手术切除加行射频消融术在肝脏原发性未分化胚胎性肉瘤外科治疗中的意义

摘要

目的 研究根治性切除+射频消融术治疗原发性肝脏未分化胚胎性肉瘤的根治效果.方法 回顾性分析2005年1月-2015年2月中国人民解放军总医院肝胆外科17例肝脏原发性未分化胚胎性肉瘤患者的诊断、治疗和预后.所有17例患者均行外科手术切除,其中8例患者加行切缘组织的射频消肖融治疗(S+ RFA组),另外9例患者仅行手术切除病灶(S组).结果 所有病例均经术后病理证实为原发性肝脏未分化胚胎性肉瘤.与S组患者相比,S+ RFA组手术时间较长(P =0.0449);但术后肝功能(转氨酶、胆红素水平)和术中出血量的差异无统计学意义.回访时间4 ～38个月,其中9例患者死亡;S+RFA组患者病死率33.3％(3/9),S组患者病死率75.0％(6/8).Kaplan-Meier生存曲线法分析,两组患者总生存期差异无统计学意义(P＞0.05).S组和S+ RFA组患者24个月无病生存率分别为0和56.8％,中位生存期分别为15个月和29个月(P =0.0476).结论 手术切除+肝脏射频消融术能进一步保证原发性肝脏未分化胚胎性肉瘤切缘的阴性率,进而降低肿瘤的复发和转移,结合全身化疗等综合治疗,能够明显延长原发性肝脏未分化胚胎性肉瘤患者的生存期、降低肿瘤复发转移率.%Objective To evaluate the treatment of radical resection plus radiofrequency ablation (RFA) of undifferentiated embryonal sarcoma of the liver (UESL).Methods From January 2005 to February 2015,17 patients of UESL treated at our hospital were retrospectively analyzed in terms of treatment and prognosis.All 17 cases received surgical resection.In eight cases (S + RFA group),after tumor resection (or hemihepatectomy),RFA was carried out for the resection margin to destruct the peritumoral tissues (RFA group),others (S group) only received tunor resection (or hemihepatectomy).Results UESL were pathologically confirmed after surgery.The surgical duration was longer in the RFA group (P =0.0449),but the two groups did not show significant difference in intraoperative blood loss and postoperative liver function (aminotransferase and bilirubin levels).All cases were followed up for 4-38 months.The mortality was 3/9 (33.3％) in the RFA group and 6/8 (75.0％) in the other patients.Kaplan-Meier survival curve indicated that the overall survival of the two groups was not significantly different (P ＞ 0.05).The disease-free survival over the length of 24 months was 0 and 56.8％ (RFA group) in the two groups,with the mnedian survival of 15 months and 29 months (RFA group,P =0.0476).Conclusions Surgical resection plus RFA for liver cancer can ensure the negative rate of the resection margin,thus reducing the recurrence and metastasis of the tumor.The survival of UESL patients can be prolonged considerably and the recurrence and metastasis can be reduced by combining with systemic chemotherapy.