CAJ | 학술논문

目的探讨手术切除联合射频消融(radiofrequency ablation,RFA)及经肝动脉化疗栓塞术(transarterial arterial chemoembolization,TACE)治疗多发性肝细胞肝癌的临床疗效.方法回顾性分析在我院行手术切除联合RFA及TACE治疗的27例多发性肝细胞肝癌患者的临床资料,观察患者治疗效果及术后并发症. 结果本组27例均顺利完成姑息性手术及RFA治疗,行肝左外叶切除4例,左半肝切除8例,右半肝切除3例,右肝不规则切除12例.手术时间(223±77) min,术中出血量(435±144) ml.术后无肝内血肿、脓肿及腹腔出血、肝功能衰竭等严重并发症,无手术死亡.术后1个月所有患者均行增强CT及TACE,24例射频消融病灶均完全坏死固化,未见碘油沉积,3例患者病灶边缘仍可见碘油沉积.术后1年共有9例患者肝内出现新的病灶,术后随访8 ～39个月,术后中位生存时间为26.3个月,术后1、2、3年累积生存率分别为92％、60％、15％.结论手术切除联合RFA及TACE治疗多发性肝细胞肝癌是安全可行的,可提高部分患者手术切除率,近期疗效肯定.
목적 탐토수술절제연합사빈소융(radiofrequency ablation,RFA)급경간동맥화료전새술(transarterial arterial chemoembolization,TACE)치료다발성간세포간암적림상료효.방법 회고성분석재아원행수술절제연합RFA급TACE치료적27례다발성간세포간암환자적림상자료,관찰환자치료효과급술후병발증. 결과 본조27례균순리완성고식성수술급RFA치료,행간좌외협절제4례,좌반간절제8례,우반간절제3례,우간불규칙절제12례.수술시간(223±77) min,술중출혈량(435±144) ml.술후무간내혈종、농종급복강출혈、간공능쇠갈등엄중병발증,무수술사망.술후1개월소유환자균행증강CT급TACE,24례사빈소융병조균완전배사고화,미견전유침적,3례환자병조변연잉가견전유침적.술후1년공유9례환자간내출현신적병조,술후수방8 ～39개월,술후중위생존시간위26.3개월,술후1、2、3년루적생존솔분별위92％、60％、15％.결론 수술절제연합RFA급TACE치료다발성간세포간암시안전가행적,가제고부분환자수술절제솔,근기료효긍정.
Objective To evaluate surgical resection combined with RFA and TACE for multiple hepatocellular carcinoma.Methods Between 2010 and 2013, 27 multiple hepatocellular carcinoma cases were treated with surgical resection combined with RFA and TACE.The clinical data and postoperative complications were observed.Results Left lateral lobectomy was performed in 4 patients, left hemihepatectomy was performed in 8 patients, right liver resection was performed in 3 patients, irregular right liver resection was performed in 12 patients.The operation time was (223 ± 77) min, The intraoperative bleeding was (435 ± 144) ml.There were not postoperative severe complications, such as hepatic hematoma, liver abscess, intraabdominal hemorrhage, liver failure.Unresected focus uderwent complete necrosis or liquefaction in the RFA regions as shown by CT scanning after 1 month in 24 patients.Postoperative, TACE was performed regularly in all the patients.Lipiodol deposition on the margin of RFA regions was found in 3 patients.After a year, new foci were found in 9 cases.Patients were followed-up from 8-39 months.The median survival time after operation was 26.3 months.The survival rates were 92％, 60％, 15％, respectively after 1, 2, 3 year.Conclusions For patients with multiple hepatocellular carcinoma, surgical resection combined with RFA and TACE was safe and effective.