射频消融及^(125)I粒子植入在预防肝癌切除术后局部复发的作用

Intraoperative radiofrequency ablation and ^(125)I therapy for preventing local recurrence in hepatocellular carcinoma after hepatectomy

目的探讨降低原发性肝癌切除术后局部复发的方法,提高肝癌患者的长期生存率。方法78例肿瘤靠近第一、第二肝门,估计切缘距肿瘤<1cm的肝癌患者,按就诊单双日分为单纯切除组和联合组。单纯切除组38例,仅行常规肝癌切除;联合组40例,在肝癌切除后,切缘行射频消融和^(125)I粒子植入。全部患者术后均定期随访。结果联合组术后1、3、5年肿瘤复发率分别为7.5%、30.0%和45.0%,术后1、3、5年生存率分别为92.5%、67.5%和30.0%,与单纯切除组比较,其中3、5年复发率差异有统计学意义((x^2=7.340,P<0.01;x^2=15.740,P<0.01);联合组的3、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射频消融和^(125)I粒子植入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生存期。

Objective To evaluate the efficacy of intraoperative radiofrequency ablation and ^125I therapy for preventing local recurrence in hepatocellular carcinoma（HCC） after hepatectomy. Methods Seventyeight HCC patients with a tumor close to the first or the second hepatic portal underwent hepatectomy with a resection margin less than 1 cm from 1999 to 2001. All patients were randomly divided into control group and combined treatment group according to their check-in date （odd or even）. In the control group, 38 patients were treated with hepatectomy alone, whereas in the combined group, 40 patients were treated with hepatectomy plus radiofrequency ablation and ^125I implantation on surgical margin. All patients were followed up regularly. Results the 1-, 3- and 5-year recurrent rate was 7.5%, 30.0% and 45.0% in the combined treatment group versus 18.4%, 60.5% and 86.8% in the control group, respectively, with a significant difference in the 3-year （X^2 =7. 340, P 〈0.01 ） and 5-year recurrent rates （X^2 = 15. 740,P 〈 0.01）. The 1-,3- and 5-year survival rate was 92.5%, 67.5% and 30.0% in the combined group versus 81.5%, 39.4% and 18.4% , respectively. Conclusion Intraoperative radiofrequency ablation and ^125I therapy on the resection margin is effective to prevent local recurrence in HCC patients after hepatectomy, and to prolong their postoperative tumor free survival.