手术联合术中放疗在肝癌治疗中的安全性及有效性—倾向性评分匹配分析

发布时间：2018-04-20 22:35

本文选题：肝切除 + 术中放疗　；参考：《北京协和医学院》2017年硕士论文

【摘要】：目的倾向性评分匹配法(Propensity Score Matching,PSM)评估手术联合术中放疗治疗原发性肝癌的安全性及疗效。方法收集2009～2012年于我院肝胆外科行手术联合术中放疗(intraoperative electron radiotherapy,IOERT)的 18 例原发性肝癌(primary liver cancer,PLC)患者的临床资料,其中16例经术后病理证实为肝细胞癌(hepatocellular carcinoma,HCC),2 例为肝内胆管细胞癌(intrahepatic cholangiocarcinomas,ICC);采用倾向性评分匹配方法,按照1:2比例从同期行单纯手术的原发性肝癌患者中筛选出36例做为对照组(32例HCC,4例ICC),比较两组患者术中及术后并发症发生情况及HCC患者术后早期(2年内)复发率。结果所有患者均获随访,随访率100%。两组患者术中出血量、术后3月内肝功能、凝血功能、血常规及术后住院天数的差异均无统计学意义,仅在手术时长方面,联合IOERT组长于单纯手术组(P0.001);此外,联合IOERT组术后出现1例急性肾功能衰竭和1例胸腔积液,单纯手术组术后出现1例肝创面出血。在疗效方面,以两组48例HCC患者为研究对象,联合IOERT组的HCC患者为16例,其中6例在2年内复发,早期复发率为37.5%;单纯手术组的HCC患者为32例,20例在2年内复发,早期复发率为62.5%,两组早期复发率的差异无统计学意义(P=0.101)。结论手术联合术中放疗治疗原发性肝癌安全可行,尽管联合治疗组早期复发率低于单纯手术组,但两组差异并无统计学意义。
[Abstract]:Objective to evaluate the safety and efficacy of surgery combined with intraoperative radiotherapy in the treatment of primary liver cancer with propensity Score matching. Methods from 2009 to 2012, the clinical data of 18 patients with primary liver cancer of primary liver cancer who underwent hepatobiliary surgery combined with intraoperative electron radiation therapy in our hospital from 2009 to 2012 were collected. Among them, 16 cases were confirmed by pathology to be hepatocellular carcinoma HCCU, 2 cases were intrahepatic cholangiocarcinomatous intrahepatic cholangiocarcinoma (ICCU), and the tendency score matching method was used. According to the 1:2 ratio, 36 cases of primary liver cancer were selected as the control group from 32 cases of HCC and 4 cases of ICCU. The incidence of intraoperative and postoperative complications and the early recurrence rate (within 2 years) of HCC patients were compared between the two groups. Results all patients were followed up and the follow-up rate was 100%. There was no significant difference in intraoperative bleeding volume, liver function, coagulation function, blood routine and postoperative hospital stay between the two groups. Only in the long time of operation, combined with IOERT group was significantly higher than that in the simple operation group (P 0.001), in addition, there was no significant difference between the two groups in the liver function, coagulation function, blood routine and postoperative hospital stay. One case of acute renal failure and one case of pleural effusion occurred in the combined IOERT group, and one case of hepatic wound bleeding occurred in the simple operation group. In terms of curative effect, 48 cases of HCC in two groups were studied, 16 cases of HCC were in combination with IOERT group, 6 cases recurred within 2 years, the early recurrence rate was 37.5%, 32 cases of HCC patients in simple operation group had recurrence within 2 years, 20 cases of HCC patients in simple operation group had recurrence within 2 years. The early recurrence rate was 62.5. There was no significant difference between the two groups in early recurrence rate. Conclusion surgery combined with intraoperative radiotherapy is safe and feasible in the treatment of primary liver cancer. Although the early recurrence rate in the combined treatment group is lower than that in the simple operation group, the difference between the two groups is not statistically significant.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

【相似文献】