经皮微波消融在结直肠癌肝转移灶治疗中的体会

发布时间：2018-08-18 20:05

【摘要】：目的:通过经皮微波消融与手术切除治疗直径3-5cm孤立性结直肠癌肝转移灶的疗效对比,对其治疗方式的选择进行深入探讨。方法:以辽宁省肿瘤医院肝胆外科于2010年9月至2013年11月期间住院行手术治疗的74例直径3-5cm孤立性结直肠癌肝脏转移病人为研究对象,进行为期36个月的随访,对全部随访资料进行回顾性研究。本研究根据选择的手术治疗方式的不同,将74例研究对象分成经皮微波消融组和手术切除组,分别包括31例和43例研究对象。收集74例患者的性别、年龄、肝脏转移灶最大径长度、ChildPugh肝功能分级、肝脏转移时间、原发灶部位、原发灶分化程度等基本资料。经皮微波消融组:采用冷循环微波消融治疗仪对患者进行微波消融治疗,术中采用彩超进行实时监控,以保证转移灶根治性治疗。手术切除组:在保证切缘阴性的前提下,肝部分切除方式的选择包括规则性肝段、肝叶切除和不规则性肝转移灶切除。术中根据转移灶位置、预计出血量多少进行半肝阻断或肝门阻断。通过对两组患者临床资料和随访结果进行分析,分别对经皮微波消融组和手术切除组在局部治疗效果、累积生存率、复发率、术后并发症、术中处理转移灶耗费时间的长短、从入院到离院时间的长短、病人住院期间的医疗费用方面进行比较。对于计量资料以?X±S(均数±标准差)表示,组间比较用t检验;计数资料以率(%)表示,组间比较采用?2检验,生存分析方法采用Kaplan-Meier法,采用log-rank检验比较生存曲线的差异。P0.05差异有统计学意义。结果:本研究中,两组病人局部治疗效果对比:经皮微波消融组31例患者中30例肝转移灶经过消融治疗达到完全消融,1例肝转移灶消融不全,首次完全消融率达96.8%,手术切除组43例患者中41例肝转移灶完全切除,2例出现原位复发,根治性切除率为95.3%,P0.05,差异无统计学意义。两组病人累积生存率及复发率比较:经皮微波消融组术后12、24、36个月的累积生存率及复发率分别为96.8%、78.9%、47.4%,9.7%、29.6%、52.0%。手术切除组术后12、24、36个月的累积生存率及复发率分别为95.3%、71.7%、49.6%,11.6%、27.0%、56.8%,P值分别为0.759、0.567、0.515,0.790、0.819、0.712。因此两组患者术后12、24、36个月累积生存率、复发率间的差别无统计学意义(P0.05)。术后两组病人并发症出现概率方面:胸腔积液(微波消融组1例、手术切除组3例),切口感染(微波消融组1例、手术切除组3例),肝脓肿(微波消融组1例、手术切除组2例),而在肺部感染、腹腔出血、肝衰竭这些并发症中,微波消融组未发生一例,手术切除组分别出现2例、2例、1例。经皮微波消融组和手术切除组并发症发生率分别为9.7%、30.2%,两组患者不同类型并发症发生率有显著差别,经皮微波消融组发生率显著低于手术切除组,且P=0.034,差异有统计学意义(P0.05)。在术中处理转移灶耗费时间长短方面,经皮微波消融组平均手术时间(46.5±16.7)min,显著短于手术切除组(163.0±53.4)min,(P0.05);住院时间方面,经皮微波消融组和手术切除组平均住院时间分别为(6.1±1.9)d、(12.1±7.1)d(P0.05),两组差异显著。治疗费用方面,经皮微波消融组为(3.1±0.6)万元,显著少于手术切除组(5.9±0.9)万元(P0.05)。结论:1、对于直径3-5cm孤立性结直肠癌肝脏转移病人,经皮微波消融与手术切除近期疗效相当。2、经皮微波消融治疗直径3-5cm孤立性结直肠癌肝脏转移病人相较手术切除治疗,患者的手术时间较短、并发症发生率较低、住院时间较短、经济负担较轻。3、临床可考虑将经皮微波消融治疗作为于直径3-5cm孤立性结直肠癌肝转移患者根治性治疗的首选治疗手段之一。
[Abstract]:Objective:To compare the therapeutic effects of percutaneous microwave ablation and surgical resection for hepatic metastases of 3-5 cm in diameter from solitary colorectal cancer.Methods:74 cases of 3-5 cm in diameter of solitary colorectal cancer were operated on in the Department of Hepatobiliary Surgery of Liaoning Cancer Hospital from September 2010 to November 2013. 74 patients with liver metastases were divided into percutaneous microwave ablation group and surgical resection group, including 31 patients and 43 patients. Seventy-four patients were selected for sex, age, and treatment. In the percutaneous microwave ablation group, the patients were treated by microwave ablation with cold circulation microwave ablation apparatus, and the patients were monitored by color Doppler ultrasound during the operation to ensure the radical treatment of the metastases. Resection group: On the premise of negative resection margin, the choice of partial hepatectomy includes regular hepatic segment, lobectomy and irregular hepatic metastasis resection. Hemi-hepatic or hepatic portal occlusion was performed according to the location of the metastasis and the estimated amount of bleeding. The results of local treatment, cumulative survival rate, recurrence rate, postoperative complications, time spent in the treatment of metastases, time spent from