微波凝固坏死疗法联合腹腔镜脾切除术治疗原发性肝癌合并脾功能亢进的效果观察

刘曙民; 孙邱; 张美菊

doi:10.3969/j.issn.1001-5256.2018.01.029

微波凝固坏死疗法联合腹腔镜脾切除术治疗原发性肝癌合并脾功能亢进的效果观察

DOI: 10.3969/j.issn.1001-5256.2018.01.029

1. 宝鸡市人民医院介入科
2. 宝鸡市第二人民医院肿瘤科

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中图分类号: R735.7
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出版历程
- 出版日期: 2018-01-20

Clinical effect on microwave coagulo-necrotic therapy combined with laparoscopic splenectomy in treatment of primary hepatocellular carcinoma complicated by hypersplenism

Department of Interventional Radiology, Baoji Municipal People′s Hospital, Baoji, Shaanxi 721000, China

摘要

摘要: 目的探讨微波凝固坏死疗法（MCN）和腹腔镜脾切除术（LS）联合治疗原发性肝癌（PHC）合并脾功能亢进患者的可行性及安全性。方法回顾性分析2008年1月-2012年12月宝鸡市人民医院收治的MCN和LS联合治疗的PHC合并脾功能亢进患者22例。收集患者临床资料,观察患者术后并发症及生存情况。计量资料比较采用t检验,累积生存曲线采用Kaplan-Meier法绘制。结果 MCN治疗中5例经胸廓切开术、15例经剖腹术、2例经腹腔镜术,LS治疗中17例采用手辅助LS、5例行单纯LS。平均手术时间（303.24±56.02）min,平均失血量（146.92±60.72）ml,平均切除脾脏重量（670.42±204.54）g。22例患者术后6例（27.27%）发病、5例（22.73%）门静脉血栓形成、2例（9.09%）存在胸腔积液。术后1个月血小板计数较术前显著升高[（15.72±5.47）×104/μl vs（4.43±1.03）×104/μl,t=6.83,P<0.001]。术后1、3、5年总生存率分别为90.91%、68.18%、59.09%,...
- 肝肿瘤 /
- 脾功能亢进 /
- 导管消融术 /
- 脾切除术 /
- 治疗结果
Abstract: Objective To investigate the feasibility and safety of microwave coagulo-necrotic therapy ( MCN) combined with laparoscopic splenectomy ( LS) in the treatment of primary hepatocellular carcinoma ( PHC) complicated by hypersplenism. Methods A retrospective analysis was performed for the clinical data of 22 PHC patients with hypersplenism who were admitted to Baoji Municipal People' s Hospital from January 2008 to December 2012 and underwent MCN combined with LS. Their clinical data were collected, and postoperative complications and survival were observed. The t-test was used for comparison of continuous data, and the Kaplan-Meier method was used to plot cumulative survival curves. Results In MCN therapy, 5 patients underwent thoracotomy, 15 underwent laparotomy, and 2 underwent laparoscopic surgery; in LS treatment, 17 underwent hand-assisted LS and 5 underwent simple LS. The mean time of operation was ( 303. 24 ±56. 02) min, the mean blood loss volume was ( 146. 92 ± 60. 72) ml, and the mean weight of the resected spleen was ( 670. 42 ± 204. 54) g. Of all patients, 6 ( 27. 27% ) experienced postoperative recurrence, 5 ( 22. 73% ) experienced portal vein thrombosis, and 2 ( 9. 09% ) experienced pleural effusion. There was a significant increase in platelet count at 1 month after surgery [ ( 15. 72 ± 5. 47) ×104/μl vs ( 4. 43 ±1. 03) ×104/μl, t = 6. 83, P < 0. 001]. The 1-, 3-, and 5-year overall survival rates after surgery were 90. 91% , 68. 18% , and 59. 09% , respectively, and the 1-, 3-, and 5-year disease-free survival rates were 59. 09% , 13. 64% , and 13. 64% , respectively.Conclusion MCN combined with LS is safe, effective, and feasible in the treatment of PHC complicated by hypersplenism.
- liver neoplasms /
- hypersplenism /
- catheter ablation /
- splenectomy /
- treatment outcome

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参考文献(23)

[1]LIANG HY, LU ZM.Current status and confusion in comprehensive interventional therapy for hepatocellular carcinoma[J].J Clin Hepatol, 2016, 32 (1) :44-48. (in Chinese) 梁宏元, 卢再鸣.原发性肝癌综合介入治疗现状与困惑[J].临床肝胆病杂志, 2016, 32 (1) :44-48.

