原发性肝癌非根治性切除术中肝断面处理方法研究

Study on the treatment of residue liver in non-radical hepatectomy of primary liver cancer

目的探讨原发性肝癌(PLC)患者肝癌非根治性切除术中肝断面处理方法对术后复发的影响。方法选择2013年1月至2015年12月郑州大学附属肿瘤医院收治的139例PLC患者为研究对象,所有患者行肝癌非根治性切除术,根据术中肝断面处理方法分为观察组和对照组。对照组38例患者术中肝断面只做结扎止血处理;观察组101例患者术中肝断面分别给予高频电刀烧灼(28例)、放置植入用缓释氟尿嘧啶(49例)、放置125I放射性粒子(24例)处理。分别于治疗前、治疗后检测患者血清丙氨酸转氨酶(ALT)、谷草转氨酶(AST)、尿素氮及全血白细胞(WBC)水平,观察2组患者术后引流量、住院时间及胆漏、腹腔出血、腹腔感染发生率;所有患者术后随访1a,统计术后6个月、6~12个月内肿瘤复发率。结果2组患者手术前后血清ALT、AST、尿素氮及WBC水平比较差异均无统计学意义(P>0.05)。观察组患者术后胆漏、腹腔出血及腹腔感染发生率分别为6.93%(7/101)、2.97%(3/101)、14.85%(15/101),对照组患者术后胆漏、腹腔出血及腹腔感染发生率分别为5.26%(2/38)、2.63%(1/38)、13.16%(5/38);2组患者术后胆漏、腹腔出血及腹腔感染发生率比较差异均无统计学意义(χ^2=0.126、0.011、0.064,P>0.05)。2组患者术后引流量及住院时间比较差异均无统计学意义(t=1.440、0.521,P>0.05)。观察组患者术后6个月、6~12个月肿瘤复发率分别为12.87%(13/101)、8.04%(7/87),对照组患者术后6个月、6~12个月肿瘤复发率分别为28.95%(11/38)、11.11%(3/27);观察组患者术后6个月肿瘤复发率显著低于对照组(χ^2=4.995,P<0.05),但2组患者术后6~12个月肿瘤复发率比较差异无统计学意义(χ^2=0.242,P<0.05)。观察组患者中,术中肝断面高频电刀烧灼患者术后6个月、6~12个月肿瘤复发率分别为14.29%%(4/28)、12.50%(3/24),肝断面放置植入用缓释氟尿嘧啶患者术后6个月、6~12个月肿瘤复发率分别为12.24%(6/49)、6.98%(3/43),肝断面放置125I放射性粒子患者术后6个月、6~12个月肿瘤复发率分别为12.50%(3/24)、4.76%(1/21);肝断面3种处理方法患者的术后6个月、6~12个月肿瘤复发率比较差异无统计学意义(χ^2=0.965、1.026,P<0.05)。结论肝癌切除术中因肿瘤较大、紧邻重要管系或肝功能较差等原因无足够的切缘时,肝断面应该进行必要的处理,肝断面高频电刀烧灼、放置植入用缓释氟尿嘧啶、放置125I放射性粒子可以明显降低肝癌术后短期复发率。

Objective To investigate the effect of hepatic section treatment on the recurrence of primary liver cancer(PLC)after non-radical hepatectomy.Methods A total of 139 patients with PLC admitted to the Affiliated Tumor Hospital of Zhengzhou University from January 2013 to December 2015 were selected as the study subjects.All patients underwent non-radical hepatectomy.They were divided into observation group and control group according to the intraoperative treatment of liver section.The 38 patients in the control group underwent only ligation and hemostasis of the liver section during operation.In the observation group,101 patients were treated with high frequency electric knife cauterization(28 cases),fluorouracil sustained release for implant(49 cases)and 125 I radioactive particles(24 cases).The levels of serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),urea nitrogen and whole blood cell(WBC)were measured before and after treatment.The postoperative drainage volume,hospitalization time,bile leakage,abdominal hemorrhage and incidence of abdominal infection were observed in the two groups.All patients were followed up for 1 year,and the tumor recurrence rate was calculated within 6 months and 6-12 months after operation.Results There was no significant difference in the levels of serum ALT,AST,urea nitrogen and WBC between the two groups before and after operation(P>0.05).The incidences of bile leakage,abdominal hemorrhage and abdominal infection were 6.93%(7/101),2.97%(3/101)and 14.85%(15/101)in the observation group,and they were 5.26%(2/38),2.63%(1/38)and 13.16%(5/38)in the control group.There was no significant difference in the incidence of bile leakage,abdominal hemorrhage and abdominal infection between the two groups(χ^2=0.126,0.011,0.064;P>0.05).There was no significant difference in postoperative drainage volume and hospitalization time between the two groups(t=1.440,0.521;P>0.05).The tumor recurrence rates in the observation group were 12.87%(13/101)and 8.04%(7/87)at 6 months and 6-12 months after operation,respectively;and they were 28.95%(11/38)and 11.11%(3/27)in the control group,respectively.The tumor recurrence rate in the observation group was significantly lower than that in the control group at 6 months after operation(χ^2=4.995,P<0.05),but there was no significant difference between the two groups at 6-12 months after operation(χ^2=0.242,P<0.05).In the observation group,the tumor recurrence rates of patients with high frequency electric knife cauterization were 14.29%(4/28)and 12.50%(3/24)at 6 months and 6-12 months after operation;and they were 12.24%(6/49)and 6.98%(3/43)in patients with fluorouracil sustained release for implant,and 12.50%(3/24)and 4.76%(1/21)in patients with 125 I radioactive particles.There was no significant difference in the tumor recurrence rate at 6 months and 6-12 months after operation(χ^2=0.965,1.026;P<0.05).Conclusions When the resection margin of liver cancer is insufficient due to large tumors,adjacent important ducts or poor liver function and other reasons,the hepatic section should be treated as necessary.The high frequency electric knife cauterization,fluorouracil sustained release for implant and 125 I radioactive particles can significantly reduced the short-term recurrence rate of liver cancer after operation.