摘要
目的 探讨肝癌射频消融治疗的手术途径。方法 对烟台毓璜顶医院肝胆外科2015年1月至2020年11月共计1284例肝癌射频消融手术进行分析、总结，按手术途径分为经皮、腹腔镜和开腹手术三组，对手术时间、术中出血量、住院时间、术后肝功能情况、术后甲胎蛋白变化、手术相关并发症情况进行对比研究；统计学分析采用SPSS 20.0。结果 门诊随访平均44±32个月，三种途径在术后肝功能变化（P＞0.05）、手术相关并发症（P＞0.05）、肿瘤复发（P＞0.05）方面差异无统计学意义，且术后甲胎蛋白水平均显著下降，无手术死亡病例，但经皮消融手术时间（t=34.312，P＜0.05）、住院时间（t=14.608，P＜0.05）较腹腔镜和开腹手术显著缩短。结论 经皮、腹腔镜和开腹手术行射频消融治疗肝癌均安全有效，且经皮消融手术时间更短，应根据患者肿瘤具体位置采用个体化方案选择手术途径。
关键词： 肝癌；射频消融；手术途径；个体化
Abstract
Objective: To explore the surgical approach of radiofrequency ablation for hepatocellular carcinoma. Methods A total of 1284 patients with hepatocellular carcinoma undergoing radiofrequency ablation in department of Hepatobiliary Surgery of Yuhuangding Hospital of Yantai from January 2015 to November 2020 were analyzed and summarized. They were divided into percutaneous, laparoscopic and open surgery groups according to surgical approaches. The operative time, intraoperative blood loss, length of hospital stay, postoperative liver function, postoperative AFP changes, and surgical complications were compared. SPSS20.0 was used for statistical analysis. Results The average follow-up was 44±32 months. There were no significant differences in postoperative liver function changes (P>0.05), surgery-related complications(P>0.05) and tumor recurrence(P>0.05) among the three approaches. The level of AFP decreased significantly after operation, and there were no surgical deaths in three groups. However, the duration of percutaneous ablation (t=34.312, P<0.05) and length of hospital stay (t=14.608, P<0.05) were significantly shorter than those of laparoscopic and open surgery. Conclusion Percutaneous, laparoscopic and open radiofrequency ablation for hepatocellular carcinoma are safe and effective, and the time of percutaneous ablation is shorter, so the surgical approach should be selected according to the specific location of the patient's tumor.
Key words： Liver cancer; Radiofrequency ablation; Treatment approach; Individualized
参考文献 References
[1] BRAY F, FERLAY J, SOERJOMATARAM I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J]. CA Cancer J Clin, 2018, 68(6): 394-424.
[2] FORNER A, REIG M, BRUIX J. Hepatocellular carcinoma[J]. Lancet, 2018, 391(10127): 1301-1314.
[3] Francesco Izzo , Vincenza Granata, Roberto Grassi, et al. Radiofrequency Ablation and Microwave Ablation in Liver Tumors: An Update[J]. Oncologist, 2019, 24(10): e990-e1005.
[4] Zhu F, Rhim H. Thermal ablation for hepatocellular carcinoma: what's new in 2019[J]. Chin Clin Oncol, 2019, 8(6): 58.
[5] Zhu ZX, Huang JW, Liao MH, et al. Treatment strategy for hepatocellular carcinoma in China: radiofrequencyablation versus liver resection[J]. Jpn J Clin Oncol, 2016, 46(12): 1075-1080.
[6] Petrou A, Neofytou K, Mihas C, et al. Radiofrequency ablation-assisted liver resection: a step toward bloodless liverresection[J]. Hepatobiliary Pancreat Dis Int, 2015, 14(1): 69-74.
[7] 宗维, 孙尧, 王刚, 等. US-MRI影像融合容积导航技术在小肝癌微波消融中的临床应用[J]. 医学影像学杂志, 2019, 29(10): 1738-1741.
[8] 中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗规范(2019年版)[J]. 中国实用外科杂志, 2020, 40(2): 121-138.
[9] Forner A. Reig M, Bruix J. Hepatocellular carcinoma[J]. Lancet, 2018, 391(10127): 1301-1314.
[10] 王忠, 刘启榆, 杨伟, 等. 微波消融对直径<5cm肝癌的治疗效果和患者长期生存的影响因素分析[J/CD]. 中国医学前沿杂志(电子版), 2019, 11(10): 58-61.
[11] 古曦, 杨俭, 杨小玲, 等. 腹腔镜肝切除术与射频消融术对原发性肝癌患者肝功能和免疫功能及3年无瘤生存率的影响[J]. 西部医学, 2020, 32(7):1016-1019, 1023.
[12] 孙文兵. 射频消融治疗肝细胞癌三十年：学术地位困境与展望[J]. 中华肝胆外科杂志, 2020, 26(6): 401-405.
[13] Jacobs A. Radiofrequency Ablation for Liver Cancer[J]. Radiol Technol, 2015, 86(6): 645-664.
[14] 张先舟, 韩风, 聂常富, 等. 人工腹水辅助腔镜超声引导重度肝硬化特殊部位肝癌射频消融术[J]. 中华普通外科杂志, 2019, 34(11): 986-987.
[15] 姜凯. 腹腔镜辅助肝癌射频消融治疗[J]. 中华医学杂志, 2015, 95(27): 2157-2159.
[16] HUANG Y, SHEN Q, BAI H X, et al. Comparison of radiofrequency ablation and hepatic resection for the treatment of hepatocellular carcinoma 2cm or less[J]. Journal of vascular and interventional radiology: JVIR, 2018, 29(9):1218-1225.
[17] EUN H S, LEE B S, KWON I S, et al. Advantages of laparoscopic radiofrequency ablation over percutaneous radiofrequency ablation in hepatocellular carcinoma[J]. Digestive Diseases and Sciences, 2017, 62(9):2586-2600.
[18] Chen F, Bao H, Xie H, et al. Heat shock protein expression and autophary after incomplete thermal ablation and their corelation[J]. Int J Hyperthermia, 2019, 36(1): 95-103.
[19] Laimer G SP, Jaschke N, Eberle, et al. Minimal ablative margin (MAM) assessment with image fusion: an independent predictor for local tumor progression in hepatocellular carcinoma after stereotactic radiofrequency ablation[J]. Eur Radiol, 2020, 30(5): 2463-2472.
[20] PUZA C J, WANG Q, KIM C Y. Evaluation of the heat sink effect after transarterial embolization when performed in combination with thermal ablation of the liver in a rabbit model[J]. Cardiovasc Intervent Radiol, 2018, 41(11): 1773-1778.