[2]LYU TS, ZOU YH, WANG J, et al.Current status of transcatheter arterial chemoembolization combined with radiofrequency ablation in treatment of primary liver cancer[J].J Clin Hepatol, 2016, 32 (1) :49-55. (in Chinese) 吕天石, 邹英华, 王健, 等.经肝动脉化疗栓塞术联合射频消融治疗原发性肝癌的现状[J].临床肝胆病杂志, 2016, 32 (1) :49-55.

[3]JIANG GQ, BAI DS, CHEN P, et al.Risk factors for portal vein system thrombosis after laparoscopic splenectomy in cirrhotic patients with hypersplenism[J].J Laparoendosc Adv Surg Tech A, 2016, 26 (6) :419-423.

[4]TSUTSUMI N, TOMIKAWA M, AKAHOSHI T, et al.Pancreatic fistula after laparoscopic splenectomy in patients with hypersplenism due to liver cirrhosis:effect of fibrin glue and polyglycolic acid felt on prophylaxis of postoperative complications[J].Am J Surg, 2016, 212 (5) :882-888.

[5]QIAO Q, LI HY, WU JH, et al.Radiofrequency ablation and microwave ablation under artificial ascites for hepatocellular carcinoma adjacent to vital organs[J].Chin J Min Inv Surg, 2016, 16 (8) :724-727. (in Chinese) 乔强, 李海莹, 吴佳恒, 等.人工腹水下射频消融和微波消融治疗毗邻重要器官的肝癌[J].中国微创外科杂志, 2016, 16 (8) :724-727.

[6]RYU T, TAKAMI Y, TSUTSUMI N, et al.Simultaneous microwave coagulo-necrotic therapy (MCN) and laparoscopic splenectomy for the treatment of hepatocellular carcinoma with cirrhotic hypersplenism[J].Surg Today, 2017, 47 (1) :548-554.

[7]XU Y, SHEN Q, WANG N, et al.Effect analysis of microwave ablation therapy for early hepatocellular carcinoma in patients over 70years old[J].J Intervent Radiol, 2016, 25 (4) :332-336. (in Chinese) 许贇, 沈强, 王能, 等.微波消融治疗>70岁早期肝细胞肝癌患者效果分析[J].介入放射学杂志, 2016, 25 (4) :332-336.

[8]KAWANAKA H, AKAHOSHI T, KINJO N, et al.Laparoscopic splenectomy with technical standardization and selection criteria for standard or hand-assisted approach in 390 patients with liver cirrhosis and portal hypertension[J].J Am Coll Surg, 2015, 221 (2) :354-366.

[9]SEEHOFER D, SUCHER R, SCHMALZLE M, et al.Evolution of laparoscopic liver surgery as standard procedure for HCC in cirrhosis?[J].Z Gastroenterol, 2017, 55 (5) :453-460.

[10]TOYADA H, KUMADA T, TADA T, et al.Non-hypervascular hypointense nodules detected by Gd-EOB-DTPA-enhanced MRI are a risk factor for recurrence of HCC after hepatectomy[J].J Hepatol, 2013, 58 (6) :1174-1180.

[11]LIU GY, WANG W, JIA WD, et al.Protective effect of S-adenosylmethionine on hepatic ischemia-reperfusion injury during hepatectomy in HCC patients with chronic HBV infection[J].World J Surg Oncol, 2014, 12 (1) :27-28.

[12]LI JS, WANG T, DAI XM, et al.Clinical effect of CT-guided microwave ablation in treatment of advanced pulmonary malignant tumors[J/CD].Chin J Clinicians:Electronic Edition, 2016, 10 (22) :3483-3486. (in Chinese) 李劲松, 王涛, 戴秀梅, 等.CT引导下微波消融治疗晚期肺部恶性肿瘤的临床疗效[J/CD].中华临床医师杂志:电子版, 2016, 10 (22) :3483-3486.

