134例不能切除肝癌的深部冷冻治疗

Cryosurgery for 134 cases of with unresectable hepatic cancer

目的探讨手术不能切除肝癌行深部冷冻治疗的效果及其并发症的防治。方法从1988年5月至2003年12月应用APCA1-3型冷冻治疗机冷冻治疗不能切除的肝癌134例,癌块直径平均为8.7cm,其中原发性肝癌122例。总结冷冻治疗效果并比较三个时期冷冻治疗肝癌后并发症及其死亡率:1988年至1992年36例,1993年至1997年32例,1998年至2003年66例。结果病理检查显示冷冻区肝组织及肝肿瘤为不可逆性坏死。其1、3、5年生存率分别为76.4%、39.8%、27.4%,围手术期死亡率为3%(4/134)。术后腹腔内出血及肝功能衰竭,两项并发症在三个时段的发生率及手术期死亡率依次递减,分别为22.1%、11.7%、7.5%;5.5%、3.1%、1.5%。结论深部冷冻治疗手术不能切除的肝癌是一个有效的方法。改进冷冻设施及手术技术措施,可以减少并发症的发生及围手术期死亡。

Objective To study the effect of cryosurgery for unresectable hepatic cancer and the prevention and treatment of complications. Methods From May 1988 to December 2003,134 patients with unresectable hepatic cancer underwent cryoablation by APCA1 - 3 apparatus. Of them there were 122 cases of primary hepatocellular carcinoma with the average diameter of the tumors being about 8.7 cm. Complications and mortality during cryoablation were compared in 3 periods： 36 cases during 1998-1992 ;34 eases during 1993-1997 and 66 cases during 1998 -2003. The 1 - ,3 - and 5 - survival rate was also observed. Results Pathological examination showed the irreversible necrosis of liver tissues and tumors in the frozen area. The perioperative mortality was about 3% ,and the 1 - ,3- and 5 - year survival rate was 76.4 % ,39.8 % and 27.4 % respectively. Postoperative abdominal bleeding and failure of liver function were the severe complications after cryosurgery of hepatic cancer,and the primary cause of death. The morbidity of the complications and operative mortality caused by abdominal bleeding and failure of liver function were decreased in the order of the three periods, 22.1%, 11.7 %, 7.5 % ; 5.5 % ,3.1%, 1.5 % respectively. Conclusion Cryosurgery is effective for patients with unresectable hepatic cancer. Improvement of frozen apparatus and surgical procedures could decrease the incidence of complications and perioperative deaths.