腹腔镜肝切除联合微波消融治疗肝细胞癌患者疗效及安全性评价

Clinical efEcacy and safety of microwave ablation combined with laparoscopic liver resection in treatment of patients with hepatocellular carcinoma

目的探讨微波消融联合腹腔镜肝切除治疗肝细胞癌合并肝硬化患者的临床疗效及安全性。方法收集2009年3月至2015年3月于我院进行治疗的肝细胞癌合并肝硬化患者70例,对观察组38例患者行微波消融联合腹腔镜肝切除治疗,对照组32例患者接受腹腔镜肝切除治疗。对两组患者围手术期情况、手术前后肝功能指标、完全切除率、术后复发率和并发症等进行观察和比较。结果观察组患者手术时间为(162.3±32.4)min,明显长于对照组【(131.0±27.9)min,P<0.05】,观察组术中出血量、腹腔引流管拔管时间和术后住院时间分别为【(132.5±25.6)m L、(5.2±1.3)d和7.3±1.8)d】,均明显少于或短于对照组【(368.4±67.1)m L、(7.0±1.6)d和(10.4±2.0)d,P<0.05】;观察组术后7 d总胆红素和谷丙转氨酶分别为【(19.7±5.2)μmol/L和(86.7±31.4)IU/L】,显著低于对照组【(24.1±5.8)μmol/L和(132.6±27.5)IU/L,P<0.05】,观察组术后7 d白蛋白为(43.3±10.8)g/L,显著高于对照组【(32.4±10.1)g/L,P<0.05】,而两组凝血酶原时间国际标准化比值(INR)分别为【(1.2±0.1)和(1.1±0.2),P>0.05】;观察组肿瘤完全切除率为94.7%,显著高于对照组的78.1%(P<0.05);观察组术后12个月肿瘤复发率为7.9%,显著低于对照组的28.1%(P<0.05)。结论微波消融联合腹腔镜肝切除治疗肝细胞癌合并肝硬化患者疗效显著,安全性高,对于肝功能损伤较小。

Objective To explore the clinical efficacy and safety of microwave ablation combined with laparoscopic liver resection in treatment of patients with hepatocellular carcinoma（HCC）with underlying liver cirrhosis. Methods 70 patients with HCC and underlying liver cirrhosis were accepted in our hospital between March 2009 and March 2015. 38 patients in observation group underwent microwave ablation combined with laparoscopic liver resection and 32 patients in control group underwent laparoscopic liver resection. The perioperative parameters,liver function indexes before and after treatment,complete resection rate,recurrence rate,and complications in the two groups were observed and compared. Results The operation time in observation group was （162.3±32.4）min,obviously longer than in control group [（131.0±27.9） min,P〈0.05],and the blood loss,drainage tube removal time and hospital stays in observation group were[（132.5±25.6）mL,（5.2±1.3）d and（7.3±1.8）d],less or shorter than in control group[（368.4±67.1） mL,（7.0±1.6） d and （10.4±2.0） d,P〈0.05];serum bilirubin and alanine transaminase levels 7 days after operation in observation group were[（19.7±5.2）μmol/L and（86.7±31.4）IU/L],obviously lower than in control group[（24.1±5.8）μmol/L and （132.6±27.5）IU/L,P〈0.05];serum albumin in the two groups were[（43.3±10.8）g/L and （32.4±10.1）g/L,P〈0.05],while the prothrombin time international normalized ratio in the two groups were not significantly different（P〉0.05）;The complete resection rate in the observation group was 94.74%,obviously higher than 78.13% （P〈0.05）in the control group;the recurrence rate in the observation group was 7.89%,much lower than in the control group （28.13%,P〈0.05）. Conclusion Microwave ablation combined with laparoscopic liver resection has a good efficacy and safety in treatment of patients with HCC and liver cirrhosis.