CAJ | 학술논문

目的总结左侧单肺通气条件下经皮穿刺射频消融治疗肝顶部癌(liver cancer of the hepatic dome,LCHD)的疗效和安全性,为拓宽经皮穿刺射频消融在LCHD病人中的应用提供理论依据.方法回顾性总结作者在2006年1月至2009年1月间收治的肝细胞癌病人的临床资料,从中纳入31例在左侧单肺通气条件下应用射频消融治疗的LCHD病人,作为LCHD组;并在不属于LCHD的右肝细胞癌病人中,按癌灶距肝包膜、胆囊和第一肝门主要分支距离≥1.0 cm的条件,纳入45例作为对照组.两组病人的年龄、性别、基础肝病原因、肝功能状况、癌灶直径等方面无统计学差异(P>0.05).癌灶残留采用射频消融后1个月增强CT和(或)甲胎蛋白追踪判定,将完全消融至局部肿瘤生长间隔作为无瘤生存时间.用Mann-Whitney检验比较两组病人的年龄、癌灶直径和平均穿刺次数,用χ2检验比较并发症发生率和不完全消融率,用Kaplan-Meier's法计算局部无瘤生存率,采用log-rank检验比较.结果 LCHD组术后右肩部疼痛发生率明显高于对照组(87.1%比11.1%,P<0.01);两组的平均穿刺次数、治疗时间、住院日数以及完全消融率之间的差异无统计学显著性(P>0.05);LCHD组1年、2年和3年局部无瘤牛存率分别为85.5%、65.8%和36.4%,对照组分别为87.7%、62.3%和34.0%,两组差异无统计学显著性(P>0.05).结论对于直径≤5 cm的LCHD,左侧单肺通气条件下经皮穿刺射频消融的近期疗效和安全性与非特殊位置肝癌相似,可以作为首选治疗方案之一.
목적 총결좌측단폐통기조건하경피천자사빈소융치료간정부암(liver cancer of the hepatic dome,LCHD)적료효화안전성,위탁관경피천자사빈소융재LCHD병인중적응용제공이론의거.방법 회고성총결작자재2006년1월지2009년1월간수치적간세포암병인적림상자료,종중납입31례재좌측단폐통기조건하응용사빈소융치료적LCHD병인,작위LCHD조;병재불속우LCHD적우간세포암병인중,안암조거간포막、담낭화제일간문주요분지거리≥1.0 cm적조건,납입45례작위대조조.량조병인적년령、성별、기출간병원인、간공능상황、암조직경등방면무통계학차이(P>0.05).암조잔류채용사빈소융후1개월증강CT화(혹)갑태단백추종판정,장완전소융지국부종류생장간격작위무류생존시간.용Mann-Whitney검험비교량조병인적년령、암조직경화평균천자차수,용χ2검험비교병발증발생솔화불완전소융솔,용Kaplan-Meier's법계산국부무류생존솔,채용log-rank검험비교.결과 LCHD조술후우견부동통발생솔명현고우대조조(87.1%비11.1%,P<0.01);량조적평균천자차수、치료시간、주원일수이급완전소융솔지간적차이무통계학현저성(P>0.05);LCHD조1년、2년화3년국부무류우존솔분별위85.5%、65.8%화36.4%,대조조분별위87.7%、62.3%화34.0%,량조차이무통계학현저성(P>0.05).결론 대우직경≤5 cm적LCHD,좌측단폐통기조건하경피천자사빈소융적근기료효화안전성여비특수위치간암상사,가이작위수선치료방안지일.
Objective To compare short-term therapeutic outcomes and the safety of percutane-ous radiofrequency ablation (PRFA) with left single lung ventilation (LSLV) for liver cancer of the hepatic dome (LCHD) and that of PRFA for right liver carcinoma in favorable location. Methods Thirty one patients with hepatocellular carcinoma (belonging to LCHD) receiving PRFA with LSLV (Group LCHD) between January 2006 and January 2009 in our hospital were selected, and 45 control patients with right lobe HCC ≥1 cm away from the liver capsule, gallbladder, and main portal bran-ches were also included. One month after PRFA, residual tumors were followed up with contrast en-hanced CT and alpha fetal protein and PRFA was repeated in the presence of residual foci. Tumor-free survival time was defined as the duration from complete ablation to diagnosed local tumor progression.The Mann-Whitney test was used to compare age, tumor diameter, and average number of punctures between LCHD patients and controls. A χ2 test was used for comparison of the incidence of complica-tions and incomplete tumor ablation rate. The Kaplan-Meier's method was used for calculation of local tumor-free survival rate compared with a log-rank test. Results The incidence of right shoulder pain was significantly higher in LCHD patients than in controls (87. 1% vs 11. 1%, P<0. 01). LCHD pa-tients showed no difference from controls in the average number of punctures (2. 8±. 5 vs 3. 2±. 5,P>0. 05). Meanwhile, there was no difference between the 2 groups in average duration of treatment and hospitalization, and the complete tumor ablation rate at first PRFA. No differences were observed in the 1-, 2- and 3-year local tumor-free survival rates between LCHD patients (85. 5% , 65. 8% , and 36. 4% ,respectively) and controls (87.7%, 62. 3% , and 34.0% , respectively). Conclusion PRFA with LSLV for LCHD seems to promise comparable short-term outcomes and safety to PRFA for right liver carcinoma of fa-vorable location and should be preferred as one of the therapeutic options for LCHD patients with tumor di-ameters≤5 cm regardless of its unique location.