肝创面植入氟尿嘧啶微粒预防肝细胞癌切除术后复发

Recurrence prevention by embedding 5-FU microparticles on the cutting surface after hepatectomy for HCC

目的探讨肝细胞癌（hepatocellular carcinoma，HCC）根治性切除术后残肝创面植入氟尿嘧啶微粒（5 fluorouracil，5-FU）对预防术后复发的价值。方法回顾分析2007年3月至2008年3月184例HCC（单发，直径≤5cm，无肉眼癌栓）行肝切除患者的临床资料。患者分为2组，用药组90例，术中肝创面植入5-FU，对照组94例，术中未植入5-FU。术后随访患者复发情况。结果用药组与对照组患者中位无瘤生存时间分别为43个月和35个月，用药组术后1、2、3年的无瘤生存率为86％、76％、64％，对照组为77％、61％、49％，2组比较差异有统计学意义（x2=4．77，P〈0．05）。2组患者术后第7天肝’肾功能主要指标（总胆红素、血清白蛋白、丙氨酸转氨酶、尿素氮、血清肌苷）以及术后并发症比较，差异无统计学意义（P〉0．05）。结论HCC肝切除术后，残肝创面植入5-FU微粒，可显著提高HCC的无瘤生存率，对患者肝肾功能无显著影响，不增加术后并发症发生率。

] Objective To evaluate embedding 5-FU microparticles during operation after hepatectomy for small hepatocellular carcinoma to prevent recurrence. Methods A retrospective analysis on 184 patients was done. All patients received liver resection for HCC from 2007 Mar. to 2008 Mar. In 90 cases, 5-FU releasing microparticles were embeded on liver cutting surface after the tumor was resected （group A）. 94 cases in which no micropaticles were given served as controls （group B）. All patients had a single tumor（ ≤ 5 cm） without visible vessel invasion. Results The postoperative disease-free survival （DFS） ,and median period of DFS of group A vs. group B was 43 months vs 35 months. Postoperative DFS rates of 1-,2-and 3-year were 86% ,76% % and 64% respectively in A group, while they were 77% ,61% and 49% respectively in B group （X2 =4.77,P 〈0. 05）. In two groups the liver and kidney main function index（ TB, ALB, ALT, BUN, Scr）on day7 and postoperative complications were not statistically different （P 〉 0. 05）. Conclusions Embeding 5-FU microparticle after hepatectomy for HCC could increase the postoperative DFS rates, and patients do not suffer from significant liver and kidney malfunctions.