CAJ | 학술논문

目的：探讨腹腔镜下微波固化联合肝切除治疗肝硬化合并肝细胞癌（肝癌）的安全性和疗效。方法回顾性研究2009年1月至2013年11月在中山大学孙逸仙纪念医院接受诊治的58例肝硬化合并肝癌患者临床资料。按治疗方式不同将患者分为微波固化联合肝切除组（联合组）和单纯微波固化组（固化组）。其中联合组37例，男29例，女8例；平均年龄（54±9）岁。固化组21例，男17例，女4例；年龄（58±10）岁。所有患者均签署知情同意书，符合医学伦理学规定。固化组仅于腹腔镜下行微波固化。联合组于微波固化后在距肿瘤边缘1～2 cm标记切割线后行肝切除术。观察两组患者术中出血量、手术时间。患者术中出血量、手术时间比较采用Wilcoxon秩和检验，生存分析采用Log-rank法和Z检验。结果联合组术中出血量146（58～250）ml明显多于固化组的13（10～25）ml（Z=7.824，P<0.05）。联合组手术时间177（83～275）min明显长于单纯固化组的93（36～135）min（Z=8.650，P<0.05）。联合组患者3年累积生存率及1、3年无瘤生存率97%、83%、92%，均明显高于固化组的64%、71%、43%（Z=10.054，9.011,7.112；P<0.05）。结论腹腔镜下微波固化联合肝切除术治疗肝硬化合并肝癌安全、有效，其远期疗效优于单纯腹腔镜微波固化。
목적：탐토복강경하미파고화연합간절제치료간경화합병간세포암（간암）적안전성화료효。방법회고성연구2009년1월지2013년11월재중산대학손일선기념의원접수진치적58례간경화합병간암환자림상자료。안치료방식불동장환자분위미파고화연합간절제조（연합조）화단순미파고화조（고화조）。기중연합조37례，남29례，녀8례；평균년령（54±9）세。고화조21례，남17례，녀4례；년령（58±10）세。소유환자균첨서지정동의서，부합의학윤리학규정。고화조부우복강경하행미파고화。연합조우미파고화후재거종류변연1～2 cm표기절할선후행간절제술。관찰량조환자술중출혈량、수술시간。환자술중출혈량、수술시간비교채용Wilcoxon질화검험，생존분석채용Log-rank법화Z검험。결과연합조술중출혈량146（58～250）ml명현다우고화조적13（10～25）ml（Z=7.824，P<0.05）。연합조수술시간177（83～275）min명현장우단순고화조적93（36～135）min（Z=8.650，P<0.05）。연합조환자3년루적생존솔급1、3년무류생존솔97%、83%、92%，균명현고우고화조적64%、71%、43%（Z=10.054，9.011,7.112；P<0.05）。결론복강경하미파고화연합간절제술치료간경화합병간암안전、유효，기원기료효우우단순복강경미파고화。
ObjectiveTo investigate the safety and curative effect of laparoscopic microwave coagulation combined with hepatectomy for liver cirrhosis complicated with hepatocellular carcinoma (HCC).MethodsClinical data of 58 patients with liver cirrhosis complicated with HCC diagnosed and treated in Sun Yat-sen Memorial Hospital of Sun Yat-sen University between Janunary 2009 and November 2013 were retrospectively studied. The patients were divided into the microwave coagulation combined with hepatectomy group (the combination group) and the simple microwave coagulation group (the coagulation group) according to different treatment methods. Among the 37 patients in the combination group, 29 were males and 8 were females with average age of (54±9) years old. Among the 21 patients in the combination group, 17 were males and 4 were females with average age of (58±10) years old. The informed consents of all patients were obtained and the local ethical committee approval had been received. The patients in the coagulation group only underwent laparoscopic microwave coagulation, while the patients in the combination group underwent hepatectomy after marking a incision line 1-2 cm from the tumor edge and undergoing microwave coagulation. The intraoperative blood loss and the duration of operation of two groups were observed. The comparison of the intraoperative blood loss and the duration of operation were conducted using Wilcoxon rank-sum test and the survival analysis was conducted using Log-rank test and Z test.ResultsThe intraoperative blood loss of the combination group was 146 (58-250) ml, which was signiifcantly higher than 13 (10-25) ml of the coagulation group (Z=7.824,P<0.05). The duration of operation of the combination group was 177 (83-275) min, which was signiifcantly longer than 93 (36-135) min of the coagulation group (Z=8.650,P<0.05). The 3-year cumulative survival rate and 1-, 3-year disease free survival of the combination group were respectively 97%, 83%, 92%, which were signiifcantly higher than 64%, 71%, 43% of the coagulation group (Z=10.054, 9.011, 7.112;P<0.05).ConclusionsLaparoscopic microwave coagulation combined with hepatectomy for liver cirrhosis complicated with HCC is safe and effective. The long-term curative effect is better than that of simple laparoscopic microwave coagulation.