肝切除联合肝断面射频消融治疗伴有微血管侵犯肝细胞癌的临床研究  

Hepatectomy combined with radiofrequency ablation on liver cross section for hepatocellular carcinoma with microvascular invasion

作　　者：汤志鹏 张丹[1,2] 秦建伟[1] 党政 许树林 李月胜 许淑梅 马甘青 范瑞芳 Tang Zhipeng;Zhang Dan;Qin Jianwei;Dang Zheng;Xu Shulin;Li Yuesheng;Xu Shumei;Ma Ganqing;Fan Ruifang(Department of General Surgery,No.940 Hospital of Joint Logistic Support Force,Chinese People's Liberation Army,Lanzhou 730050,China;The Second Clinical Medical College of Lanzhou University,Lanzhou 730030,China)

机构地区：[1]中国人民解放军联勤保障部队第940医院普通外科,兰州730050 [2]兰州大学第二临床医学院,兰州730030

出　　处：《中华普通外科杂志》2022年第11期807-811,共5页Chinese Journal of General Surgery

基　　金：军队后勤科研计划项目(20BJZ23)。

摘　　要：目的探讨肝切除术中联合肝断面射频消融术对于伴有微血管侵犯(MVI)肝细胞癌早期复发的影响。方法将2015年6月至2020年6月收治的82例肝细胞癌患者分为两组。联合治疗组(n=41)采用非解剖性肝切除联合术中肝断面射频消融治疗,单纯肝切除组(n=41)仅采用非解剖性肝切除术。根据术后MVI病理诊断结果将患者进一步分为MVI阳性亚组和MVI阴性亚组,并分别比较亚组中采用联合治疗和单纯肝切除治疗患者的无复发生存率。结果两组患者的基线资料差异无统计学意义。联合治疗组的无复发生存率与单纯肝切除组相比差异无统计学意义(χ^(2)=0.177,P=0.674),但在亚组分析中,对MVI阳性患者联合治疗的无复发生存率高于单纯肝切除治疗,差异有统计学意义(χ^(2)=5.096,P=0.024);对于MVI阴性患者,两种治疗方式的无复发生存率差异无统计学意义(χ^(2)=0.688,P=0.407)。多因素分析显示仅肿瘤直径(HR=1.32,95%CI 1.02~1.72,P=0.036)为局部切缘复发的独立危险因素;而手术方式(HR=0.15,95%CI 0.04~0.52,P=0.003)和MVI(HR=8.65,95%CI 2.19~34.19,P=0.002)则为肝内远处复发的独立危险因素。结论非解剖性肝切除联合肝断面射频消融术可以有效地降低肝细胞癌伴MVI阳性患者的术后早期复发率。Objective To evaluate radiofrequency ablation-assisted liver resection on early recurrence of hepatocellular carcinoma(HCC)with microvascular invasion(MVI).Methods A total of 82 HCC patients from Jun 2015 to Jun 2020 were divided into assisted group(n=41)and control group(n=41)after local hepatectomy.And by pathology,both groups were further substratified into with or without MVI subgroups.Results There was no statistically significant difference in the baseline data between two groups,nor there was difference in recurrence-free survival rate between the two groups(χ^(2)=0.177,P=0.674).However,by subgroup analysis,the recurrence-free survival rate of ablation assisted group was higher than that of the simple local hepatectomy group among MVI positive patients(χ^(2)=5.096,P=0.024).Multivariate analysis showed that only tumor diameter(HR=1.32,95%CI:1.02-1.72,P=0.036)was an independent risk factor for local recurrence at the incisal margin,while mode of operation(HR=0.15,95%CI:0.04-0.52,P=0.003)and MVI(HR=8.65,95%CI:2.19-34.19,P=0.002)were independent risk factors for intrahepatic distant metastasis.Conclusion Local hepatectomy assisted by intraoperative radiofrequency ablation on hepatic cross section could effectively reduce the postoperative early recurrence rate for hepatocellular carcinoma patients with MVI.

关 键 词：癌 肝细胞 肝切除术 微血管侵犯 射频消融术 肝断面 

分 类 号：R735.7[医药卫生—肿瘤]