切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2020, Vol. 14 ›› Issue (06) : 577 -580. doi: 10.3877/cma.j.issn.1674-3946.2020.06.013

所属专题: 文献

论著

三种术式治疗肝细胞癌的近期临床疗效比较
唐聃1, 刘公伟1, 敖宇1, 谭阳1, 杨秀智1, 李雄雄1, 蔡治方1,(), 赵礼金2   
  1. 1. 563000 遵义医科大学第二附属医院肝胆胰外科
    2. 563003 遵义医科大学附属医院肝胆胰外科
  • 收稿日期:2020-03-20 出版日期:2020-12-26
  • 通信作者: 蔡治方

Comparison of short-term clinical efficacy of three surgical methods for hepatocellular carcinoma

Dan Tang1, Gongwei liu1, Yu Ao1, Yang Tan1, Xiuzhi Yang1, Xiongxiong Li1, Zhifang Cai1,(), Lijin Zhao2   

  1. 1. Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Zunyi Medical University 563000
    2. Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Zunyi Medical University 563003
  • Received:2020-03-20 Published:2020-12-26
  • Corresponding author: Zhifang Cai
  • About author:
    Correspondence author: Cai Zhifang, Emil:
  • Supported by:
    Zunyi Science and Technology Bureau Zunyi Medical University City School Joint(Zun Shi Ke He HZ (2019) No.8); Major Research on Innovation Group of Education Department of Guizhou Province(Qiankehe KY 2016039)
引用本文:

唐聃, 刘公伟, 敖宇, 谭阳, 杨秀智, 李雄雄, 蔡治方, 赵礼金. 三种术式治疗肝细胞癌的近期临床疗效比较[J/OL]. 中华普外科手术学杂志(电子版), 2020, 14(06): 577-580.

Dan Tang, Gongwei liu, Yu Ao, Yang Tan, Xiuzhi Yang, Xiongxiong Li, Zhifang Cai, Lijin Zhao. Comparison of short-term clinical efficacy of three surgical methods for hepatocellular carcinoma[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2020, 14(06): 577-580.

目的

比较腹腔镜切除术(LR)、开腹切除术(OR)与超声定位下的射频消融术(RFA)治疗肝细胞癌的近期临床疗效。

方法

回顾性分析2010年6月至2018年6月接受手术治疗的152例肝细胞癌患者的病例资料,71例患者纳入LR组,52例患者纳入OR组,29例患者纳入RFA组。采用SPSS 25.0软件分析数据,手术相关指标、VAS评分等计量资料以(±s)描述,行f检验;近期疗效、并发症等计数资料行χ2检验,P<0.05为差异有统计学意义。

结果

三组患者术后3个月治疗总有效率比较,LR组(76.1%)>OR组(73.1%)>RFA组(72.4%),差异无统计学意义(P>0.05)。三组手术时间、术中总出血量及住院时间相比,OR组>LR组>RFA组(P<0.05);术后24 h及1周后VAS评分比较,OR组>LR组>RFA组(P<0.05);OR组并发症总发生率(36.5%)>LR组(29.6%)>RFA组(6.7%),差异有统计学意义(P<0.05);术后随访3个月的复发率比较,OR组(7.7%)<LR组(8.5%)<RFA组(10.3%)差异无统计学意义(P>0.05)。

结论

对分期早且肿瘤小的肝细胞癌患者分别采用LR术、OR术与RFA术治疗,患者近期疗效相当,但RFA术具有损伤小、术后恢复快等优点,可减轻患者术后疼痛程度,安全性更高。但对于瘤体较大且靠近重要血管胆管的肝细胞癌患者,还需进行个体化治疗。

Objective

To compare the short-term clinical efficacy of laparoscopic resection(LR), open resection(OR) and radiofrequency ablation under ultrasound localization for hepatocellular carcinoma(RFA).

Methods

The data of 152 patients with hepatocellular carcinoma who underwent surgery in our hospital from June 2010 to June 2018 were retrospectively analyzed.71 patients who were treated with laparoscopic resection (LR) were included in the LR group, 52 patients who were treated with open resection (OR) were included in the OR group, and 29 patients who were treated with ultrasound-localized radiofrequency ablation (RFA) were included in the RFA group.SPSS 25.0 software package was used to verify the entire group of data. Measurement data such as surgery-related indicators and VAS scores were described by (±s) and t tests were performed. Frequency (n) and rate (%) were used for counting data such as recent efficacy and complications. Description, χ2 test was performed, and comparison among multiple groups was performed by one-way analysis of variance. P<0.05 was considered statistically significant.

Results

Comparing the total effective rate of three groups of patients 3 months after operation, LR group (76.1%) > OR group (73.1%) > RFA group (72.4%), but the difference was not statistically significant (P>0.05); The operation time, total bleeding volume and hospitalization time of the three groups were compared, the OR group > Lr Group > RFA group (P<0.05) ; The Vas scores after 24 hours and 1 week after operation were compared, the overall incidence of complications in the OR group (36.5%) > LR group (29.6%) > RFA group (6.7%)(P<0.05) ; The comparison of the recurrence rate after 3 months of follow-up, OR group (7.7%) <LR group (8.5%) <RFA group (10.3%) (P>0.05).

Conclusion

For patients with hepatocellular carcinoma with early stage and small tumors treated with LR, OR, and RFA, the recent treatment results are comparable, but compared with LR and OR, RFA has less damage and faster postoperative recovery Advantages can reduce the degree of postoperative pain and higher safety. However, for patients with hepatocellular carcinoma with large tumors and close to important vascular bile ducts, individualized treatment is still needed.

