肝细胞癌切除术中微波处理肝断面对肿瘤复发的影响

Impact of microwave dealing with the cutting after hepatectomy

目的探讨微波处理肝细胞癌（HCC）切除术中肝断面对患者围手术期肝功能恢复和复发转移的影响。方法回顾性分析2009年3月至2010年11月133例HCC患者的临床资料，分为常规手术组（66例）和微波治疗组（67例）。微波治疗组患者在肿瘤切除后，肝脏断面拟国产ECO-100微波刀，将微波刀头在距离切缘0．5cm处插入断面，取多点反复烧灼，平均烧灼时向25min。比较微波治疗组和常规手术组HCC患者围手术期肝功能的恢复情况和复发转移情况。结果常规手术组患者的手术时间为（158．0±31．0）min，微波治疗组患者的手术时间为（181．0±28．0）min，差异有统计学意义（P=0．027）。微波治疗组和常规手术组患者围手术期肝功能和一般指标的比较，差异均无统计学意义（均P〉0．05）。常规手术组和微波治疗组术后6个月分别有15和6例患者复发转移，差异有统计学意义（P=0．034）。常规手术组和微波治疗组术后12个月分别有20和9例患者复发转移，差异有统计学意义（P=0．022）。结论HCC患者的肝切除断面以微波处理后，对患者围手术期肝功能和一般情况的恢复无明显影响，且微波治疗可以降低HCC患者1年内的原位复发率，具有较好的临床应用价值。

Objective To explore the impact of microwave dealing with cutting surface on perioperative liver function recovery and recurrence and metastasis after hepatectomy for HCC. Methods Clinical data of 133 patients with HCC from March 2009 to November 2010 were retrospectively analyzed. They were divided into the conventional surgery group （66 cases ） and microwave treatment group （67 cases ）. A domestic ECO-100 microwave knife was inserted into the liver cutting surface 0.5 cm from the cutting edge, and repeated multi-point burning with an average time of 25 minutes in the microwave treatment group. Then the perioperative liver function recovery and recurrence and metastasis in the two groups were compared. Results The operation time of conventional surgery group was （158.0 ± 31.0） minutes, and that of microwave treatment group was significantly longer （ 181.0 ± 28.0 ） minutes （ P = 0.027 ）. There were no significant differences in the liver function recovery between the two groups （P〉0.05）. There were 6 cases of recurrence and metastasis after 6 months and 9 cases after 12 months in the microwave treatment group, while there were 15 cases of recurrence and metastasis after 6 months and 20 cases after 12 months in the conventional surgery group, showing a significant difference （P = 0. 034 and 0. 022, respectively ）. Conclusions Microwave dealing with the cutting surface has no significant effect on perioperative liver function recovery in hepatectomy. However, microwave treatment can reduce the in situ recurrence in HCC patients within the first year after surgery, indicating a good clinical application value.