肝切除联合术中热消融治疗多灶性原发性肝癌

Combined hepatic resection and intraoperative thermal ablation for multifocal hepatocellular carcinoma

目的探讨肝切除联合术中热消融治疗多灶性原发性肝癌的安全性和治疗效果。方法回顾性分析1998年3月至2007年9月收治的17例原发性肝癌行肝切除联合术中热消融治疗患者的临床资料，对患者的治疗情况、术后并发症和生存期状况进行分析。结果1例术后因肝功能衰竭发生死亡，其余16例患者术后恢复良好。术后并发症发生率为23．5％，包括切口感染1例、胆瘘1例、膈下和胸腔积液1例、消融相关性肝脓肿1例，均经保守治疗后好转。平均存活时间25．9个月，1、3、5年生存率分别为70．6％（12／17）、23．5％（4／17）、17．6％（3／17）。3例术后生存时间超过5年。随访至2008年4月，共有4例存活。结论肝切除联合术中热消融可以提高原发性肝癌的切除率，改善预后，是多灶性原发性肝癌治疗的有效方法。

Objective To investigate the safety and efficacy of hepatic resection combined with intraoperative ablation to treat muhifocal hepatocellular carcinoma. Methods Clinical data of patients diagnosed with multifocal hepatoccllular carcinoma and treated with hepatic resection combined with intraoperative ablation from March 1998 to September 2007 were retrospectively reviewed. Treatment response, postoperative complications and survival data were analyzed. Results Combined treatment modalities were well tolerated except one patient dying of postoperative hepatic functional failure. The postoperative complication rate was 23.5% with a mortality rate of 6. 7% . Postoperative complication included wound infection （ 1 case ） , bile leakage （ 1 case ） , subphrenic and pleural effusion （ 1 case ） , ablation-associated liver abscess（ 1 case）,all of which were treated with non-surgical methods. The median survival time was 25.9 months. The 1,3,5 year survival rates were 70. 6% （12/17）,23.5% （4/17）, 17.6% （3/17） ,respectively. Three patients survived more than 5 years after surgery. Up to April 2008,4 patients were still alive. Conclusion Hepatectomy combined with intraoperative thermal ablation provides a treatment modality for patients with muhifocal hepatocellular carcinoma and may improve the prognosis.