腹腔镜超声与经皮超声引导微波消融治疗复发性肝癌的临床效果比较

Clinical effect of microwave ablation for recurrent hepatocellular carcinoma under the guidance of laparoscopic ultrasound versus percutaneous ultrasound

目的比较腹腔镜超声与经皮超声引导微波消融治疗复发性肝癌的临床效果。方法回顾性分析2015-06~2018-02四川省医学科学院·四川省人民医院东院收治的90例复发性肝癌的临床资料,将腹腔镜超声引导微波消融的患者作为观察组,经皮超声引导微波消融的患者作为对照组,每组45例,比较两组术中出血量、手术时间、术后住院时间、总住院时间、病灶直径及消融时间、累积生存率及未复发生存率。结果对照组术中出血量、手术时间、消融时间、术后住院时间、总住院时间均少于或短于观察组(P<0.05)。观察组80.3%(49/61)病灶位于特殊部位,对照组3.4%(2/58)病灶位于特殊部位。随访0.5年、1年、1.5年,观察组累积生存率分别为100.0%、88.9%、75.6%,对照组分别为100.0%、82.2%、71.1%,差异无统计学意义(P>0.05);观察组未复发生存率分别为71.1%、60.0%、37.8%,对照组分别为66.7%、53.3%、31.1%,差异无统计学意义(P>0.05)。结论经皮超声引导治疗更微创,腹腔镜超声适用于特殊部位病灶。超声引导微波治疗适用于不能实施开腹手术的患者,使得治疗复发性肝癌的范围更广。

Objective To compare the clinical effect of microwave ablation for recurrent hepatocellular carcinoma under the guidance of laparoscopic ultrasound versus percutaneous ultrasound.Methods The clinical data of 90 patients with recurrent hepatocellular carcinoma in Eastern Hospital,Sichuan Provincial Medical Sciences Academy&Sichuan Provincial People′s Hospital from June 2015 to February 2018 were retrospectively analyzed.The patients were divided into observation group and control group according to different ways of microwave ablation,with 45 cases in each group.The observation group received laparoscopic ultrasound-guided microwave ablation,and the control group received percutaneous ultrasound-guided microwave ablation.The intraoperative blood loss,operative time,postoperative hospital stay,total hospital stay,lesion diameter and ablation time,cumulative survival rate and recurrence-free survival rate were compared between the two groups.Results The intraoperative blood loss in the control group was significantly less than that in the observation group(P<0.05).The operative time,ablation time,the postoperative hospital stay and total hospital stay in the control group was significantly shorter than that in the observation group(P<0.05).80.3%(49/61)of the lesions in the observation group and 3.4%(2/58)of the lesions in the control group were at specific sites.After 0.5,1 and 1.5 years of follow-up,the cumulative survival rates of the observation group were 100.0%,88.9%and 75.6%respectively,and those of the control group were 100.0%,82.2%and 71.1%respectively,and there were no significant differences between the two groups(P>0.05);the recurrence-free survival rates of the observation group were 71.1%,60.0%and 37.8%respectively,and those of the control group were 66.7%,53.3%and 31.1%respectively,and there were no significant differences between the two groups(P>0.05).ConclusionPercutaneous ultrasound-guided microwave ablation treatment is more minimally invasive,while laparoscopic ultrasound-guided microwave ablation is suitable for the lesions at specific sites.Percutaneous ultrasound-guided microwave ablation treatment is suitable for the patients who cannot be treated with laparotomy,which makes the scope of the treatment for recurrent hepatocellular carcinoma wider.