经皮微波消融在多发肝细胞性癌患者中的应用效果

Effect of percutaneous microwave ablation in patients with multifocal hepatocellular carcinoma

摘要:

目的探讨经皮微波消融（PWMA）在多发肝细胞性肝癌（HCC）患者中的应用效果。方法选取2007 年1 月-2012 年12 月青海省人民医院收治的164 例多发HCC（共有2～4 个癌灶，直径1～7 cm）患者作为研究对象，根据治疗方法分为PWMA 组（n =67）和肝切除组（n =97），所有癌灶均完全消融或切除。调查并比较两组的术前基线资料、术中和术后资料及随访结果。采用多因素Cox 比例风险模型筛选出影响患者复发/转移、死亡的影响因素。结果PMWA 组的术前血清白蛋白（ALB）≥40 g/L的比例、术后血红蛋白（Hb）的下降 值、术中出血量、术后输血率、总住院天数低于肝切除组，差异有统计学意义（p <0.05）。随访结果表明PMWA组的无疾病进展期（PFS）和总生存期（OS）高于肝切除组，差异有统计学意义（P <0.05）。PMWA 组、肝切除组的复发率分别为37.3％和41.2％，两组比较差异无统计学意义（P >0.05）。而PMWA 组的再次治疗率高于肝切除组，差异有统计学意义（P <0.05）。多因素Cox 比例风险模型分析结果表明PWMA治疗方法是患者发生复发/转移、死亡的保护因素（P <0.05）。结论对于多发HCC 患者而言，PWMA 的复发/ 转移及总体生存状况优于肝切除术，可重复性高、创伤小、安全可靠，值得临床推广应用。

Abstract:

Objective To investigate the effect of percutaneous microwave ablation (PMWA) in patients with multifocal hepatocellular carcinoma (HCC). Methods A total of 164 patients with multifocal HCC (2-4 lesions, 1-7cm in diameter) from January 2007 to December 2012 were enrolled for the study and divided into PMWA group (67cases) and liver resection group (97 cases) according to the therapeutic method. All lesions were completely ablated or removed. Preoperative baseline data, intraoperative and postoperative data and follow-up results were investigated and compared between the two groups. Multivariable Cox proportional hazards model was adopted to screen the factors related to recurrence, metastasis and death. Results Preoperative ratio of albumin ≥40 g/L, reduction value of hemoglobin after treatment, intraoperative blood loss and postoperative blood transfusion rate were significantly lower, the total hospitalization time was shorter in the PWMA group than in the liver resection group, the differences were all statistically significant (P < 0.05). Results of follow-up showed that the progression-free survival (PFS) and overall survival (OS) in the PWMA group were significantly higher than those in the liver resection group (P < 0.05).The recurrence rates of the PMWA group and the liver resection group were 37.3% and 41.2% respectively, there was no statistical difference (P > 0.05). And the retreatment rate of the PMWA group was significantly higher than that of the liver resection group (P < 0.05). Multivariable Cox proportional hazards model analysis showed that the treatment method of PMWA was an independent protective factor for recurrence, metastasis and death of the HCC patients (P < 0.05). Conclusions For patients with multifocal HCC, the condition of recurrence, metastasis and overall living after PWMA is better than that after liver resection. PMWA is safe and reliable, and has high repeatability but little trauma; it is worthy of clinical popularization and application.