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目的对比单纯微波消融,探讨腹腔镜辅助下微波消融联合125Ⅰ粒子植入治疗不可切除肝细胞癌的安全性及有效性。方法对我院2005年3月至2010年5月收治的65例不能手术切除的肝细胞癌患者,随机分为单纯微波消融治疗组(30例)和微波消融治疗联合125Ⅰ粒子植入治疗组(35例),所有患者均行CT增强扫描,并按病灶大小分为A组(最大直径≤5 cm)和B组(最大直径5.0～9.8 cm)。以生存率、局部复发率及治疗相关并发症发生率作为评价标准,比较两种治疗方法的临床治疗效果。结果65例患者未发生治疗相关死亡。单纯微波消融治疗及联合治疗患者的12、18、24个月生存率分别为87.1%、77.8%、70.2%及89.1%、84.1%、77.9%,差异无统计学意义(P=0.6171)。根据肿瘤大小分组分层分析,A组和B组分别单纯微波治疗和联合治疗患者生存率差异无统计学意义。单纯微波消融治疗患者12、18、24个月肿瘤局部复发率分别为9.6%、19.3%、33.0%,联合治疗患者分别为5.7%、11.4%、17.1%,差异无统计学意义(P=0.2530)。根据肿瘤大小分组分层分析,B组联合治疗患者局部复发率低于单纯微波消融治疗患者,差异有统计学意义(P=0.0441)。单纯微波治疗和联合治疗患者总体治疗相关并发症发生率无统计学差异(36.7%vs.34.3%,P<0.05)。结论腹腔镜辅助下微波消融联合125Ⅰ粒子植入治疗晚期不可切除肝癌安全有效,特别是对于肿瘤最大直径>5 cm的单发病灶,能有效降低术后局部复发率。
Objective To compare the safety and effectiveness of microwave ablation alone with laparoscopy assisted microwave ablation combined with 125 Ⅰ seed implantation in the treatment of unresectable hepatocellular carcinoma. Methods A total of 65 patients with unresectable hepatocellular carcinoma who were treated in our hospital from March 2005 to May 2010 were randomly divided into microwave ablation group (30 cases) and microwave ablation group (group Ⅰ) 35 cases). All patients underwent CT enhanced scanning and were divided into group A (maximum diameter ≤5 cm) and group B (maximum diameter 5.0 ~ 9.8 cm) according to the lesion size. Survival rate, local recurrence rate and the incidence of treatment-related complications as the evaluation criteria to compare the clinical efficacy of the two treatment methods. Results There were no treatment-related deaths in 65 patients. The survival rates at 12, 18 and 24 months after microwave ablation and combined therapy were 87.1%, 77.8%, 70.2% and 89.1%, 84.1% and 77.9% respectively, with no significant difference (P = 0.6171). According to the tumor size group stratification analysis, there was no significant difference in the survival rates of patients in group A and group B when compared with microwave treatment and combination therapy respectively. The local tumor recurrence rates of patients treated with microwave ablation alone were 9.6%, 19.3% and 33.0% at 12, 18 and 24 months respectively, and were 5.7%, 11.4% and 17.1% respectively in the combination therapy group (P = 0.2530 ). According to the tumor size group stratification analysis, the local recurrence rate of patients in combination therapy group B was lower than that of simple microwave ablation therapy, the difference was statistically significant (P = 0.0441). There was no significant difference in overall treatment-related complication between simple microwave treatment and combination therapy (36.7% vs.34.3%, P <0.05). Conclusion Laparoscopic assisted microwave ablation combined with 125I seed implantation in the treatment of advanced unresectable hepatocellular carcinoma is safe and effective, especially for single lesions> 5 cm in diameter, which can effectively reduce the local recurrence rate.