腹腔镜下微波消融治疗肝恶性肿瘤的效果分析
安东均 安琳 张成 赵维安 韩立
摘 要
目的：探讨腹腔镜下微波消融（MWA）治疗肝恶性肿瘤的局部疗效和安全性。
方法：回顾性分析2014年6月～2016年5月南方医科大学附属咸阳市中心医院采用微波消融治疗的肝恶性肿瘤患者105例。按照MWA的入路分为超声引导下经皮肝穿刺MWA组（A组）55例和腹腔镜下MWA组（B组）50例。采用Kaplan-Meier法计算平均无瘤生存时间。计数资料组间比较采用x2x检验，正态分布的计量资料组间比较采用t检验。
结果：所有患者术后症状均有改善，肝区疼痛明显减轻，食欲增进。A、B组MWA并发症发生率分别为27.3%和8.0%，差异有统计学意义（x2=6.144，P＜0.05）；一次性完全消融率分别为74.5%和92.0%，差异有统计学意义（ 2x=5.162，P＜0.05）；术后1个月肝功能Child-Pugh分级评价比较差异有统计学意义（x2=2.135，P＜0.05）；平均住院费用B组高于A组（t=3.612，P＜0.05）；2组患者平均住院时间、平均无瘤生存时间及1年无瘤生存率无明显差异（P值均＞0.05）；术后2年及3年无瘤生存率比较B组优于A组，（x2=6.426、3.162，P值均＜0.05）；
结论：经腹腔镜途径扩大和优化了肝肿瘤微波治疗适应证范围，疗效好，并发症少，是对肝恶性肿瘤微波治疗的拓展、完善和优化。
关键词
肝肿瘤；导管消融术；腹腔镜；治疗结果
Efficacy of laparoscopic microwave ablation in treatment of malignant liver tumors
AN Dongjun，AN Lin，ZHANG Cheng，et al.（Department of Hepatobiliary Surgery，Xianyang Central Hospital，Southern Medical University，Xianyang，Shaanxi712000，China）
ABSTRACT
Objective:To investigate the local efficacy and safety of laparoscopic microwave ablation（MWA）in the treatment of malignant liver tumors.
Methods:A retrospective analysis was performed for the clinical data of 105 patients with malignant liver tumors who were admitted to Xianyang Central Hospital，Southern Medical University，from June 2014 to May 2016 and treated by MWA.According to the surgical approach of MWA，these patients were divided into ultrasound guided percutaneous microwave coagulation therapy group（group A）with 55 patients and laparoscopic MWA group（group B）with 50 patients.The Kaplan-Meier method was used to calculate mean disease frees survival.As for the data of postoperative complications，local efficacy of MWA，liver function at 1 month after surgery，mean disease free survival time，and 1-，2- ，and3-year disease-free survival rates after surgery，the chi-square test was used for the comparison of categorical data between groups；the normally distributed continuous data were expressed as mean ±SD，and the t-test was used for comparison.
Results:All patients had improvements in the symptoms after surgery，marked alleviation of liver pain，and increased appetite.There were significant differences between group A and group B in the incidence rate of complications（27.3%vs8.0%x2=6.144，P＜0.05），one time complete ablation rate（74.5%vs92.0%，x2=5.162，P＜0.05），and Child-Pugh class of liver function at 1 month after surgery（x2=2.135，P＜0.05）.Group B had significantly higher mean hospital costs than group A（t=3.612，P＜0.05）.There were no significant differences between the two groups in mean hospital stay，mean disease-free survival time，and 1-year disease-free survival rate（t=0.628，x2=0.562 and 0.288，all P＞0.05）.Compared with group A，group B had significantly higher2-and3-year disease-free survival rates（x2=6.426 and 3.162，both P＜0.05）.
Conclusion:The laparoscopic approach expands and optimizes the range of the indications for microwave therapy for liver tumors and has good efficacy and few complications.
KEY WORDS
liver malignant tumors；catheter ablation；laparoscope；treatment outcome
微波消融（microwave ablation，MWA）治疗肝恶性肿瘤具有简便有效、创伤小、安全可靠、适应证广的优势［1-2］。近年来经皮MWA在肝肿瘤的治疗中得到广泛应用，同时也应用于肝癌经肝动脉栓塞化疗后的加强治疗以及开腹手术难以完全切除的肝肿瘤治疗［3］。经皮MWA相关死亡率仅为0.1%～1.0%，对于早期肝癌可获得与手术切除相近的生存率［4］。通过对本院采用MWA治疗肝恶性肿瘤的病例资料进行回顾性分析，探讨腹腔镜MWA治疗肝恶性肿瘤的局部疗效和安全性。