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中华腔镜外科杂志(电子版)

中华腔镜外科杂志(电子版) ›› 2021, Vol. 14 ›› Issue (05) : 271 -276. doi: 10.3877/cma.j.issn.1674-6899.2021.05.004

论著

腹腔镜微波消融治疗≤3 cm肝细胞肝癌的临床疗效分析
陈亚峰1, 李江斌1, 钟文钧1, 董瑞1,†(), 臧莉1, 阴继凯1, 杜锡林1, 鲁建国1   
  1. 1. 710038　西安，空军军医大学第二附属医院普通外科
  • 收稿日期:2021-08-20 出版日期:2021-10-30
  • 通信作者: 董瑞
  • 基金资助:
    陕西省重点研发计划项目(2020SF-067)

Clinical effect analysis of laparoscopic microwave ablation for HCC ≤ 3 cm

Yafeng Chen1, Jiangbin Li1, Wenjun Zhong1, Rui Dong1,†(), Li Zang1, Jikai Yin1, Xilin Du1, Jianguo Lu1   

  1. 1. Department of General Surgery, The Second Affiliated Hospital, Air Force Military Medical University, Xi’an 710038, China
  • Received:2021-08-20 Published:2021-10-30
  • Corresponding author: Rui Dong
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陈亚峰, 李江斌, 钟文钧, 董瑞, 臧莉, 阴继凯, 杜锡林, 鲁建国. 腹腔镜微波消融治疗≤3 cm肝细胞肝癌的临床疗效分析[J/OL]. 中华腔镜外科杂志(电子版), 2021, 14(05): 271-276.

Yafeng Chen, Jiangbin Li, Wenjun Zhong, Rui Dong, Li Zang, Jikai Yin, Xilin Du, Jianguo Lu. Clinical effect analysis of laparoscopic microwave ablation for HCC ≤ 3 cm[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2021, 14(05): 271-276.

目的

探讨经腹腔镜微波消融术(laparoscopic microwave ablation，LMWA)治疗≤3 cm肝细胞肝癌(hepatocellular carcinoma，HCC)的临床疗效。

方法

回顾性分析2015年1月至2016年8月空军军医大学第二附属医院普通外科收治的166例HCC患者的临床资料。依据手术方式分为LMWA组90例、腹腔镜肝切除术(laparoscopic hepatectomy，LH)组76例。比较两组的临床疗效和安全性。

结果

LMWA组的手术时间、术中出血量、胃肠功能恢复时间、腹腔引流管拔除时间、术后住院时间明显少于LH组，差异有统计学意义(P<0.05)。LMWA组术后2 d的WBC、ALT、TBIL、PT显著低于LH组，ALB显著高于LH组，差异有统计学意义(P<0.05)。两组的发热、腹腔出血、胆漏、肝周脓肿、胸腔积液、腹水比较，差异无统计学意义(P>0.05)。术后1个月，LMWA组的客观缓解率为96.67%，稍低于LH组的100.00%，但差异无统计学意义(P>0.05)。LMWA组术后1、3、5年总体生存率分别为96.67%、85.56%、73.33%，LH组分别为97.37%、86.84%、75.00%，差异无统计学意义(P>0.05)。LMWA组术后1、3、5年无病生存率分别为93.33%、77.78%、54.44%，LH组分别为94.74%、80.26%、56.58%，差异无统计学意义(P>0.05)。

结论

LMWA治疗≤3 cm且无血管侵犯的单发肝细胞肝癌是安全、可行、有效的。与LH相比，近期效果和远期效果可观。

关键词: 原发性肝癌, 肝细胞肝癌, 微波消融治疗, 腹腔镜, 肝切除术
Objective

To investigate the clinical efficacy of laparoscopic microwave ablation on hepatocellular carcinoma(HCC)≤3 cm.

Methods

Clinical data of 166 HCC patients in Department of General Surgery, The Second Affiliated Hospital, Air Force Military Medical University from Jan. 2015 to Aug. 2016 were retrospectively analyzed. According to surgical procedure, the patients were divided into laparoscopic microwave ablation group(LMWA group)and laparoscopic hepatectomy group(LH group). The clinical efficacy and safety of the two groups were compared.

