Shen Perry, Hoffman Aaron, Howerton Russell, Loggie Brian W
Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina 27157, USA.
Am Surg. 2002 Aug;68(8):695-703; discussion 703.
Obtaining a one-centimeter negative margin is an important factor in preventing disease recurrence after surgery for hepatic tumors. Cryotherapy of the resected edge has been used to achieve optimal margin clearance in cases in which the alternative would be an extended high-risk liver resection. The effect of this technique on margin recurrence was examined. Between 1994 and 2001 a total of 56 patients underwent cryosurgery with or without resection for primary and metastatic hepatobiliary malignancies. A 5-cm cryotherapy lollipop probe was used to ablate surgical margins less than one centimeter in 13 of these patients. There were seven colorectal metastases, three hepatocellular carcinomas, and three gallbladder carcinomas. The median size of the colorectal and hepatocellular lesions was 3 cm (range 2-14 cm), and all gallbladder primaries were T2 tumors. All tumors except three were located centrally in the liver requiring cryoablation of margins at segments 4, 5, and 8. Most patients had one site frozen (n = 9) with a median target temperature of -190 degrees C and a median of two freeze-thaw cycles. Final pathological analysis of the resected specimens revealed nine close (<1 cm) and four positive margins. With a median follow-up of 16 months seven patients are alive with no evidence of disease and six have developed recurrences with three of them dying of their disease. Only one (8%) of the initial recurrences was at the cryoablated margin. Cryosurgery of the resection edge facilitates liver resection for malignant tumors when margins are close or positive. Because disease recurrence at the cryoablated margin is low this technique may allow more patients to undergo effective surgical treatment of their hepatobiliary cancers.
获得1厘米的阴性切缘是预防肝肿瘤手术后疾病复发的重要因素。对于那些替代方案是扩大的高风险肝切除术的病例，已采用对切除边缘进行冷冻治疗来实现最佳的切缘清除。研究了该技术对切缘复发的影响。1994年至2001年间，共有56例患者因原发性和转移性肝胆恶性肿瘤接受了冷冻手术，其中部分患者同时进行了切除术。在这些患者中，有13例使用5厘米的冷冻治疗棒棒糖探头对小于1厘米的手术切缘进行消融。其中有7例结直肠转移瘤、3例肝细胞癌和3例胆囊癌。结直肠和肝细胞病变的中位大小为3厘米（范围2 - 14厘米），所有胆囊原发性肿瘤均为T2期肿瘤。除3例肿瘤外，所有肿瘤均位于肝脏中央，需要对第4、5和8段的切缘进行冷冻消融。大多数患者有一个部位接受冷冻（n = 9），中位目标温度为 - 190摄氏度，中位冻融周期为2次。切除标本的最终病理分析显示9例切缘接近（<1厘米），4例切缘阳性。中位随访16个月时，7例患者存活且无疾病证据，6例出现复发，其中3例死于疾病。最初的复发中只有1例（8%）发生在冷冻消融的切缘处。当切缘接近或阳性时，切除边缘的冷冻手术有助于肝脏恶性肿瘤的切除。由于冷冻消融边缘的疾病复发率较低，该技术可能使更多患者能够接受有效的肝胆癌手术治疗。
