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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,提高肝癌患者的长期生存率。方法78例肿瘤靠近第一、第二肝门,估计切缘距肿瘤<1cm的肝癌患者,按就诊单双日分为单纯切除组和联合组。单纯切除组38例,仅行常规肝癌切除;联合组40例,在肝癌切除后,切缘行射频消融和~(125)I粒子植入。全部患者术后均定期随访。结果联合组术后1、3、5年肿瘤复发率分别为7.5%、30.0%和45.0%,术后1、3、5年生存率分别为92.5%、67.5%和30.0%,与单纯切除组比较,其中3、5年复发率差异有统计学意义((x~2=7.340,P<0.01;x~2=15.740,P<0.01);联合组的3、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射频消融和~(125)I粒子植入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生存期。
Objective To explore ways to reduce the local recurrence after primary hepatectomy and to improve the long-term survival rate of patients with liver cancer. Methods 78 patients with tumor near the first and the second hepatic portal, the estimated margin of tumor away from the tumor <1cm of liver cancer patients, according to the treatment of single and double day were divided into simple resection group and the combined group. In the simple resection group, 38 cases were treated with conventional hepatectomy only. Forty cases in the combination group were treated with radiofrequency ablation and ~ (125) I seed implantation after resection of the liver cancer. All patients were followed up regularly. Results The recurrence rates at 1, 3 and 5 years after operation in the combined group were 7.5%, 30.0% and 45.0%, respectively. The 1,3 and 5-year survival rates were 92.5%, 67.5% and 30.0% The recurrence rates at 3 and 5 years were significantly different between the two groups (x ~ 2 = 7.340, P <0.01; x ~ 2 = 15.740, P <0.01) (P <0.05) .Conclusion Incision radiofrequency ablation and ~ (125) I particle implantation can effectively reduce the local recurrence rate and improve the therapeutic effect after liver resection, and may prolong the survival of patients with liver cancer.