant difference between the two groups respectively(χ^2=1.27,P=0.26).The disease free survive rate of 1,3 and 5-year were 68.4%,35.6%and 18.5%in the MWA group,and 50.4%,22.4%and 7.6%in the conventional group,with significant difference between the two groups respectively(χ^2=5.13,P=0.02).The 6-months,1-year and 3-years cumulative recurrence rates were 6.2%,28.1%and 56.2%in the MWA group and 11.4%,34.6%and 83.3%in the conventional group,with significant difference between the two groups respectively(χ^2=4.14,P=0.04).Conclusion The application of microwave ablation in treating residual liver after hepatectomy with resection margin of<1 cm for HCC wou

关 键 词：癌 肝细胞 肝切除术 微波 消融技术 复发 

分 类 号：R735.7[医药卫生—肿瘤]