摘要:
Objective To study the results of repeat hepatectomy,followed by transcatheter arterial chemoembolization (TACE) and percutaneous microwave coagulation therapy (PMCT),but with or without portal vein chemotherapy (PVC) in patients with recurrence of hepatocelluar carcinoma (HCC) after partial hepatectomy.Methods The data of 33 patients were analyzed retrospectively.All these patients received repeat hepatectomy.They were then divided into two groups:the PVC group (n =19) was treated with PVC + TACE + PMCT,and the non-PVC group (n =14) with TACE + PMCT.Results For the 33 patients,13 (39.4%) developed tumor recurrence >2 years from the initial resection while 20 patients (60.6%) developed recurrence within ≤ 2 years.The tumor recurrence consisted of local recurrence in 14 patients (42.4%),and heterochronous recurrence in 19 patients (57.6%).There was a significantly difference in the cumulative survival rates between the two groups (x2 =4.319; P =0.038).The 1y,3y,5y survival rates were 84.2%,42.1%,31.6% in the PVC Group,and 71.4%,28.6%,14.3% in the Non-PVC Group respectively.28 sessions of PMCT and 97 sessions of TACE were performed postoperatively (the medians were 1,0.5; 3,3 respectively,the mean ranks were 17.68,16.07; 15.05,19.64 respectively,and the P values were 0.612,0.163 respectively between the two groups).Conclusions For patients with recurrence of HCC after hepatic resection,after repeat hepatectomy PVC + TACE + PMCT gave better survival than those with TACE + PMCT but without PVC.%目的 评估手术切除、肝动脉化疗栓塞术(TACE)、经皮微波固化治疗术(PMCT)联合门静脉化疗术(PVC)对肝细胞癌(HCC)术后复发的疗效.方法 回顾性分析我院33例HCC首次术后复发再次实施肝切除的患者资料.根据术后治疗情况分为两组对比分析.其中门静脉化疗组(19例),为手术切除之后辅以PVC+ TACE+ PMCT;非门静脉化疗组(14例),术后辅以TACE+PMCT.结果 再次手术距首次手术的复发时间>2年13例(39.4%),≤2年20例(60.6%).局部复发14例(42.4%),异时复发19例(57.6%).门静脉化疗组1年、3年、5年生存率分别是84.2%、42.1%、31.6%;非门静脉化疗组分别是71.4%、28.6%、14.3%.两组患者累积生存率差异有统计学意义(x2 =4.319,P=0.038).门静脉化疗与非门静脉化疗两组患者术后共实施PMCT 28次,TACE97次.两组实施PMCT和TACE(中位数分别为1、0.5和3、3;平均秩分别是17.68、16.07和15.05、19.64;P值分别为0.612、0.163).结论 对于HCC术后复发,实施再次手术+TACE+ PMCT联合PVC较无PVC的疗效佳.