腹腔镜微波消融治疗小肝癌合并肝硬化的临床疗效

发布时间：2018-01-26 05:28

本文关键词： 小肝癌肝硬化微波消融　出处：《中国微创外科杂志》2017年06期 　论文类型：期刊论文

【摘要】：目的探讨腹腔镜微波消融治疗小肝癌合并肝硬化的效果。方法回顾性分析我科2009年4月~2013年6月收治的50例小肝癌合并肝硬化的患者资料,26例行腹腔镜下微波消融(消融组),24例行腹腔镜下肝癌切除(切除组)。比较2组手术时间、术中出血量、住院时间、术后并发症、术后肝功能,以及1、2、3年生存率。结果 2组术后丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)升高,白蛋白(ALB)降低,术后7 d恢复正常水平,但消融组术后1、3 d ALT、AST明显低于切除组,ALB明显高于切除组,差异有统计学意义(P0.05)。消融组手术时间(53.5±8.5)min,明显短于切除组(92.9±19.8)min(t=-9.019,P=0.000);消融组术中出血(41.9±17.2)ml,明显少于切除组(131.3±66.0)ml(t=-6.663,P=0.000);消融组住院时间(7.8±1.0)d,明显短于切除组(10.4±1.3)d(t=-7.742,P=0.000);消融组术后并发症发生率19.2%(5/26),明显少于切除组45.8%(11/24)(χ~2=4.059,P=0.044)。消融组术后1、2、3年生存率分别为100%、88.5%、80.8%,切除组分别为100%、91.7%、83.3%,差异无显著性(log-rank χ~2=0.077,P=0.782)。结论位于特殊部位的、腔镜不容易切除的小肝癌合并肝硬化,可实施腹腔镜下微波消融治疗,且操作简单,创伤小,并发症少。
[Abstract]:Objective to evaluate the efficacy of laparoscopic microwave ablation in the treatment of small hepatocellular carcinoma with cirrhosis. Methods the data of 50 patients with small liver cancer complicated with cirrhosis from April 2009 to June 2013 were retrospectively analyzed. 26 cases were treated with laparoscopic microwave ablation (ablation group, 24 cases underwent laparoscopic hepatectomy). The operative time, blood loss, hospital stay, postoperative complications and postoperative liver function were compared between the two groups. Results the alanine aminotransferase (alt), aspartate aminotransferase (AST) and albumin (ALB) decreased in both groups. The level of ALB in the ablation group was significantly lower than that in the resection group at 1 and 3 days after operation, but the level of ALB in the ablation group was significantly higher than that in the resection group. The operative time of ablation group was 53.5 卤8.5 min, which was significantly shorter than that of resection group (92.9 卤19.8min). P0. 000; The intraoperative bleeding in the ablation group was 41.9 卤17.2ml, which was significantly less than that in the resection group (131.3 卤66.0). The length of hospitalization in the ablation group was 7.8 卤1.0 days, which was significantly shorter than that in the resection group (10.4 卤1.3). The incidence of postoperative complications in the ablation group was significantly lower than that in the resection group (19.2 / 26), which was significantly lower than that in the resectable group (45.8 / 24 / 11) (蠂 ~ (2 / 2) 4.059). The 2- and 3-year survival rates were 80.8% and 91.7% respectively in the resection group and 83.3% in the resected group. There was no significant difference in log-rank 蠂 ~ 2 ~ (2) -rank (蠂 ~ 2 / 0. 077) (P < 0. 782). Conclusion small hepatocellular carcinoma with cirrhosis is located in a special site and is difficult to be resected by endoscope. Laparoscopic microwave ablation can be performed with simple operation, less trauma and less complications.
【作者单位】：安徽医科大学解放军八一临床学院普外科;
【分类号】：R657.31;R735.7
【正文快照】： *通讯作者,E-mail:xg30lxs@sina.com原发性肝细胞肝癌(hepatocellular carcinoma,HCC)中85%~90%合并不同程度的肝炎后肝硬化[1,2]。我国2011年版《原发性肝癌诊疗规范》中规定小肝癌是最大直径≤3 cm的单个癌结节,或数目≤2个,最大直径总和≤3 cm的多个癌结节[3]。即使是小肝

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