摘要
目的探讨肝切除术中不同断肝方式治疗多病灶原发性肝癌的临床效果,分析射频消融术(RFA)辅助断肝治疗多病灶原发性肝癌的优势。方法回顾性分析2014年1月至2019年12月于安徽医科大学附属六安医院确诊为多病灶原发性肝癌的156例患者临床资料,其中72例为肝切除术中应用RFA辅助断肝(RFA组),84例采用传统肝切除术(对照组)。观察两组患者手术时间、肝门阻断时间、术中出血量及术后住院时间等手术相关指标;对比两组患者手术前后丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、甲胎蛋白(AFP)、总胆酸(TBA)及总胆红素(TBIL)等肝功能指标水平,以及术后并发症、术后生存情况。结果与对照组相比,RFA组患者的手术时间、肝门阻断时间、术后住院时间显著缩短,术中出血量亦明显减少,差异均有统计学意义(P<0.05)。术前两组患者肝功能指标ALT、AST、AFP、TBA及TBIL水平比较,差异无统计学意义,术后7 d时均显著下降(P<0.05),且RFA组ALT、AST、AFP水平显著低于对照组(P<0.05)。术后RFA组并发症发生率为5.56%(4/72),低于对照组的15.48%(χ^(2)=3.930,P=0.047)。对照组患者术后1、3、5年累积总生存率和无病生存率分别为92.85%、64.28%、57.14%和88.10%、58.33%、47.62%;RFA组术后1、3、5年累积生存率和无病生存率分别为100.0%、87.50%、69.44%和95.83%、75.00%、61.11%。两组术后3、5年累积总生存率和1、3、5年累积无病生存率比较,差异均有统计学意义(P<0.05)。结论在肝切除术中应用RFA辅助断肝,对于治疗多病灶原发性肝癌患者具有出血少、手术并发症发生率低、远期生存率高等优势,可在临床中大力推广。
Objective To explore the clinical effect of different liver transection methods in hepatectomy for multifocal primary liver cancer,and analyze the advantages of radiofrequency ablation(RFA)assisted liver transection in hepatectomy.Methods The clinical data of 156 patients with multifocal primary liver cancer diagnosed in Lu’an Hospital Affiliated to Anhui Medical University from January 2014 to December 2019 were analyzed retrospectively.Among them,72 cases were treated with RFA assisted liver transection during hepatectomy(RFA group),and 84 cases only underwent hepatectomy as the control group.The operation time,hilar blocking time,intraoperative bleeding and postoperative hospital stay were observed.The levels of liver function indexes such as alanine aminotransferase(ALT),aspartate aminotransferase(AST),alpha-fetoprotein(AFP),total cholic acid(TBA)and total bilirubin(TBIL)before and after operation,as well as postoperative complications and postoperative survival were compared between the two groups.Results Compared with the control group,the operation time,hilar blocking time,postoperative hospital stay and intraoperative bleeding in RFA group were significantly shorter or less(all P<0.05).There were no significant differences in the levels of ALT,AST,AFP,TBA and TBIL between the two groups before operation,and the corresponding liver function indexes of all patients were significantly decreased on the 7th day after surgery(P<0.05).In addition,the levels of ALT,AST and AFP in the RFA group after surgery were significantly different from those in the control group(P<0.05).The incidence of complications in RFA group was 5.56%(4/72),which was lower than 15.48%in the control group(χ^(2)=3.930,P=0.047).The cumulative overall survival rate and disease-free survival rate at 1-,3-and 5-year were 92.85%,64.28%,57.14%and 88.10%,58.33%and 47.62%in the control group;100.0%,87.50%,69.44%,and 95.83%,75.00%,and 61.11%in RFA group,respectively.There were significant differences between the two groups in the 3-,5-year cumulative overall survival rate and 1-,3-,5-year cumulative disease-free survival rate(P<0.05).Conclusions RFA assisted liver transection in hepatectomy has the advantages of less bleeding,lower incidence of postoperative complications and higher long-term survival rate for the treatment of paitents with multifocal primary liver cancer.It can be used in the combination with hepatectomy in clinical application and has high promotion value.
作者
周保富
吴乐乐
李永红
胡世超
Zhou Baofu;Wu Lele;Li Yonghong;Hu Shichao(Department of General Surgery(Hepatobiliary Surgery),Lu’an Hospital Affiliated to Anhui Medical University,Lu’an 237000,China)
出处
《中华普通外科学文献（电子版）》
CAS
2022年第3期205-209,共5页
Chinese Archives of General Surgery(Electronic Edition)
关键词
原发性肝癌
多病灶
射频消融
肝切除术
临床疗效
Primary liver cancer
Multifocal
Radiofrequency ablation
Hepatectomy
Clinical effect
