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目的探讨降低原发性肝癌切除术后局部复发的方法,改善肝癌患者的长期生存率。方法自1998年4月至2002年4月,我院行肝癌切除术切缘距肿瘤不足1 cm的患者共45例,分为冷冻组和单纯切除组两组。冷冻组23例,常规肿瘤切除后以扁平探头对肝切缘进行接触冷冻,冷冻深度控制在1．0～1．5 cm；单纯切除组22例,单纯行常规肝癌切除手术,不予冷冻治疗。全部患者术后均定期随访复发及生存时间。结果冷冻组术后1年、3年和5年复发率分别为8．7%、26．1%和34．8%,术后1年、3年和5年生存率分别为82．6%、56．5%和30．4%,与单纯切除组比较,其中3年(X~2=5．021,P=0．025)、5年复发率差异有统计学意义(X~2=12．465,P=0)；冷冻组的3年、5年生存率较单纯切除组呈现明显升高的趋势。结论肝癌切除后切缘冷冻能有效地降低术后局部复发率,提高治疗效果,且有可能延长肝癌患者的长期生存时间。
Objective To explore ways to reduce the local recurrence after primary hepatectomy and to improve the long-term survival of patients with liver cancer. Methods From April 1998 to April 2002, 45 patients with resection margin resected from the tumor less than 1 cm in tumor were divided into two groups: frozen group and simple resection group. Frozen group 23 cases, after conventional resection of the flat probe on the hepatic margins were frozen, the depth of control in the 1.0 ~ 1.5 cm; simple resection group of 22 cases, simple routine hepatectomy, not frozen . All patients were followed up regularly for recurrence and survival time. Results The recurrence rates at 1 year, 3 years and 5 years in the frozen group were 8.7%, 26.1% and 34.8% respectively, and the 1, 3 and 5 year survival rates were 82.6% , 56.5% and 30.4% respectively. There was significant difference in the 5-year recurrence rate between the two groups (X ~ 2 = 5.021, P = 0.025) 12.465, P = 0). The 3-year and 5-year survival rates of the frozen group were significantly higher than those of the simple resection group. Conclusion The resected margin resection of liver cancer can effectively reduce the local recurrence rate and improve the therapeutic effect, and may prolong the long-term survival time of patients with liver cancer.