原发性肝癌切除术中联合残肝断面射频消融对术后局部复发的预防  

Prevention of postoperative local recurrence by combined radiofrequency ablation of residual liver section during primary liver cancer resection

作　　者：朱建平 余国华 薛晨辉 牟东成 孙伟光 李永猛 华玲莉 Jian-Ping Zhu;Guo-Hua Yu;Chen-Hui Xue;Dong-Cheng Mou;Wei-Guang Sun;Yong-Meng Li;Ling-Li Hua(Department of Hepatobiliary Surgery,Cancer Center of Beijing First Hospital of Integrated Chinese and Western Medicine,Beijing 100018,China;Department of General Surgery,Yuping Dong Autonomous County Peoples Hospital,Yuping 554000,Guizhou Province,China;Department of Surgery,Tang County Kangding Hospital,Baoding 072350,Hebei Province,China)

机构地区：[1]北京市第一中西医结合医院肿瘤中心肝胆外科,北京市100018 [2]贵州省玉屏侗族自治县人民医院普外科,贵州省玉屏县554000 [3]河北省保定市唐县康定医院外科,河北省保定市072350

出　　处：《世界华人消化杂志》2020年第13期526-531,共6页World Chinese Journal of Digestology

摘　　要：背景手术切除是可能治愈肝癌的主要方法,小肝癌的射频消融治疗也能达到手术切除的相同效果,但术后的高复发率很大程度上制约了其治疗效果,为预防或减少术后肝断面的局部复发,我们设计了本联合处理方法,初步效果良好.目的为探讨原发性肝癌切除手术中残肝断面处理的新方法对患者术后肿瘤局部复发的预防作用.方法回顾2016-10/2019-09期间17例原发性肝癌切除术中联合残肝断面使用射频消融(腹腔镜手术8例,开腹手术9例)患者的临床资料,分析其术后肿瘤局部复发情况.结果所有患者无严重术后并发症,术后每3 mo随访复查,已坚持随访6-36 mo,中位随访时间25.7 mo±4.4 mo,所有患者残肝断面局部无复发;术后15 mo腹腔淋巴结转移1例,术后18 mo远离肝断面的新发肝内癌灶1例,这2例患者均采用现代中西医结合模式进一步治疗,现带瘤生存良好,其他患者状况良好,全组无死亡.结论原发性肝癌切除术中应用射频消融处理残肝断面可显著降低肿瘤局部复发,在提高患者生存方面有积极的临床意义,值得临床推广应用.BACKGROUND Surgical resection is the main method that may cure liver cancer. Radiofrequency ablation treatment of small liver cancer can also achieve the same effect as surgical resection, but the high postoperative recurrence rate greatly limits its therapeutic effect. To prevent or reduce local recurrence of postoperative residual liver section, we designed a combined treatment method.AIM To explore the preventive effect of a new method for treating residual liver section during primary liver cancer resection on local tumor recurrence after surgery.METHODS The clinical data of 17 cases undergoing primary liver cancer resection by surgery combined with radiofrequency ablation(8 cases of laparoscopy and 9 cases of open surgery) from October 2016 to September 2019 were retrospectively reviewed to analyze local tumor recurrence after operation. RESULTS No severe postoperative complications occurred in all patients. The patients were followed every 3 mo after surgery, and had been followed for 6 mo to 36 mo,with a median follow-up time of 25.7 mo ± 4.4 mo. No local recurrence of residual liver section occurred in all patients. There was one case of abdominal lymph node metastasis at 15 mo after operation and one case of new intrahepatic tumor away from the residual liver section at 18 mo after surgery. These two cases were further treated with modern integrated traditional Chinese and Western medicine, and live well with tumor now. All other cases are in good condition now. No deaths occurred.CONCLUSION Radiofrequency ablation of residual liver section during resection of primary liver cancer can significantly reduce local tumor recurrence and improve patient survival.

关 键 词：原发性肝癌 肝切除术 射频消融 癌转移 局部肿瘤复发 肝断面处理 

分 类 号：R735.7[医药卫生—肿瘤]