腹腔镜下微波固化联合肝切除治疗肝硬化合并肝细胞癌的疗效

Curative effect of laparoscopic microwave coagulation combined with hepatectomy for liver cirrhosis complicated with hepatocellular carcinoma

目的 探讨腹腔镜下微波固化联合肝切除治疗肝硬化合并肝细胞癌（肝癌）的安全性和疗效.方法 回顾性研究2009 年1 月至2013 年11 月在中山大学孙逸仙纪念医院接受诊治的58 例肝硬化合并肝癌患者临床资料.按治疗方式不同将患者分为微波固化联合肝切除组（联合组）和单纯微波固化组（固化组）.其中联合组37 例,男29 例,女8 例;平均年龄（54±9）岁.固化组21 例,男17 例,女4 例;年龄（58±10）岁.所有患者均签署知情同意书,符合医学伦理学规定.固化组仅于腹腔镜下行微波固化.联合组于微波固化后在距肿瘤边缘1～2 cm 标记切割线后行肝切除术.观察两组患者术中出血量、手术时间.患者术中出血量、手术时间比较采用Wilcoxon 秩和检验,生存分析采用Log-rank 法和Z 检验. 结果 联合组术中出血量146 （58～250）ml 明显多于固化组的13（ 10～25）ml（Z=7.824,P〈0.05）.联合组手术时间177（ 83～275）min 明显长于单纯固化组的93（ 36～135）min（Z=8.650,P〈0.05）.联合组患者3 年累积生存率及1、3 年无瘤生存率97%、83%、92%,均明显高于固化组的64%、71%、43%（Z=10.054,9.011, 7.112;P〈0.05）.结论 腹腔镜下微波固化联合肝切除术治疗肝硬化合并肝癌安全、有效,其远期疗效优于单纯腹腔镜微波固化.

Objective To investigate the safety and curative effect of laparoscopic microwave coagulation combined with hepatectomy for liver cirrhosis complicated with hepatocellular carcinoma(HCC).Methods Clinical data of 58 patients with liver cirrhosis complicated with HCC diagnosed and treated in Sun Yat-sen Memorial Hospital of Sun Yat-sen University between Janunary 2009 and November 2013 were retrospectively studied.The patients were divided into the microwave coagulation combined with hepatectomy group(the combination group) and the simple microwave coagulation group(the coagulation group) according to different treatment methods.Among the 37 patients in the combination group,29 were males and 8 were females with average age of(54±9) years old.Among the 21 patients in the combination group,17 were males and 4 were females with average age of(58±10) years old.The informed consentsof all patients were obtained and the local ethical committee approval had been received.The patients in the coagulation group only underwent laparoscopic microwave coagulation,while the patients in the combination group underwent hepatectomy after marking a incision line 1-2 cm from the tumor edge and undergoing microwave coagulation.The intraoperative blood loss and the duration of operation of two groups were observed.The comparison of the intraoperative blood loss and the duration of operation were conducted using Wilcoxon rank-sum test and the survival analysis was conducted using Log-rank test and Z test.Results The intraoperative blood loss of the combination group was 146(58-250) ml,which was significantly higher than 13(10-25) ml of the coagulation group(Z=7.824,P<0.05).The duration of operation of the combination group was 177(83-275) min,which was significantly longer than 93(36-135) min of the coagulation group(Z=8.650,P<0.05).The 3-year cumulative survival rate and 1-,3-year disease free survival of the combination group were respectively 97%,83%,92%,which were significantly higher than 64%,71%,43% of the coagulation group(Z=10.054,9.011,7.112;P<0.05).Conclusions Laparoscopic microwave coagulation combined with hepatectomy for liver cirrhosis complicated with HCC is safe and effective.The long-term curative effect is better than that of simple laparoscopic microwave coagulation.