腹腔镜微波消融治疗小肝癌合并肝硬化的临床疗效

摘要

目的 探讨腹腔镜微波消融治疗小肝癌合并肝硬化的效果.方法 回顾性分析我科2009年4月～2013年6月收治的50例小肝癌合并肝硬化的患者资料,26例行腹腔镜下微波消融(消融组),24例行腹腔镜下肝癌切除(切除组).比较2组手术时间、术中出血量、住院时间、术后并发症、术后肝功能,以及1、2、3年生存率.结果 2组术后丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)升高,白蛋白(ALB)降低,术后7d恢复正常水平,但消融组术后1、3 d ALT、AST明显低于切除组,ALB明显高于切除组,差异有统计学意义(P＜0.05).消融组手术时间(53.5±8.5)min,明显短于切除组(92.9±19.8)min(t=-9.019,P=0.000);消融组术中出血(41.9±17.2) ml,明显少于切除组(131.3±66.0) ml(t=-6.663,P=0.000);消融组住院时间(7.8±1.0)d,明显短于切除组(10.4±1.3)d(t=-7.742,P=0.000);消融组术后并发症发生率19.2％(5/26),明显少于切除组45.8％(11/24)(x2 =4.059,P=0.044).消融组术后1、2、3年生存率分别为100％、88.5％、80.8％,切除组分别为100％、91.7％、83.3％,差异无显著性(log-rank x2=0.077,P=0.782).结论 位于特殊部位的、腔镜不容易切除的小肝癌合并肝硬化,可实施腹腔镜下微波消融治疗,且操作简单,创伤小,并发症少.%Objective To evaluate the efficacy of microwave ablation in the treatment of small hepatic carcinoma with liver cirrhosis.Methods Altogether 50 patients with small hepatic carcinoma with liver cirrhosis from April 2009 to June 2013 were divided into microwave ablation group (n =26) or resection group (n =24).The microwave ablation group was treated by laparoscopic microwave ablation while the resection group was treated by laparoscopic resection.The time of operation,intraoperative blood loss,length of hospital stay,postoperative complications,postoperative liver functions,and 1-year,2-year,3-year survival rate of each group were observed.Results The alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were increased and the albumin (ALB) was decreased postoperatively in both groups,and all recovered in 7 days after operation.The ALT and AST in microwave ablation group were lower than resection group,and the ALB was higher than resection group,with statistical significances (P ＜ 0.05).The operation time in microwave ablation group was (53.5 ± 8.5) min,significantly less than the resection group [(92.9 ± 19.8) min,t =-9.019,P =0.000].The intraoperative blood loss in microwave ablation group was (41.9 ± 17.2) ml,significantly less than the resection group [(131.3 ± 66.0) ml,t =-6.663,P =0.000].The length of hospital stay in microwave ablation group was (7.8 ± 1.0) d,significantly less than the resection group [(10.4 ± 1.3) d,t =-7.742,P =0.000].The rate of postoperative complication in microwave ablation group was 19.2％ (5/26),significantly less than the resection group [45.8％ (11/24),x2 =4.059,P =0.044].The 1-year,2-year,and 3-year survival rates in microwave ablation group were 100％,88.5％,80.8％,respectively,and those in resection group were 100％,91.7％,83.3％,respectively.There were no statistical differences between the two groups (log-rank x2 =0.077,P =0.792).Conclusions Microwave ablation therapy is feasible in the treatment of small hepatocellular carcinoma with cirrhosis that located in the special area and endoscopic surgery is not easy to remove.Microwave ablation has advantages of less trauma,simple performance and less complications.