CAJ | 학술논문

目的探讨中央型肝癌切除联合放疗的安全性及治疗效果.方法本研究为前瞻性研究.2007年至2010年于我院行手术治疗的34例中央型肝癌患者入选.所有患者术前均通过影像学评估手术的可切除性.术中采用区域性肝血流阻断配合超声乳化吸引刀技术切肝.瘤床放置金属标记、术后进行适形调强放射治疗,并予定期随访.结果术后病理证实34例均为肝细胞癌,5例见脉管瘤栓,1例有门静脉瘤栓,30例(88.2％)伴有肝硬化.术后5例出现并发症,肺部感染、右侧胸腔积液、腹腔感染、急性肾功能衰竭、房颤各1例.3例患者未完成放疗疗程,31例完成术后放疗.除3例出现Ⅲ°骨髓抑制外,其余均为Ⅰ°或Ⅱ°副反应.34例均获随访,随访率100％,中位随访时间19个月.1年、3年无瘤生存率分别为69.5％、64.2％;1年、3年总生存率分别为97.0％、86.2％.结论中央型肝癌手术切除联合放疗安全,疗效较好.
목적 탐토중앙형간암절제연합방료적안전성급치료효과.방법 본연구위전첨성연구.2007년지2010년우아원행수술치료적34례중앙형간암환자입선.소유환자술전균통과영상학평고수술적가절제성.술중채용구역성간혈류조단배합초성유화흡인도기술절간.류상방치금속표기、술후진행괄형조강방사치료,병여정기수방.결과 술후병리증실34례균위간세포암,5례견맥관류전,1례유문정맥류전,30례(88.2％)반유간경화.술후5례출현병발증,폐부감염、우측흉강적액、복강감염、급성신공능쇠갈、방전각1례.3례환자미완성방료료정,31례완성술후방료.제3례출현Ⅲ°골수억제외,기여균위Ⅰ°혹Ⅱ°부반응.34례균획수방,수방솔100％,중위수방시간19개월.1년、3년무류생존솔분별위69.5％、64.2％;1년、3년총생존솔분별위97.0％、86.2％.결론 중앙형간암수술절제연합방료안전,료효교호.
Objective To investigate the safety and efficacy of partial hepatectomy combined with radiotherapy for centrally located hepatocellular carcinoma.Methods From 2007 to 2010,34 patients with centrally located hepatocellular carcinoma treated in our institution were enrolled into this prospective study.Preoperatively,computed tomography and/or magnetic resonance imaging were used to evaluate the resectability of tumor.During operation,selective regional-hepatic vascular occlusion technique was used.Cavitron ultrasonic surgical aspirator was applied for parenchymal transection.Surgical clips were placed on the tumor bed to guide postoperative three dimensional conformal radiotherapy.All patients were followed up regularly.Results Histopathologically,all patients had hepatocellular carcinoma.Microvascular invasion was seen in 5 patients,and portal vein thrombosis in 1,30 patients (88.2％) had liver cirrhosis.5 patients developed postoperative complications:1 pulmonary infection,1 right pleural effusion,1 intra-abdominal infection,1 acute renal failure,and 1 atrial fibrillation.3 patients did not receive a complete course of radiotherapy.3 patients developed Ⅲ degree myelosuppression while Ⅰ or Ⅱ degree side effects were seen in the other patients.The follow up rate was 100％ and the median follow-up time was 19 months.The 1-and 3-year disease-free survival rates were 69.5％ and 64.2％,respectively.The 1-and 3-year overall survival rates were 97％and 86.2％,respectively.Conclusion For the centrally located hepatocellular carcinoma,partial hepatectomy combined with radiotherapy was safe and efficacious.