手术切除联合术中氩氦刀冷冻治疗中晚期肝癌

Intraoperative argon cryosurgery in surgical resection of advanced hepatic carcinoma:safety and efficacy

目的探讨开腹手术联合氩氦超冷手术系统-氩氦刀(ASSS)治疗中晚期肝癌的方法、安全性及疗效。方法开腹对86例中晚期肝癌患者在TACE基础上行ASSS冷冻治疗或手术切除联合ASSS,其中单纯开腹ASSS14例,手术切除减瘤联合ASSS72例,门静脉置泵化疗6例,肝动脉置泵化疗9例。结果全组病例无术中及住院期间死亡。术后临床症状改善者66例(76.74%),无明显变化者15例(17.44%),恶化5例(5.82%)。术后复查CT,肿瘤明显缩小58例(67.44%),无明显变化30例(34.88%)。随访70例中死亡42例(60%),存活28例(40%)。原发性肝癌(PHC)ASSS术后0.5、1、3、5年生存率分别为44/48(91.67%)、35/48(72.92%)、28/48(58.33%)、20/48(41.67%);转移性肝癌(MHC)ASSS术后分别为21/22(95.45%)、18/22(81.82%)、13/22(50.09%)、8/22(36.36%);ASSS术后3、5年生存率PHC优于MHC(P<0.05)。手术切除联合ASSS组术后1、3、5年生存率分别为65/72(90.27%)、47/60(78.33%)、24/58(41.38%),显著高于ASSS组的10/14(71.43%)、8/12(66.67%)、4/12(33.33%)(P<0.05)。结论开腹手术联合ASSS靶向性强,疗效确切,可最大限度减少并发症,为中晚期肝癌提供了一种有效的治疗途径,联合其他方法可望进一步提高疗效。

Objective To evaluate the safety and efficacy of intraoperative argon/helittm cryosurgery in surgical resection of advanced hepatic carcinoma. Methods Eighty-six surgical patients with advanced hepatic carcinoma were enrolled in this study, including 14 undergoing argon cryosurgery for tumor removal and 72 receiving cryosurgery in addition to surgical tumor reduction. Portal vein or hepatic arterial pump placement was performed in 15 patients for chemotherapy. Results No death occurred in the operation or during the postoperative hospitalization period in these patients. Improvement of the clinical symptoms was observed in 66 cases （76.74%） and 43 （78.18%） patients showed significantly decreased blood AFP levels after the surgeries. Postoperative CT demonstrated obviously reduced tumor size in 58 cases （67.44%）. Of the 70 patients available for the follow-up, 28 survived with a survival rate of 40%. The 0.5-, 1-, 3 and 5-year survival rates were 44/48 （91.67%）, 35/48 （72.92%）, 28/48 （58.33%）, and 20/48（41.67%） in the patients with primary hepatic carcinoma （PHC）, respectively, as compared with those of 21/22 （95.45%）, 18/22 （81.82%）, 13/22 （50.09%）, and 8/22 （36.36%） in patients with metastasis hepatic carcinoma （MHC）. The 1-, 3- and 5-year survival rates of the patients undergoing surgical tumor resection and cryosurgery were 65/72 （90.27%）, 47/60 （78.33%） and 24/58 （41.38%）, respectively, significantly higher than the rates of 10/14 （71.43%）, 8/12 （66.67%） and 4/12 （33.33%） in the patients receiving cryosurgery only （P〈0.05）. Conclusions Argon cryosurgery offers an effective and safe option for management of advanced hepatic carcinoma, and its combination with other therapeutic approaches may achieve better clinical effects.