摘要
目的探讨腹腔镜联合应用射频消融和^125I粒子植入治疗肝转移癌的临床价值。方法对41例术前经CT或MR确诊肝脏有转移灶的患者，行腹腔镜下肝转移瘤切除或射频消融及^125I粒子植入（综合治疗组）。并与同期的83例肝转移癌行肝动脉化疗栓塞（TACE）及全身化疗患者进行对比研究（对照组）。结果综合治疗组术中超声发现新病灶9个。13例患者的18个边缘转移病灶行腹腔镜切除。28例患者的59个转移病灶位于第一、二肝门或靠近大血管仅行腹腔镜下射频消融及^125I粒子植入。所有患者均获随访26～45个月（平均35．4个月），综合治疗组中全部缓解（CR）18例，部分缓解（PR）19例，稳定（SD）3例，进展（PD）1例，缓解率（CR＋PR）90．2％。中位生存时间19个月，1、2、3年生存率分别为80．5％，48．8％和24．4％；对照组中全部缓解（CR）4例，部分缓解（PR）21例，稳定（SD）28例，进展（PD）30例，缓解率（CR＋PR）30．1％。中位生存时间11个月，1、2、3年生存率分别为54．2％、28．9％和9．6％。两组相比缓解率（χ^2=39．68，P〈0．05）、中位生存时间（t=-9．74，P〈0．05）以及1、2、3年生存率（分别χ^2=8．11，4．73，4．81，均P〈0．05）差异均有统计学意义。结论腹腔镜联合应用RFA和^125I粒子植入治疗肝转移癌具有安全、有效，对延长患者生存期有一定效果。
Objective To study the efficacy of laparoscopic hepatectomy combined with Iodine-125 and radiofrequency ablation （ RFA ） in the treatment of metastatic hepatic carcinoma. Methods There were 124 patients diagnosed as hepatic metastasis detected by CT or MR scan, and were divided into two treatment groups. Group A （combined group of 41 cases） with laparoscopic excision, RFA and iodine-125 treatment and group B （control group of 83 cases） with transhepatic artery chemoembolization （TACE） and systematic chemotherapy. Results Nine new hepatic metastatic loci were found by laparoseopic ulstrasound during the operation in group A, and in this group, 18 hepatic metastatic lesions located on the surface in 13 patients were removed, then RAF applied to the hepatic metastases, and iodine-125 planted in place, altogether 59 foci near to the porta hepatis or large vessels were treated by laparoscopic RFA and iodine-125 implantation. All patients were followed-up from 26 to 45 months （ average 35.4 months）. The total relief rate was 90. 2% and 30. 1% in group A and B respectively （ χ^2 = 39. 68, P 〈 0. 05 ）. The median survival time was 19 and 11 months in group A and B respectively （t = - 9.74, P 〈 0. 05 ）. The survival rate at 1-, 2- and 3-years was 80.5% ,48.8% ,24.4% and 54.2% ,28.9% ,9.6% in group A and B respectively （ χ^2 = 8.11, 4. 73, 4. 81, P 〈 0. 05）. Conclusions Laparoscopic excision, Iodine-125 implantation and radiofrequency ablation in the treatment of metastatic liver carcinoma is safe, effective, and this approach prolongs the patient＇s survival time.
出处
《中华普通外科杂志》
CSCD
北大核心
2009年第10期799-801,共3页
Chinese Journal of General Surgery
关键词
肿瘤转移
腹腔镜
射频消融
^125I粒子
Neoplasm metastasis
Laparoscopes
Radiofrequency ablation
Iodine-125
