开腹射频消融综合治疗不可切除大肝癌探讨

Laparotomy Radiofrequency Ablation Applied in Unresectable Large Primary Hepatocellular Carcinoma

目的:探讨开腹射频消融术在不可切除大肝癌患者中的应用价值。方法:回顾分析16例开腹射频治疗不可切除原发性大肝癌患者临床病历资料,Kaplan-Meier法进行生存分析,总结该术式优缺点。结果:手术成功率100%,无手术死亡,术后并发症:腹腔出血1例,上消化道出血1例,出现术后炎症反应综合征(SIRS)3例。手术时间330~720min,平均手术时间511.56min,出血量10~700ml,平均出血量190.63ml,射频针数7~30针,平均针数14.13针。射频消融范围:CR(complete response):2例,ICR(incomplete response):14例。术后随访时间3~52个月,中位生存时间为15个月。结论:开腹射频消融术在不可切除大肝癌患者中的应用可以使大部分患者生存期得到延长,手术安全性高,合理掌握适应证及综合治疗模式能够进一步提高该术式疗效。

Objective:To investigate the value of laparotomy radiofrequency ablation(RFA)in unresectable large primary hepatocellular carcinoma(PHC).Methods:The clinical data of 16 unresectable large PHC patients underwent laparotomy RFA in General Surgery Department of Capital Medical University affiliated Beijing Youan Hospital from May2011 to January 2014 were retrospectively analyzed.We use Kaplan-Meier method to analyze the Survival and discuss the advantages and disadvantages of this procedure.Results:Technical success of RFA was achieved in all 16 patients with no operation death.Main complication included 1 case abdominal bleeding,1 case of upper gastrointestinal bleeding and 3 cases of systemic inflammatory response syndrome(SIRS).Operation time last 330~ 720 min,average511.56 min.Blood loss was 10~700 ml and 190.63 ml in average.The average RFA sites in operation was 14.13(7~30).2 cases achieved complete response(CR)and 14 cases achieved incomplete response(ICR)which was measured 1 month after operation.15 patients were followed up from 3~52 months,the median survival time was 15 months.Conclusion:The laparotomy RFA is safe for patients and can prolong most patients' survival.Taking the indications reasonably and conducting the comprehensive treatment can improve the therapeutic effect of laparotomy RFA.