admission to discharge, and medical costs of patients during hospitalization were compared between the microwave ablation group and the surgical resection group. The difference of survival curves was compared by Kaplan-Meier method and log-rank test. Results: In this study, the local therapeutic effects of the two groups were compared: 30 liver metastases were ablated in 31 patients of the percutaneous microwave ablation group. The first complete ablation rate was 96.8%. Of the 43 patients in the resection group, 41 were completely resected and 2 had recurrence in situ. The radical resection rate was 95.3% and P 0.05 respectively. There was no significant difference in cumulative survival rate and recurrence rate between the two groups. The cumulative survival rate and recurrence rate at 12, 24 and 36 months after operation were 96.8%, 78.9%, 47.4%, 9.7%, 29.6% and 52.0%, respectively. The cumulative survival rate and recurrence rate at 12, 24 and 36 months after operation were 95.3%, 71.7%, 49.6%, 11.6%, 27.0%, 56.8%, P values were 0.759, 0.567, 0.515, 0.790, 0.819, 0.712, respectively. Postoperative complications were pleural effusion (1 case in microwave ablation group, 3 cases in surgical resection group), incision infection (1 case in microwave ablation group, 3 cases in surgical resection group), liver abscess (1 case in microwave ablation group, 2 cases in surgical resection group), and pulmonary infection, abdominal hemorrhage, liver failure. Of these complications, there was no case in the microwave ablation group, 2 cases in the surgical resection group, 1 case in the surgical resection group. The incidence of complications in the percutaneous microwave ablation group and the surgical resection group were 9.7% and 30.2%, respectively. The incidence of different types of complications in the two groups was significantly different. The incidence of complications in the percutaneous microwave ablation group was significantly lower than that in the surgical resection group, and P=0.034. The average operation time in the percutaneous microwave ablation group was (46.5 (+ 16.7) min, significantly shorter than that in the surgical resection group (163.0 (+ 53.4) min, (P 0.05). The average hospitalization time in the percutaneous microwave ablation group and the surgical resection group was (6.1 (+ 1.9) d, (12.1 (+ 7.1) D (P The cost of percutaneous microwave ablation was (3.1 0.6) million yuan, significantly less than that of surgical resection (5.9 0.9) million yuan (P 0.05). Conclusion: 1. Percutaneous microwave ablation has the same short-term effect as surgical resection in the treatment of solitary colorectal cancer with hepatic metastasis with a diameter of 3-5 cm. Compared with surgical resection, patients with liver metastasis from colorectal cancer have shorter operation time, lower complication rate, shorter hospitalization time and less economic burden.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.34

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