中央型肝癌手术切除联合放疗的临床研究

Partial hepatectomy combined with radiotherapy for centrally located hepatocellular carcinoma

目的探讨中央型肝癌切除联合放疗的安全性及治疗效果。方法本研究为前瞻性研究。2007年至2010年于我院行手术治疗的34例中央型肝癌患者入选。所有患者术前均通过影像学评估手术的可切除性。术中采用区域性肝血流阻断配合超声乳化吸引刀技术切肝。瘤床放置金属标记、术后进行适形调强放射治疗，并予定期随访。结果术后病理证实34例均为肝细胞癌，5例见脉管瘤栓，1例有门静脉瘤栓，30例（88．2％）伴有肝硬化。术后5例出现并发症，肺部感染、右侧胸腔积液、腹腔感染、急性肾功能衰竭、房颤各1例。3例患者未完成放疗疗程，31例完成术后放疗。除3例出现Ⅲ。骨髓抑制外，其余均为I。或Ⅱ。副反应。34例均获随访，随访率100％，中位随访时间19个月。1年、3年无瘤生存率分别为69．5％、64．2％；1年、3年总生存率分别为97．0％、86．2％。结论中央型肝癌手术切除联合放疗安全，疗效较好。

Objective To investigate the safety and efficacy of partial hepatectomy combined with radiotherapy for centrally located hepatocellular carcinoma. Methods From 2007 to 2010, 34 pa- tients with centrally located hepatocellular carcinoma treated in our institution were enrolled into this prospective study. Preoperatively, computed tomography and/or magnetic resonance imaging were used to evaluate the resectability of tumor. During operation, selective regional-hepatic vascular occlu- sion technique was used. Cavitron ultrasonic surgical aspirator was applied for parenehymal transec- tion. Surgical clips were placed on the tumor bed to guide postoperative three dimensional conformal radiotherapy. All patients were followed up regularly. Results Histopathologically, all patients had hepatocellular carcinoma. Microvascular invasion was seen in 5 patients, and portal vein thrombosis in 1, 30 patients （88.2%） had liver cirrhosis. 5 patients developed postoperative complications： 1 pul monary infection, 1 right pleural effusion, 1 intra-abdominal infection, 1 acute renal failure, and 1 at- rial fibrillation. 3 patients did not receive a complete course of radiotherapy. 3 patients developed Ⅲ degree myelosuppression while I or Ⅱ degree side effects were seen in the other patients. The follow up rate was 100% and the median follow-up time was 19 months. The 1- and 3-year disease-free sur- vival rates were 69.5% and 64.2%, respectively. The 1- and 3-year overall survival rates were 97% and 86.2%, respectively. Conclusion For the centrally located hepatocellular carcinoma, partial hep- atectomy combined with radiotherapy was safe and efficacious.