[13]BERBER E.Laparoscopic microwave thermosphere ablation of malignant liver tumors:an initial clinical evaluation[J].Surg Endosc, 2016, 30 (2) :692-698.

[14]GUO ZY, FU LP, FU ZG, et al.Comparison of efficacy of percutaneous radiofrequency ablation and microwave ablation for liver cancer[J].Pract J Cancer, 2015, 30 (9) :1386-1388. (in Chinese) 郭志远, 付吕平, 付志国, 等.经皮射频消融术与微波消融治疗肝癌的治疗效果对比[J].实用癌症杂志, 2015, 30 (9) :1386-1388.

[15]CHANG P, ZHANG HY, XIAO M, et al.Efficacy of transcatheter arterial chemoembolization alone or combined with microwave ablation in treatment of primary large liver cancer:a comparative analysis[J].J Clin Hepatol, 2015, 31 (6) :880-885. (in Chinese) 常鹏, 张洪义, 肖梅.单纯经肝动脉化疗栓塞术及其联合微波消融治疗原发性大肝癌的疗效对比分析[J].临床肝胆病杂志, 2015, 31 (6) :880-885.

[16]LI ZY, LIU Y, LIU Y, et al.Impact of splenectomy with periesophagogastric devascularization on liver function of patients withliver cirrhosis and hypersplenism[J/CD].Chin J Hepat Surg:Electronic Edition, 2014, 3 (3) :235-237. (in Chinese) 李展翼, 刘莹, 刘宇, 等.脾切除加贲门周围血管离断术对肝硬化合并脾功能亢进患者肝功能的影响[J/CD].中华肝脏外科手术学电子杂志, 2014, 3 (3) :235-237.

[17]CHENG J, TAO K, YU P.Laparoscopic splenectomy is a better surgical approach for spleen-relevant disorders:a comprehensive meta-analysis based on 15-year literatures[J].Surg Endosc, 2016, 30 (10) :4575-4588.

[18]LIN GS, XU Q, ZHAO SY, et al.Clinical features of liver cirrhosis complicated by portal vein thrombosis and related risk factors[J].Chin J Hepatol, 2016, 24 (7) :513-517. (in Chinese) 林国帅, 徐琴, 赵淑一, 等.肝硬化合并门静脉血栓形成的临床特点及其相关危险因素分析[J].中华肝脏病杂志, 2016, 24 (7) :513-517.

[19]KAWANAKA H, AKAHOSHI T, KINJO N, et al.Impact of antithrombin III concentrates on portal vein thrombosis after splenectomy in patients with liver cirrhosis and hypersplenism[J].Annals of Surgery, 2010, 251 (1) :76-83.

[20]ZHU XL, SHEN J.Application of local ablative therapies for hepatocellular carcinoma[J].J Clin Hepatol, 2016, 32 (1) :56-61. (in Chinese) 朱晓黎, 沈健.局部消融在肝细胞癌治疗中的应用[J].临床肝胆病杂志, 2016, 32 (1) :56-61.

[21]YANG Y, ZHANG YC.Reflections on future directions of liver transplantation for liver cancer[J].Organ Transplant, 2016, 7 (1) :1-7. (in Chinese) 杨扬, 张英才.肝癌肝移植未来方向的思考[J].器官移植, 2016, 7 (1) :1-7.

[22]HU CX, ZHENG JS, LIN W, et al.Application of local ablative therapies for hepatocellular carcinoma[J].J Clin Hepatol, 2015, 31 (2) :228-231. (in Chinese) 扈彩霞, 郑加生, 林伟, 等.原发性肝癌微波消融术后早期复发危险因素分析[J].临床肝胆病杂志, 2015, 31 (2) :228-231.

[23]IKEDA K, ARASE Y, KOBAYASHI M, et al.Significance of multicentric cancer recurrence after potentially curative ablation of hepatocellular carcinoma:a longterm cohort study of 892 patients with viral cirrhosis[J].J Gastroenterol, 2003, 38 (9) :865-876.

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