CAJ | 학술논문

目的探讨腹腔镜联合应用射频消融和~(125)I粒子植入治疗肝转移痛的临床价值.方法对41例术前经CT或MR确诊肝脏有转移灶的患者,行腹腔镜下肝转移瘤切除或射频消融及~(125)I粒子植入(综合治疗组).并与同期的83例肝转移癌行肝动脉化疗栓塞(TACE)及全身化疗患者进行对比研究(对照组).结果综合治疗组术中超声发现新病灶9个.13例患者的18个边缘转移病灶行腹腔镜切除.28例患者的59个转移病灶位于第一、二肝门或靠近大血管仅行腹腔镜下射频消融及~(125)I粒子植入.所有患者均获随访26～45个月(平均35.4个月),综合治疗组中全部缓解(CR)18例,部分缓解(PR)19例,稳定(SD)3例,进展(PD)1例,缓解率(CR+PR)90.2%.中位生存时间19个月,1、2、3年生存率分别为80.5%,48.8%和24.4%;对照组中全部缓解(CR)4例,部分缓解(PR)21例,稳定(SD)28例,进展(PD)30例,缓解率(CR+PR)30.1%.中位生存时间11个月,1、2、3年生存率分别为54.2%、28.9%和9.6%.两组相比缓解率(x~2=39.68,P＜0.05＝、中位生存时间(t=-9.74,P＜0.05＝以及1、2、3年生存率(分别x~2=8.11,4.73,4.81,均P＜0.05＝差异均有统计学意义.结论腹腔镜联合应用RFA和~(125)I粒子植入治疗肝转移癌具有安全、有效,对延长患者生存期有一定效果.
목적 탐토복강경연합응용사빈소융화~(125)I입자식입치료간전이통적림상개치.방법 대41례술전경CT혹MR학진간장유전이조적환자,행복강경하간전이류절제혹사빈소융급~(125)I입자식입(종합치료조).병여동기적83례간전이암행간동맥화료전새(TACE)급전신화료환자진행대비연구(대조조).결과 종합치료조술중초성발현신병조9개.13례환자적18개변연전이병조행복강경절제.28례환자적59개전이병조위우제일、이간문혹고근대혈관부행복강경하사빈소융급~(125)I입자식입.소유환자균획수방26～45개월(평균35.4개월),종합치료조중전부완해(CR)18례,부분완해(PR)19례,은정(SD)3례,진전(PD)1례,완해솔(CR+PR)90.2%.중위생존시간19개월,1、2、3년생존솔분별위80.5%,48.8%화24.4%;대조조중전부완해(CR)4례,부분완해(PR)21례,은정(SD)28례,진전(PD)30례,완해솔(CR+PR)30.1%.중위생존시간11개월,1、2、3년생존솔분별위54.2%、28.9%화9.6%.량조상비완해솔(x~2=39.68,P＜0.05＝、중위생존시간(t=-9.74,P＜0.05＝이급1、2、3년생존솔(분별x~2=8.11,4.73,4.81,균P＜0.05＝차이균유통계학의의.결론 복강경연합응용RFA화~(125)I입자식입치료간전이암구유안전、유효,대연장환자생존기유일정효과.
Objective To study the efficacy of laparoscopic hepatectomy combined with Iodine-125 and radiofrequency ablation(RFA)in the treatment of metastatic hepatic carcinoma.Methods There were 124 patients diagnosed as hepatic metastasis detected by CT or MR scan, and were divided into two treatment groups. Group A(combined group of 41 cases)with laparoscopic excision,RFA and iodine-125 treatment and group B(control group of 83 cases)with transhepatic artery chemoembolization(TACE)and systematic chemotherapy.Results Nine new hepatic metastatic foci were found by laparoscopic ulstrasound during the operation in group A,and in this group,18 hepatic metastatic lesions located on the surface in 13 patients were removed,then RAF applied to the hepatic metastases,and iodine-125 planted in place,altogether 59 foci near to the porta hepatis or large vessels were treated by laparoscopic RFA and iodine-125 implantation.All patients were followed-up from 26 to 45 months(average 35.4 months).The total relief rate was 90.2% and 30.1 % in group A and B respectively(x~2=39.68,P＜0.05＝.The median survival time was 19 and 11 months in group A and B respectively(t=-9.74,P＜0.05＝.The survival rate at 1-,2-and 3-years was 80.5%,48.8%,24.4% and 54.2%,28.9%,9.6% in group A and B respectively (x~2=8.11,4.73,4.81,P＜0.05＝.Conclusions Laparoscopic excision,Iodine-125 implantation and radiofrequency ablation in the treatment of metastatic liver carcinoma is safe、effective,and this approach prolongs the patient's survival time.