摘要
目的探讨解剖性肝切除联合微波消融对CNLC-Ⅱ期患者的治疗效果。方法回顾性分析自2017年1月至2021年12月期间就诊于陕西省人民医院肝胆外科一病区CNLC-Ⅱ期且Child-PughA级HCC患者79例患者临床资料,其中男性63例,女性16例,年龄51.8±10.1岁。根据患者接受治疗方式不同分为解性肝切除术联合微波消融的联合组(n=32),肝动脉化疗栓塞术的介入组(n=47)。记录两组患者围手术期各项实验室检查指标及术后并发症进行评价。结果1.解剖性肝切除联合微波消融组中,22例患者(22/32,68.7%)在术后1月的复查中达到了完全缓解。1、2、3年总生存率为76.3%、67.8%、46.5%,1、2、3年无瘤生存率分别为63.8%、21.6%、19.1%,中位生存时间27.6个月。2.TACE组中18例患者(18/47,38.2%)达到完全缓解。TACE组患者的1、2、3年总生存率分别为49.7%、27.1%、17.8%,1年无瘤生存率为4.6%,中位生存时间11.9月(P<0.05)。结论1.解剖性肝切除联合微波消融在治疗CNLC-Ⅱ期HCC患者是安全有效的。2.联合治疗组较TACE组更能延长患者的生存时间,使患者远期获益。
Objective This study is to investigate the efficiency and clinical value of anatomical liver resection combined with microwave ablation in the treatment of CNLC-Ⅱ patients.Methods A retrospective analysis have been executed from January 2017 to January 2021 in the first hepatobiliary Surgery ward of Shannxi Provincial People's Hospital.The clinical data of 79 consecutive pa-tients with multifocal tumors meeting CNLC-Ⅱ and Child-Pugh A were collected.All the patients included in the study have never re-ceived the treatment of anti-tumor drugs and related surgery before being separated two groups.By evaluating performance state,preoper-ative imaging examinations,the Child-Pugh score system and the assessment of vital organs,they have undergone comprehensive and systematic evaluation.The result shows that all the patients could tolerate the risk of receiving operation.32 patients receive anatomical liver resection combined with microwave ablation simultaneous.meanwhile,47 patients undergo transarterial chemoembolization.Periop-erative complications are evaluated by observing the 1st,3rd and 7th day of outcomes after operation.AFP,enhanced CT/MRI,ultra-sound contrast should be reviewed in a month later and follow up regularly.Results 1.Anatomical liver resection combined with micro-wave ablation group of 32 cases,22 cases of the patients'reviews could acquire complete remission at the rate of 68.7%in a month later.1,2,3 year overall survival rates were 76.3%,67.8%,46.5%,respectively.1,2,3 year disease-free survival rates were 63.8%,21.6%,19.1%,respectively.the median survival times were 27.6 months.2.In TACE group,18 patients achieved complete remission at rate was 38.2%.The 1,2,3 year overall survival rates of patients in group TACE were 49.7%,27.1%,17.8%,1 years disease-free survival rate was 4.6%,the median survival times were 11.9 months(P<0.05).Conclusions 1.Anatomical liver resection combined with microwave ablation,a aggressive strategy,has been considered as a safe and effective one for the HCC patients with mul-tifocal tumors meeting CNLC-Ⅱ and Child-Pugh A.2.Compared with the TACE group,the patients'survival could be prlonged in combined treatment group and this group yielded better long-term outcomes.
作者
严翔
常虎林
陈思攀
孙超
张智勇
张煜
郑伟
YAN Xiang;CHANG Hu-lin;CHEN Si-pan;无(Department of Hepatobiliary Surgery,Shaanxi Provincial People's Hospital,Xi'an 710068,China;Department of Interventional Radiology,Shaanxi Provincial People's Hospital,Xi'an 710068,China;Department of Medical Oncology,Shaanxi Provincial People's Hospital,Xi'an 710068,China)
出处
《肝胆外科杂志》
2024年第1期40-44,共5页
Journal of Hepatobiliary Surgery
基金
西安市科技计划项目(22YXYJ0133)。
