肝切除联合射频消融及经肝动脉化疗栓塞术治疗多发性肝细胞肝癌

Hepatectomy combined with radiofrequency ablation and transarterial chemoembolization for multiple hepatocellular carcinomas

目的探讨手术切除联合射频消融（radiofrequency ablation，RFA）及经肝动脉化疗栓塞术（transarterial arterial chemoembolization，TACE）治疗多发性肝细胞肝癌的临床疗效。方法回顾性分析在我院行手术切除联合RFA及TACE治疗的27例多发性肝细胞肝癌患者的临床资料，观察患者治疗效果及术后并发症。结果本组27例均顺利完成姑息性手术及RFA治疗．行肝左外叶切除4例，左半肝切除8例，右半肝切除3例，右肝不规则切除12例。手术时间（223±77）min，术中出血量（435±144）ml。术后无肝内血肿、脓肿及腹腔出血、肝功能衰竭等严重并发症，无手术死亡。术后1个月所有患者均行增强CT及TACE，24例射频消融病灶均完全坏死固化，未见碘油沉积，3例患者病灶边缘仍可见碘油沉积。术后1年共有9例患者肝内出现新的病灶，术后随访8～39个月，术后中位生存时间为26．3个月。术后1、2、3年累积生存率分别为92％、60％、15％。结论手术切除联合RFA及TACE治疗多发性肝细胞肝癌是安全可行的，可提高部分患者手术切除率，近期疗效肯定。

Objective To evaluate surgical resection combined with RFA and TACE for multiple hepatocellular carcinoma. Methods Between 2010 and 2013, 27 multiple hepatocellular carcinoma cases were treated with surgical resection combined with RFA and TACE. The clinical data and postoperative complications were observed. Results Left lateral lobeetomy was performed in 4 patients, left hemihepatectomy was performed in 8 patients, right liver resection was performed in 3 patients, irregular right liver resection was performed in 12 patients. The operation time was （223±77 ） min, The intraoperative bleeding was （435 ± 144 ） ml. There were not postoperative severe complications, such as hepatic hematoma, liver abscess, intraabdominal hemorrhage, liver failure. Unresected focus uderwent complete necrosis or liquefaction in the RFA regions as shown by CT scanning after 1 month in 24 patients. Postoperative, TACE was performed regularly in all the patients. Lipiodol deposition on the margin of RFA regions was found in 3 patients. After a year, new foci were found in 9 eases. Patients were followed-up from 8 - 39 months. The median survival time after operation was 26, 3 months. The survival rates were 92% , 60%, 15%, respectively after 1, 2, 3 year. Conclusions For patients with multiple hepatocellular carcinoma, surgical resection combined with RFA and TACE was safe and effective .