摘要
目的评估腹腔镜脾切除联合射频消融术(RFA)治疗极早期肝癌(BCLC-0期)合并脾功能亢进伴血小板减少症的有效性、安全性和可行性.方法收集同期行腹腔镜脾切除联合射频消融的极早期肝癌伴脾功能患者共23例收入腹腔镜组,对照组根据腹腔镜组患者的年龄、肿瘤数目及大小等为配对原则,按照1∶1的比例收集同时期接受开腹脾切除联合射频消融治疗的BCLC 0期患者,比较两组患者的围手术期恢复情况及远期生存情况.结果腹腔镜组患者的1,2,5 a总生存率为95.7%,91.1%,56.1%,对照组1,2,5 a总生存率为95.7%,90.3%,77.3%(P=0.710);腹腔镜组患者的1,2,5 a无肿瘤生存率为91.1%,81.5%,42.8%,对照组患者的1,2,5a无肿瘤生存率为95.7%,86.1%,70.6%(P=0.341);腹腔镜组与对照组的术中出血量分别为(293.91±128.86),(406.95±143.12)mL(P<0.01);腹腔镜组与对照组的平均住院日为(6.78±3.49),(9.52±5.29)d(P=0.04);腹腔镜组与对照组的平均手术时间为(223.47±54.40),(268.91±51.27)min(P<0.01).结论腹腔镜脾切除联合射频消融术在治疗极早期肝细胞癌合并脾功能亢进血小板减少症与开腹手术具有相似的远期预后和围手术期并发症发生率,且具有更短手术时间、手术出血少、住院日短等优点.
Objective To evaluate the efficacy,safety and feasibility of laparoscopic splenectomy combined with radiofrequency ablation(RFA)on the treatment of very early stage hepatocellular carcinoma(BCLC-0)complicated with hypersplenism and thrombocytopenia.Method 23 cases of patients who underwent laparoscopic splenectomy combined with radiofrequency ablation for the treatment of hepatocellular carcinoma complicated with hypersplenism were enrolled as the laparoscopic group.According to the age,tumor number and size of the laparoscopic group,with the ratio of 1∶1,the patients in BCLC-0 stage who underwent open splenectomy combined with radiofrequency ablation were collected as the control group.The datum were collected and the patient’s perioperative recovery and long-term survival situations were compared between the two groups.Results The survival rates of the laparoscopic group at 1,2,5 year were 95.7%,91.1%and 56.1%,and the survival rates of the control group were 95.7%,90.3%,77.3%(P=0.710).The tumor free survival rates of the laparoscopic group at 1,2,5 year were 91.1%,81.5%and 42.8%,and the rates of the control group were 95.7%,86.1%and 70.6%(P=0.341).The amount of bleeding of the laparoscopic surgery group and the control group were(293.91±128.86)mL vs(406.95±143.12)mL(P<0.01),the average hospitalization days were(6.78±3.49)d vs(9.52±5.29)d(P=0.04),and the average operative time were(223.47±54.40)minutes vs(268.91±51.27)minutes(P<0.01).Conclusion Laparoscopic splenectomy combined with radiofrequency ablation and open splenectomy combined with radiofrequency ablation for the treatment of very early hepatocellular carcinoma complicated with hypersplenism and thrombocytopenia have similar incidence of long-term prognosis and perioperative complications.While the former treatment has more advantages,such as shorter operative time,hospitalization days,and less blood losing amount etc.However,more studies are needed for further prospective studies and RCT evidence support.
作者
沈灏德
李宏宇
李波
魏永刚
刘非
陈克霏
Shen Haode;Li Hongyu;Li Bo;Wei Yonggang;Liu Fei;Chen Kefei(West China Hospital of Sichuan University,Chengdu 610041,China)
出处
《北华大学学报（自然科学版）》
CAS
2018年第4期469-473,共5页
Journal of Beihua University（Natural Science）
基金
四川省科技厅科技支撑项目(2015SZ0173)
四川省卫生和计划生育委员会科研基金项目(150213)
关键词
腹腔镜
肝细胞癌
射频消融
脾功能亢进
laparoscope
radiofrequency ablation
hepatocellular carcinoma
hypersplenism
