原发性肝癌合并肝硬化手术方法的探讨

Discussion on Surgical Methods of Primary Liver Cancer Complicated with Cirrhosis

目的:探讨原发性肝癌合并肝硬化应用经皮微波消融术联合肝动脉化疗栓塞术与肝切除术的治疗效果及预后情况.方法:选择本院2012年5月-2015年5月收治的原发性肝癌合并肝硬化100例,按照随机数字表法分为观察组与对照组,各50例.研究组采用经皮微波消融术联合肝动脉化疗栓塞术治疗,对照组采用常规肝切除术治疗,对比两组治疗效果及预后情况.结果:观察组术中出血量、手术时间、住院天数均少于对照组(P<0.05).术前,两组血清总胆红素(TBIL)、丙氨酸转氨酶(ALT)比较,差异均无统计学意义(P>0.05).术后1周,观察组TBIL、ALT与术前比较,差异均无统计学意义(P>0.05),而对照组TBIL与ALT均明显高于术前(P<0.05),且观察组TBIL与ALT均明显低于对照组(P<0.05).观察组并发症发生率为4.0%,低于对照组的22.0%(P<0.05).两组术后3年无瘤生存率与肿瘤复发率比较,差异均无统计学意义(P>0.05).结论:原发性肝癌合并肝硬化应用经皮微波消融术联合肝动脉化疗栓塞术治疗,可提高手术质量,缩短住院时间,保护肝功能,降低并发症发生率,在无瘤生存时限与肿瘤复发率方面,与肝切除术相近.

Objective:To investigate the therapeutic effect and prognosis of percutaneous microwave ablation combined with transcatheter arterial chemoembolization and the hepatectomy in the treatment of primary liver cancer with cirrhosis.Method:100 cases of primary liver cancer with cirrhosis admitted to our hospital from May 2012 to May 2015 were selected.They were divided into observation group and control group according to the random number table method,50 cases in each group.The observation group was treated with percutaneous microwave ablation combined with transcatheter arterial chemoembolization,and the control group was treated with conventional hepatectomy.The therapeutic effect and prognosis of the two groups were compared.Result:The amount of bleeding,surgery time and hospital stay in the observation group were lower than those in the control group(P<0.05).There were no differences in serum total bilirubin(TBIL),alanine aminotransferase(ALT) before surgery between the two groups(P>0.05).After surgery 1 week,TBIL and ALT of the observation group compared with those before surgery,the differences were not statistically significant(P>0.05),while TBIL and ALT of the control group were significantly higher than those before surgery(P<0.05),and TBIL and ALT of the observation group were significantly lower than those of the control group(P<0.05).The complication rate of the observation group was 4.0%,lower than 22.0% of the control group(P<0.05).There were no significant differences in the rate of tumor-free survival at 3 years after surgery and tumor recurrence between the two groups (P>0.05).Conclusion:Percutaneous microwave ablation combined with transcatheter arterial chemoembolization can improve the quality of surgery,shorten the course of disease,protect liver function and reduce the complication rate,the tumor-free survival time and tumor recurrence rate are similar to those of hepatectomy.