伴有门静脉高压症的早期肝癌病人肝切除与微波消融的疗效比较

摘要

目的 通过对病毒性肝炎相关的早期肝癌合并门静脉高压症病人肝切除与微波消融的疗效比较,探究肝切除的疗效和安全性.方法 回顾性分析2012年1月至2016年7月收治的89例病毒性肝炎相关的巴塞罗那分期早期肝癌合并门静脉高压症的病人,将病人分为肝切除组(41例)及微波消融组(48例),并分析预后的影响因素、比较两组的术后生存率.结果 肝切除组肿瘤直径大于消融组,分别为(3.6±1.7) cm和(2.4±0.95) cm,P=0.01.而肝脏储备功能肝切除组则优于微波消融组(吲哚菁绿15 min滞留率＞10％),分别为19％和66.7％,P=0.01,经由单因素和多因素分析,术前甲胎蛋白(AFP) ＞400 μg/L(P=0.019)及围手术期输血(P=0.001)是全部89例早期肝癌合并门静脉高压症病人术后总生存期的独立危险因素,尽管两组的术后总生存期相似(P=0.908),但肝切除组在术后累积肿瘤无复发生存期上具有比微波消融组更好的预后(P=0.033).结论 肝切除对具有良好肝脏储备功能的巴塞罗那早期肝癌伴门静脉高压症病人是一种安全、有效的治疗选择,而微波消融治疗则适用于肝脏储备功能较差的小肝癌病人.%Objective This article aims to compare the outcomes between hepatic resection and microwave ablation for patients with hepatitis virus-related hepatocellular carcinoma (HCC) and portal hypertension in early stage,in order to evaluate the safety and efficacy of hepatic resection.Methods A series of 89 hepatitis virus-related HCC and portal hypertension in BCLC early stage from 2012 to 2016 were retrospectively analyzed.Patients were divided into 2 groups:hepatic resection group (n =41) and microwave ablation group (n =48).Then the predictive factors of prognosis were analyzed and the outcomes of survival rate were compared.Results As compared with the microwave ablation group,Patients in the liver resection group had bigger tumor sizes (3.6 ± 1.7 cm vs.2.4± 0.95 cm,P =0.01) and better liver reserve function (ICG R15＞10％:19％ vs.66.7％,P =0.01) than in the microvave ablation group.Univariate and multivariate analysis revealed that the AFP level ＞400 μg/L (P =0.019) and perioperative blood transfusion (P =0.001) were predictive factors of overall survival in the entire study population of 89 patients with HCC and portal hypertension in BCLC early stage.Although the overall survival of hepatic resection group and microwave ablation group was comparable (P =0.908),the hepatic resection group had better outcomes of the recurrence-free survival (P =0.033).Conclusions Under the premise of good liver reserve function,the hepatic resection is a safe and effective option for patients with HCC and portal hypertension in BCLC early stage.And microwave ablation is applicable for the patients with small HCC and poor liver reserve function.