HCC术中放疗的安全性研究

Safety of intraoperative electron radiation therapy for primary hepatocellular carcinoma： a cohort study

目的 采用队列研究方法探讨IOERT在Ⅰ期HCC治疗中的安全性.方法 2010-2012年间初次病理诊断为Ⅰ期HCC的16例患者接受了IOERT.采用队列研究方法筛选同期行单纯根治术的87例Ⅰ期HCC患者,根据肿瘤大小（＞5 cm与≤5 cm）及切缘情况（近切缘与切缘阴性）进行1∶2配对,共32例为对照组.评价两组患者术中、术后不良事件,反映肝功能的生化、凝血象及血常规等指标变化,以及与IOERT相关的不良反应.独立样本t检验组间差异.结果 IOERT组与对照组相比,手术时间明显延长[（275.4±71.55） min和（184.7 ±64.74） min,P=0.000],术中不良事件发生率稍高（18.75％和6.25％,P=1.000）,手术并发症发生率稍低（12.50％和28.12％,P=0.460）,围手术期死亡率分别为0和6％ （P=0.440）.反映肝功能的实验室指标两组均相近（P＞0.05）,术后均降至1级或恢复正常.中位术后住院时间、外科住院时间、切口愈合时间及切口愈合级别两组也相似（P＞0.05）.IOERT组无放射性肝炎发生.结论 IOERT作为早期HCC术后的辅助治疗,对术后康复及肝功能等无影响,IORT剂量15 ～ 16 Gy是安全可行的.

Objective To investigate the safety of intraoperative electron radiation therapy （IOERT） for stage Ⅰ hepatocellular carcinoma （HCC） by a cohort study.Methods From November 2010 to May 2012,16 patients who were pathologically diagnosed with stage Ⅰ HCC underwent IOERT after radical resection.With a cohort study,87 patients with stage Ⅰ HCC who underwent radical resection alone during the same period were qualified,and according to tumor size （〉 5 cm and ≤ 5 cm） and resection margin （close margin and negative margin）,32 of 87 patients made up the control group.The intraoperative and postoperative adverse events,liver function parameters,coagulogram,and routine blood parameters,as well as IOERT-related adverse reactions,were evaluated.Independent-samples t test was used for analyzing the differences between groups.Results Compared with the control group,the IOERT group had a significantly longer operative time （（275.4 ± 71.55） min vs.（184.7 ± 64.74） min,P =0.000）,a slightly higher incidence of intraoperative adverse events （18.75% vs.6.25%,P=1.000）,a slightly lower incidence of operative complications （12.50% vs.28.12%,P =0.460）,and a lower perioperative mortality （0 vs.6%,P =0.440）.Liver function parameters showed no significant differences between the two groups （P 〉 0.05）.There were no significant differences between the two groups in postoperative time to grade 1 or normal liver function parameters,median length of postoperative hospital stay,length of hospital stay in the surgical department,time to incision healing,and level of incision healing （P 〉 0.05）.During follow-up,no radiation hepatitis was found in the IOERT group.Conclusions As an adjuvant therapy after radical resection for early HCC,IOERT has no significant side effects on postoperative recovery and liver function,and an intraoperative dose of 15-16 Gy is safe.