小肝癌切缘复发预防及临床处理方法的探讨

Prophylaxis and Clinical Treatment for Surgical Margin Recurrence of Small Primary Hepatocellular Carcinoma

背景与目的随着医疗诊断技术的提高,越来越多的小肝癌被发现,目前治疗小肝癌首选的方法仍是手术切除,但其术后复发率高达60%以上。本研究中我们对临床小肝癌进行回顾对照分析,拟探讨降低小肝癌手术切缘复发率的方法。方法回顾性分析广东省开平市中心医院和中山大学肿瘤医院在1991年1月～2003年5月间收治的283例小肝癌患者的临床病理资料。由于85%以上的肝癌患者合并不同程度肝硬化和肝储备功能不良,故以非规则性肝切除术为主。其中作肿瘤剔出术加残端切缘注射无水乙醇或无水乙醇明胶海绵创面填塞术140例(研究组);143例仅作普通常规处理(对照组)。比较两组患者的年龄、性别、肿瘤部位、肿瘤分期、Child-Pugh分期无统计学意义。结果研究组和对照组切缘1年复发率分别为21.4%和4.4%,有显著性差异(P<0.05);肝内转移/再发率分别为26.1%和24.5%,无统计学意义(P>0.05)。研究组和对照组5年总生存率分别为57.3%、52.8%(P=0.48),5年无瘤生存率分别为35.2%、36.9%(P=0.51)。两组患者术后一周内体温均在39℃以下;均无明显白细胞升高、胆漏及出血出现。结论不规则肝切除术后残端用无水乙醇明胶海绵填塞,或在残端处注射无水乙醇,对减少术后残端局部复发有一定效果,但对术后转移复发再发无作用,此法简单经济实用,便于推广应用,副作用少。

BACKGROUND & OBJECTIVE: Along with the advance of medical technology and instruments, many patients with small primary hepatocellular carcinoma (HCC) had been found, who are mainly treated with surgical resection with high postoperative recurrence rate of over 60%. This study was to explore prophylaxis and clinical treatment for these patients to reduce postoperative recurrence rate. METHODS: Clinicopathologic data of 283 patients with small HCC, treated in Central Hospital of Kaiping and Cancer Center of Sun Yat-sen University from 1991 through May 2003, were analyzed. Over 85% patients suffered cirrhosis with liver reserve dysfunction, and were mainly treated with irregular hepatectomy. Of the 283 patients, 140 received application of anhydrous alcohol injection or alcohol-soaked gelatin sponge on surgical margin (test group), 143 received no application of alcohol on surgical margin (control group). The 2 groups were comparable in age, gender, tumor location, clinical stage, and Child-Pugh stage. RESULTS: The 1-year surgical margin recurrence rate was significantly higher in test group than in control group (21.4% vs. 4.4%, P﹤0.05). Intrahepatic metastasis or recurrence rate, 5-year overall survival rate, and tumor-free survival rate were not different between the 2 groups. Both groups had no severe complications. CONCLUSIONS: Application of anhydrous alcohol on surgical margin or anhydrous alcohol injection in remnant liver after irregular hepatectomy may benefit to reduce postoperative recurrence in surgical margin for small PLC, but has no impact on intrahepatic metastases and recurrence in remnant liver.