表1 152例肝细胞癌患者不同术式三组患者一般资料对比[(±s),例]
表2 152例肝细胞癌患者不同术式两组患者近期疗效对比(例)
表3 152例肝细胞癌患者不同术式三组手术相关指标比较(±s)
表4 152例肝细胞癌患者不同术式三组患者不同时间VAS评分对比[(±s),分]
表5 152例肝细胞癌患者不同术式三组并发症情况比较(例)
[1]
张浩,董科,俞小炯,等.完全腹腔镜和开腹肝切除手术治疗原发性肝细胞肝癌的近期和远期疗效比较[J].实用医学杂志,2017, 33(12): 1943-1948.
[2]
王新团,张引涛.腹腔镜精准肝切除治疗原发性肝癌的疗效观察[J/CD].中华普外科手术学杂志(电子版),2018, 12(5): 379-381.
[3]
刘爱祥,王海清,薄文滔,等.肝细胞癌肝切除术的临床疗效及预后因素分析[J].中华消化外科杂志,2019, 18(4): 368-374.
[4]
陈漪,周俭,樊嘉,等.术中射频消融治疗合并重度肝硬化肝细胞癌的临床疗效及预后因素分析[J].中华消化外科杂志,2017, 16(2): 159-163.
[5]
中华人民共和国卫生和计划生育委员会医政医管局.原发性肝癌诊疗规范(2017年版)[J].传染病信息,2017, 16(3): 705-720.
[6]
周际昌.实用肿瘤内科学[M].北京:人民卫生出版社,2000:1-647.
[7]
Benedetto A, Bocca C, Brizio P, et al. Effects of the rare elements lanthanum and cerium on the growth of colorectal and hepatic cancer cell lines[J]. Toxicol In Vitro, 2018, 46: 9-18.
[8]
蔡涵晖,邵洁超,胡智明,等.腹腔镜肝切除联合射频消融术在难治性肝癌中的临床应用[J].中华普通外科杂志,2019, 34(5): 417-420.
[9]
邹浩,吴力群.肝切除术与射频消融术治疗单发肿瘤直径≤5cm肝细胞癌合并门静脉高压症患者的倾向评分匹配疗效分析[J].中华消化外科杂志,2018, 17(10): 1018-1023.
[10]
梁勇,廖波,李春林,等.腹腔镜下肝癌切除术与射频消融术治疗肝细胞癌的疗效观察[J].中国肿瘤临床与康复,2019, 26(6): 671-674.
[11]
陈雪芳,谢浩荣,王恺,等.腹腔镜与开腹再次肝切除术治疗复发性肝细胞癌的安全性及疗效对比[J].中华肝胆外科杂志,2019, 25(3): 175-178.
[12]
向伦建,刘燕,程黎,等.腹腔镜肝切除术与开腹肝切除术治疗肝细胞癌的临床疗效[J].国际外科学杂志,2019, 46(2): 112-118.
[13]
Lee JM, Shehta A, Lee KW, et al.Donor Wound Satisfaction After Living Donor Liver Transplantation in the Era of Pure Laparoscopic Donor Hepatectomy[J]. Surg Endosc, 2020.Online ahead of print.
[14]
李晓涛.射频消融术治疗早期原发性肝癌的近远期疗效及血清miR-202水平相关分析[J/CD].中华普外科手术学杂志(电子版),2019, 13(3): 250-252.
[15]
孙启峰,赵志强,周童,等.腹腔镜肝部分切除术治疗肝癌患者血清肿瘤标志物的变化[J].实用肝脏病杂志,2018, 21(1): 121-122.
[16]
匡铭,罗华,郭道宁.开腹射频消融与开腹手术切除治疗小肝癌的临床疗效分析[J].安徽医药,2018, 22(7): 1357-1359.
[17]
向磊,秦春宏,费书珂.射频消融术治疗肝细胞癌的研究进展[J].国际外科学杂志,2019, 46(2): 140-144.
[18]
梁勇,廖波,李春林,等.腹腔镜下肝癌切除术与射频消融术治疗肝细胞癌的疗效观察[J].中国肿瘤临床与康复,2019, 26(6): 671-674.
[19]
Song JL, Wu H, J, Yang JY. Pure three-dimensional laparoscopic full left hepatectomy of a living donor for an adolescent in China[J]. Chin Med J, 2019, 132(2): 242-244.
[20]
范学科,史良俊,郭林.经腹腔镜引导射频消融术与腹腔镜肝切除术治疗肝细胞癌的近远期疗效对比分析[J].临床和实验医学杂志,2018, 17(14): 1540-1544.
[1] 燕速, 霍博文. 腹腔镜食管胃结合部腺癌根治性切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 13-13.
[2] 母德安, 李凯, 张志远, 张伟. 超微创器械辅助单孔腹腔镜下脾部分切除术[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 14-14.
[3] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[4] 李子禹, 卢信星, 李双喜, 陕飞. 食管胃结合部腺癌腹腔镜手术重建方式的选择[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 5-8.
[5] 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[6] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[7] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[8] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[9] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[10] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[11] 李华志, 曹广, 刘殿刚, 张雅静. 不同入路下行肝切除术治疗原发性肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 52-55.
[12] 常小伟, 蔡瑜, 赵志勇, 张伟. 高强度聚焦超声消融术联合肝动脉化疗栓塞术治疗原发性肝细胞癌的效果及安全性分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 56-59.
[13] 王庆亮, 党兮, 师凯, 刘波. 腹腔镜联合胆道子镜经胆囊管胆总管探查取石术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 313-313.
[14] 杨建辉, 段文斌, 马忠志, 卿宇豪. 腹腔镜下脾部分切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 314-314.
[15] 叶劲松, 刘驳强, 柳胜君, 吴浩然. 腹腔镜肝Ⅶ+Ⅷ段背侧段切除[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 315-315.
阅读次数
全文


摘要