Jungraithmayr Wolfgang, Burger Dieter, Olschewski Manfred, Eggstein Stefan
Department of Thoracic Surgery, University Hospital of Freiburg, Hugstetter Strabetae 55, 79106 Freiburg, Germany.
Hepatobiliary Pancreat Dis Int. 2005 Nov;4(4):554-60.
Local ablative procedures such as cryosurgery and thermo-ablation are increasingly employed as a supplement to liver resection for the therapy of primary and secondary liver tumors. It is still unclear if the survival time can be extended through local ablative procedures. This prospective study shows operative actions, complications and long-term follow-up of 19 patients undergoing cryotherapy.
Between 1997 and 1998, 19 patients underwent cryotherapy due to a non-resectable malignant liver tumor (17 patients with metastases of a colon carcinoma, 2 patients with a hepatocellular carcinoma). Twelve patients (63.2%) received cryotherapy only and seven patients (36.8%) received a combination of resection and cryotherapy. The median follow-up period was 23 months.
In a total of 59 liver tumors (18 were resected and 41 received cryotherapy), 12 had cryotherapy only, and 7 had a combination of cryotherapy and resection. The 30-day lethality was 0%, and the rate of major complications was 21%. After one year, 27.3% of the patients were still recurrence-free. The recurrence rate for all tumors treated was 58.8%. The median survival time for all patients was 21 months. The one- and three-year survival rates were 62.5% and 15.8%, respectively.
The mortality for cryotherapy is low, but there is a high rate of complications and long-term tumor control is not sufficient. If local ablative procedures of hepatic lesions are to be performed, not laparotomy but percutaneous, percutaneous thermoablation should be discussed as an alternative therapeutic measure.
诸如冷冻手术和热消融等局部消融手术越来越多地被用作肝切除术的补充，用于治疗原发性和继发性肝肿瘤。局部消融手术是否能延长生存时间仍不明确。这项前瞻性研究展示了19例接受冷冻治疗患者的手术操作、并发症及长期随访情况。
1997年至1998年间，19例患者因不可切除的恶性肝肿瘤接受冷冻治疗（17例为结肠癌转移，2例为肝细胞癌）。12例患者（63.2%）仅接受冷冻治疗，7例患者（36.8%）接受了切除与冷冻治疗相结合的方法。中位随访期为23个月。
总共59个肝肿瘤（18个接受了切除，41个接受了冷冻治疗），其中12个仅接受冷冻治疗，7个接受了冷冻与切除相结合的治疗。30天死亡率为0%，主要并发症发生率为21%。一年后，27.3%的患者仍无复发。所有接受治疗肿瘤的复发率为58.8%。所有患者的中位生存时间为21个月。一年和三年生存率分别为62.5%和15.8%。
冷冻治疗的死亡率较低，但并发症发生率较高且长期肿瘤控制效果不佳。如果要进行肝脏病变的局部消融手术，不应选择剖腹手术，而应探讨经皮热消融作为一种替代治疗措施。
