经皮微波消融与腹腔镜下解剖性肝切除治疗直径≤3cm原发肝癌的疗效分析  

Comparison of Percutaneous Microwave Ablation and Laparoscopic Anatomic Liver Resection in the Treatment of Hepatocellular Carcinoma with a Tumor Diameter≤3cm

作　　者：季鹏 孟凡征 张珅瑜 张少博 王永帅 王继洲 宋瑞鹏 JI Peng;MENG Fan-zheng;Zhang Shenyu(Graduate School,Bengbu Medical University,Benbu 270030,China;不详)

机构地区：[1]蚌埠医学院研究生院,蚌埠233030 [2]中国科学技术大学附属第一医院(安徽省立医院)肝胆外科

出　　处：《肝胆外科杂志》2024年第6期438-444,共7页Journal of Hepatobiliary Surgery

摘　　要：目的研究经皮微波消融与腹腔镜下解剖性肝切除术在治疗直径≤3 cm原发性肝癌(hepatocellular carcinoma,HCC)患者中的临床疗效。方法回顾性分析2017年1月至2022年12月在中国科学技术大学附属第一医院收治的167例单发肿瘤直径≤3 cm的HCC患者的临床病理资料,其中89例接受腹腔镜下解剖性肝切除术作为腔镜手术组,78例接受超声引导下经皮微波消融术作为微波消融组。使用倾向性评分匹配(PSM)法平衡两组基线资料,比较两组患者术前、术后血清肝功能指标、并发症发生率及术后随访的生存情况。比较两组1、2、3年的总生存率(Overall Survival,OS)及无复发生存率(recurrence-free survival,RFS)情况。用Cox回归模型分析影响OS和RFS的危险因素。结果倾向性评分匹配按1:1最近邻匹配法后,两组共计48对匹配成功,与腔镜手术组相比,微波消融组手术时间、术后住院时间及住院费用显著减少,差异具有统计学意义(P<0.05)。术后肝功能指标丙氨酸氨基转移酶(alanine aminotransferase ALT)和天冬氨酸氨基转移酶(aspartate aminotransferase AST)在微波消融组显著优于腔镜手术组(P<0.05)。并发症发生率方面,微波消融组明显低于腔镜手术组(4.2%vs.27.1%,P<0.05)。微波消融组和腔镜手术组1、2、3年的无复发生存率,腔镜手术组均显著高于微波消融组(P<0.05)。1、2、3年的总生存率,两组差异无统计学意义(P>0.05)。多因素Cox回归分析显示,谷草转氨酶(HR=2.18,95%CI:1.18-4.02,P=0.013)为影响病人RFS的独立危险因素。结论对于手术适应性良好的患者优先选择腔镜肝切除术,而对于不适合手术或偏好微创治疗的患者,可考虑微波消融术。Objective To compare the clinical efficacy of percutaneous microwave ablation(MWA)versus laparoscopic anatomic liver resection(LALR)in the treatment of hepatocellular carcinoma(HCC)with tumors≤3 cm in diameter.Methods A retrospective analysis was conducted on 167 patients with a single HCC tumor≤3 cm treated at The First Affiliated Hospital of the University of Science and Technology of China from January 2017 to December 2022.Among them,89 patients underwent laparoscopic anatomic liver resection(LALR)as the laparoscopic surgery group,and 78 patients received ultrasound-guided percutaneous microwave ablation(MWA)as the microwave ablation group.Propensity score matching(PSM)with 1:1 nearest-neighbor matching was used to balance the baseline characteristics of the two groups.Preoperative and postoperative serum liver function markers,complication rates,and survival outcomes were compared between the two groups.The overall survival(OS)and recurrence-free survival(RFS)rates at1,2,and 3 years were compared,and Cox regression analysis was performed to identify independent risk factors affecting OS and RFS.Results After matching 48 pairs of patients between the two groups using propensity score matching,the MWA group had significantly shorter operation times,shorter postoperative hospital stays,and lower hospitalization costs compared to the LALR group,with statistical significance(P<0.05).Postoperative liver function indicators,including alanine aminotransferase(ALT)and aspartate aminotransferase(AST),were significantly better in the MWA group compared to the LALR group(P<0.05).The complication rate was significantly lower in the MWA group than in the LALR group(4.2%vs.27.1%,P<0.05).The MWA group had significantly lower 1-,2-,and 3-year recurrence-free survival rates compared to the LALR group(P<0.05).There was no significant difference in overall survival rates between the two groups at 1,2,and 3 years(P>0.05).Multivariate Cox regression analysis revealed that aspartate aminotransferase(AST)(HR-2.18,95%CI:1.18-4.0

关 键 词：肝癌 微波消融 解剖性肝切除 腹腔镜 

分 类 号：R735.7[医药卫生—肿瘤]