再次肝切除与腹腔镜微波消融治疗复发性小肝癌临床疗效比较  

Comparison of clinical efficacy between re-hepatectomy and laparoscopic microwave ablation for recurrent small hepatocellular carcinoma

作　　者：谢静 毛先海[2] 杨建辉[2] 段小辉[2] 田朕安 张雄 高绪照 Xie Jing;Mao Xianhai;Yang Jianhui;Duan Xiaohui;Tian Zhen'an;Zhang Xiong;Gao Xuzhao(Department of Hepatobiliary Surgery,Zhangjiajie City People's Hospital,Zhangjiajie 427000,China;Department of Hepatobiliary Surgery,Hunan Provincial People's Hospital,Changsha 410005,China)

机构地区：[1]湖南省张家界市人民医院肝胆外科,427000 [2]湖南省人民医院肝胆外科,长沙410005

出　　处：《中华肝脏外科手术学电子杂志》2022年第3期258-262,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：湖南省自然科学基金(2018JJ3294,2019JJ80007);湖南省教育厅科学研究重点项目(16A127)。

摘　　要：目的比较再次肝切除(RH)与腹腔镜微波消融(LMWA)治疗复发性小肝癌的临床疗效。方法回顾性分析2016年1月至2018年1月湖南省人民医院诊治的71例复发性肝癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男44例,女27例;年龄34~76岁,中位年龄51岁。根据治疗方式将患者分为RH组(40例)和LMWA组(31例)。两组手术时间、术后住院时间、住院费用比较采用t检验;术中出血量比较采用Mann-Whitney U检验;术后并发症发生率比较采用χ^(2)检验。生存分析采用Kaplan-Meier法和Log-rank检验。结果LMWA组术中出血量为10(10)ml,明显少于RH组的200(100)ml(Z=-7.278,P<0.05);手术时间、术后住院时间、住院费用分别为(37±11)min、(4.7±1.1)d、(1.6±0.4)万元,亦明显少于RH组的(141±37)min、(9.6±1.9)d、(3.4±2.1)万元(t=-235.125,-161.889,-23.359;P<0.05)。LMWA组术后并发症发生率为29%(9/31),明显低于RH组的73%(29/40)(χ^(2)=1.309,P<0.05)。RH组和LMWA组1、2、3年无瘤生存率分别为70.0%、52.5%、30.0%和67.7%、48.4%、29.0%,差异无统计学意义(χ^(2)=0.042,P>0.05)。结论对复发性小肝癌的治疗,RH和LMWA两种治疗方法疗效无明显差异,但LMWA在操作可重复性、经济性、微创性及安全性等方面具有明显优势。Objective To compare the clinical efficacy between re-hepatectomy(RH)and laparoscopic microwave ablation(LMWA)in the treatment of recurrent small hepatocellular carcinoma(HCC).Methods Clinical data of 71 patients with recurrent small HCC treated in Hunan Provincial People's Hospital from January 2016 to January 2018 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,44 patients were male and 27 female,aged from 34 to 76 years,with a median age of 51 years.All patients were divided into the RH(n=40)and LMWA groups(n=31)according to different treatments.The operation time,length of postoperative hospital stay and hospitalization expense between two groups were compared by t test.Intraoperative blood loss was compared by Mann-Whitney U test.The incidence of postoperative complications was compared by Chi-square test.Survival analysis was performed by Kaplan-Meier method and Log-rank test.Results Intraoperative blood loss in the LMWA group was 10(10)ml,significantly less than 200(100)ml in the RH group(Z=-7.278,P<0.05).In the LMWA group,the operation time,length of postoperative hospital stay and hospitalization expense were(37±11)min,(4.7±1.1)d and(1.6±0.4)×10^(4) Yuan,significantly less compared with(141±37)min,(9.6±1.9)d and(3.4±2.1)×10^(4) Yuan in the RH group(t=-235.125,-161.889,-23.359;P<0.05).In the LMWA group,the incidence of postoperative complications was 29%(9/31),significantly lower than 73%(29/40)in the RH group(χ^(2)=1.309,P<0.05).The 1-,2-and 3-year tumor-free survival rates in the RH and LMWA groups were 70.0%,52.5%,30.0%,and 67.7%,48.4%,29.0%,with no significant differences(χ^(2)=0.042,P>0.05).Conclusions RH and LMWA yield similar clinical efficacy in the treatment of recurrent small HCC,whereas LMWA has significant advantages over RH in repeatability,expense,minimal invasiveness and safety,etc.

关 键 词：癌 肝细胞 腹腔镜 微波消融 肝切除术 疗效 

分 类 号：R73[医药卫生—肿瘤]