腹腔镜肝切除术联合微波消融治疗多发性结直肠癌肝转移  

Laparoscopic hepatectomy combined with intraoperative microwave ablation in the treatment of multiple colorectal liver metastases

作　　者：宋华传 季鹏 姚焕章 王永帅 张珅瑜 宋瑞鹏 王继洲 Huachuan Song;Peng Ji;Huanzhang Yao;Yongshuai Wang;Shenyu Zhang;Ruipeng Song;Jizhou Wang(Department of Hepatobiliary Surgery,the First Affiliated Hospital of University of Science and Technology of China,Anhui 230002,China)

机构地区：[1]中国科学技术大学第一附属医院肝胆外科,安徽230002

出　　处：《中华腔镜外科杂志（电子版）》2024年第4期222-226,共5页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

摘　　要：目的比较腹腔镜肝切除术联合微波消融与仅腹腔镜肝切除术治疗多发性结直肠癌肝转移(colorectal liver metastases,CRLM)的术后并发症发生率和复发情况。方法回顾性分析了2018年12月至2024年1月中国科学技术大学第一附属医院124例接受腹腔镜肝切除术联合或不联合腹腔镜超声引导微波消融治疗的多发性CRLM患者的临床资料。其中,腹腔镜肝切除术联合微波消融组42(33.9%)例、腹腔镜肝切除术组82(66.1%)例。采用单因素和多因素logistic回归模型分析与术后主要并发症相关的因素。Kaplan-Meier生存分析方法和对数秩检验用于比较不同手术组患者的无复发生存(recurrence-free survival,RFS)情况。结果腹腔镜肝切除术联合微波消融组患者的病灶数目更多(P<0.001),肝两叶受累比例更高(P<0.001)。20(16.1%)例发生Clavien-Dindo分级Ⅱ级及以上的并发症。多因素分析结果提示,体质量指数(body mass index,BMI)≥24.0 kg/m2(OR 5.11,95%CI:1.54~16.95,P=0.008)和术中输血(OR=7.90,95%CI:1.00~62.15,P=0.050)是术后主要并发症的独立危险因素。两种手术方式的RFS差异无统计学意义(P=0.81),中位RFS分别为8.8个月和10.2个月。结论腹腔镜肝切除联合微波消融为肿瘤数目较多和肝两叶受累的CRLM患者提供了一个根治性手术的机会。CRLM个体化治疗时,可以在保留肝功能的情况下,采取更加积极的根治性手术方案以改善预后。Objective To compare the postoperative complications and recurrence of multiple colorectal liver metastases(CRLM)treated by laparoscopic hepatectomy combined with microwave ablation and laparoscopic hepatectomy alone.Methods The clinical data of 124 patients with multiple CRLM who underwent laparoscopic hepatectomy combined with or without intraoperative microwave ablation from Dec.2018 to Jan.2024 were retrospectively analyzed.42 cases(33.9%)underwent laparoscopic hepatectomy combined with microwave ablation,and 82 cases(66.1%)underwent laparoscopic hepatectomy.Univariate and multivariate Logistic regression models were used to analyze the factors associated with major postoperative complications.Kaplan-Meier survival analysis and logarithmic rank test were used to compare recurrence-free survival(RFS)in different surgical groups.Results The number of lesions in laparoscopic hepatectomy combined with microwave ablation group was higher(P<0.001),and the proportion of hepatic bilobar involvement was higher(P<0.001).Complications of Clavien-Dindo gradeⅡand higher occurred in 20(16.1%)patients.Multivariate analysis suggested that BMI≥24.0 kg/m2(OR 5.11,95%CI:1.54-16.95,P=0.008)and intraoperative blood transfusion(OR 7.90,95%CI:1.00-62.15,P=0.050)was independent risk factors for postoperative complications.There was no significant difference in RFS between the two groups(P=0.81),and the median RFS was 8.8 and 10.2 months,respectively.Conclusions Laparoscopic hepatectomy combined with microwave ablation provides an opportunity for radical surgery in multiple CRLM patients with bilobar involvement.In the individual treatment of CRLM,a more aggressive radical surgical strategy can be adopted to improve the prognosis while preserving liver function.

关 键 词：结直肠癌肝转移 腹腔镜肝切除 微波消融 术后并发症 无复发生存率 

分 类 号：R735.37[医药卫生—肿瘤]