切缘冷冻对原发性肝癌切除术后局部复发的预防作用

Incisal edge cryotherapy for the prevention of local recurrence in primary liver cancer patients undergoing hepatectomy

目的探讨降低原发性肝癌切除术后局部复发的方法,改善肝癌患者的长期生存率。方法自1998年4月至2002年4月,我院行肝癌切除术切缘距肿瘤不足1 cm的患者共45例,分为冷冻组和单纯切除组两组。冷冻组23例,常规肿瘤切除后以扁平探头对肝切缘进行接触冷冻,冷冻深度控制在1．0～1．5 cm；单纯切除组22例,单纯行常规肝癌切除手术,不予冷冻治疗。全部患者术后均定期随访复发及生存时间。结果冷冻组术后1年、3年和5年复发率分别为8．7%、26．1%和34．8%,术后1年、3年和5年生存率分别为82．6%、56．5%和30．4%,与单纯切除组比较,其中3年(X^2=5．021,P=0．025)、5年复发率差异有统计学意义(X^2=12．465,P=0)；冷冻组的3年、5年生存率较单纯切除组呈现明显升高的趋势。结论肝癌切除后切缘冷冻能有效地降低术后局部复发率,提高治疗效果,且有可能延长肝癌患者的长期生存时间。

Objective To evaluate intraoperative cryotherapy in the prevention of local recurrence in patients of hepatocellular carcinoma （HCC） undergoing hepatectomy. Methods Between 1998 and 2002, there were a total of 45 HCC patients undergoing liver resection with a surgical margin less than 1 cm. A paddle probe was used to freeze surgical margins in 23 patients with a resultant ablation depth of 1.0 - 1.5 cm. The other 22 cases served as controls. Results All postoperative patients were followed up regularly. In cryosurgery group, the 1-, 3-, 5-year recurrent rates were 8.7%, 26. 1% and 34. 8%, respectively. The 1-, 3-, 5-year survival rates were 82. 6%, 56. 5% and 30. 4%, respectively. Compared with controls, the 3-year（ χ^2 = 5.021, P = 0. 025 ） and 5-year （ χ^2 = 12. 465, P = 0. 000 ） recurrent rates were significantly lower, the 3-, 5-year survival rates in the cryosurgery group were higher. Conclusions Incisal edge cryotherapy is effective for the prevention of local recurrence of HCC patients undergoing hepatectomy resulting in a longer postoperative tumor free survival.