Results

The operation time, intraoperative blood loss, gastrointestinal function recovery time, abdominal drainage tube removal time and postoperative hospital stay in the LMWA group were significantly shorter than those in the LH group, with statistically significant differences between groups(P<0.05). WBC, ALT, TBIL and PT in LMWA group were significantly lower than those in LH group(P<0.05), and ALB in LMWA group was significantly higher than that in LH group(P<0.05), and the difference was statistically significant. There were no significant differences in fever, abdominal bleeding, biliary leakage, perihepatic abscess, pleural effusion and abdominal effusion between the two groups(P>0.05). The overall response rate of LMWA group 1 month postoperative was 96.67%, slightly lower than that of LH group (100.00%), but the difference was not statistically significant(P>0.05). The overall survival rates at 1, 3 and 5 years after operation were 96.67%, 85.56% and 73.33% in the LMWA group and 97.37%, 86.84% and 75.00% in the LH group, respectively, with no statistical significance(P>0.05). The disease-free survival rates at 1, 3 and 5 years after operation were 93.33%, 77.78% and 54.44% in LMWA group and 94.74%, 80.26% and 56.58% in LH group, respectively, and the difference was not statistically significant(P>0.05).

Conclusions

Laparoscopic microwave ablation is safe, feasible and effective in the treatment of single hepatocellular carcinoma ≤3 cm without vascular invasion. Compared with laparoscopic hepatectomy, the short-term and long-term effects are considerable.

Key words: Primary liver cancer, Hepatocellular carcinoma, Microwave ablation therapy, Laparoscope, Hepatectomy
表1 两组肝细胞肝癌患者一般资料比较
组别 例数 性别(男/女，例) 年龄(岁，±s) BMI(kg/m2，±s) 直径(cm，±s) HBV/HCV(例) AFP(>400/≤400 ng/ml，例) 肝功能Child-Pugh分级(A/B级，例) ICGR 15(%，±s)
LMWA组 90 49/41 53±14 24.0±3.9 2.6±0.3 62/13 52/38 60/30 6.8±5.7
LH组 76 42/34 49±13 23.4±2.8 2.5±0.3 54/10 40/36 50/26 5.9±4.8
统计值   χ2＝0.011 t＝1.383 t＝1.136 t＝1.132 χ2＝0.073 χ2＝0.442 χ2＝0.014 t＝1.357
P值   0.916 0.183 0.275 0.277 0.787 0.506 0.905 0.191
表2 两组肝细胞肝癌患者手术情况比较(±s)
组别 例数 手术时间(min) 术中出血量(ml) 术后胃肠功能恢复时间(d) 术后腹腔引流管拔除时间(d) 术后住院时间(d)
LMWA组 90 47±10 24±10 1.2±0.4 2.0±0.5 3.9±0.7
LH组 76 75±20 58±21 1.9±0.4 3.0±0.6 5.1±0.8
t值   -6.748 -5.927 -3.031 -7.071 -5.295
P值   <0.000 <0.000 0.007 <0.000 <0.000
表3 两组肝细胞肝癌患者术后2 d化验指标比较(±s)
组别 例数 WBC(×109/L) ALT(U/L) TBIL(μmol/L) ALB(g/L) PT(s)
LMWA组 90 0.97±0.29 90±55 23±8 33.6±1.9 12.3±1.9
LH组 76 1.22±0.26 144±88 28±10 32.6±2.2 13.0±2.0
t值   -3.033 -6.639 -3.319 5.916 -10.746
P值   0.007 <0.000 0.004 <0.000 <0.000
表4 术后两组肝细胞肝癌患者并发症比较[例(%)]
组别 例数 发热 腹腔出血 胆漏 肝周脓肿 胸腔积液 腹水
LMWA组 90 7(7.78) 2(2.22) 1(1.11) 1(1.11) 2(2.22) 2(2.22)
LH组 76 3(3.95) 5(6.58) 3(3.95) 3(3.95) 4(5.26) 6(7.89)
χ2值   1.068 1.936 1.410 1.410 1.094 2.890
P值   0.301 0.164 0.235 0.235 0.296 0.089
表5 术后1个月两组肝细胞肝癌患者治疗效果比较[例(%)]
组别 例数 完全缓解 部分缓解 疾病稳定 疾病进展 客观缓解
LMWA组 90 84(93.33) 3(3.33) 3(3.33) 0(0.00) 87(96.67)
LH组 76 74(97.37) 2(2.63) 0(0.00) 0(0.00) 76(100.00)
χ2值   1.463 0.069 2.580 - 2.580
P值   0.227 0.792 0.108 - 0.108
表6 两组肝细胞肝癌患者术后总体生存和无瘤生存比较[例(%)]
组别 例数 总体生存 无病生存
1年 3年 5年 1年 3年 5年
LMWA组 90 87(96.67) 77(85.56) 66(73.33) 84(93.33) 70(77.78) 49(54.44)
LH组 76 74(97.37) 66(86.84) 57(75.00) 72(94.74) 61(80.26) 43(56.58)
χ2值   0.069 0.057 0.060 0.143 0.153 0.076
P值   0.792 0.811 0.807 0.705 0.696 0.783
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