Department of Gastroenterology, Shandong Provincial Hospital, Shandong University, 324, Jing 5 Rd, Jinan, Shandong, 250021, China.
Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
Eur Radiol. 2024 May;34(5):3226-3235. doi: 10.1007/s00330-023-10268-0. Epub 2023 Oct 25.
The study of postoperative liver decompensation after microwave ablation (MWA) for hepatocellular carcinoma (HCC) in patients with clinically significant portal hypertension (CSPH) is still lacking. The purpose of the present study was to compare the postoperative liver decompensation after MWA and laparoscopic resection (LR) for HCC in patients with CSPH.
The present retrospective study enrolled 222 HCC patients with CSPH who underwent MWA (n = 67) or LR (n = 155). Postoperative liver decompensation, complications, postoperative hospital stays, and overall survival were analyzed. Factors associated with postoperative liver decompensation were identified.
After propensity score matching, the postoperative liver decompensation rate was significantly lower in the MWA group than that in the LR group (15.5% versus 32.8%, p = 0.030). The multivariable regression analysis identified that type of treatment (MWA vs. LR, odds ratio [OR] 0.44; 95% confidence interval [CI], 0.21-0.91; p = 0.026) and Child-Pugh B (OR, 2.86; 95% CI, 1.24-6.61; p = 0.014) were independent predictors for postoperative liver decompensation. The rate of complications for patients in the MWA group was significantly lower than that in the LR group (p < 0.001). And MWA showed shorter postoperative hospital stays than LR (3 days vs. 6 days, p < 0.001). Overall survival rate between the two groups was not significantly different (p = 0.163).
Compared with laparoscopic resection, microwave ablation has a lower rate of postoperative liver decompensation and might be a better option for HCC patients with CSPH.
Microwave ablation exhibited a lower incidence of postoperative liver decompensation in comparison to laparoscopic resection, thereby conferring greater advantages to hepatocellular carcinoma patients with clinically significant portal hypertension.
•Postoperative liver decompensation rate after microwave ablation was lower than that of laparoscopic resection for hepatocellular carcinoma in patients with clinically significant portal hypertension. •Microwave ablation showed shorter postoperative hospital stays than laparoscopic resection. •Microwave ablation had fewer complications than laparoscopic resection.
对于伴有临床显著门脉高压（CSPH）的肝细胞癌（HCC）患者，微波消融（MWA）术后肝失代偿的研究仍然缺乏。本研究的目的是比较伴有 CSPH 的 HCC 患者行 MWA 与腹腔镜切除术（LR）后的术后肝失代偿情况。
本回顾性研究纳入了 222 例伴有 CSPH 的 HCC 患者，其中 67 例行 MWA（MWA 组），155 例行 LR（LR 组）。分析术后肝失代偿、并发症、术后住院时间和总生存情况。并确定与术后肝失代偿相关的因素。
在倾向评分匹配后，MWA 组的术后肝失代偿发生率明显低于 LR 组（15.5%比 32.8%，p=0.030）。多变量回归分析发现，治疗方式（MWA 比 LR，比值比[OR]0.44；95%置信区间[CI]0.21-0.91；p=0.026）和 Child-Pugh B 级（OR 2.86；95%CI 1.24-6.61；p=0.014）是术后肝失代偿的独立预测因素。MWA 组的并发症发生率明显低于 LR 组（p<0.001）。而且 MWA 组的术后住院时间明显短于 LR 组（3 天比 6 天，p<0.001）。两组的总生存率无显著差异（p=0.163）。
与腹腔镜切除术相比，微波消融术后肝失代偿的发生率较低，可能是伴有 CSPH 的 HCC 患者的更好选择。
与腹腔镜切除术相比，微波消融术后肝失代偿发生率较低，从而为伴有临床显著门脉高压的肝细胞癌患者带来了更大的优势。
MWA 治疗伴有临床显著门脉高压的 HCC 患者，术后肝失代偿发生率低于 LR。
MWA 组术后住院时间短于 LR 组。
MWA 组的并发症少于 LR 组。
