腹腔镜辅助微波消融治疗小肝癌：与腹腔镜肝切除术的安全性和疗效比较。

Laparoscopic-assisted microwave ablation in treatment of small hepatocellular carcinoma: safety and efficacy in comparison with laparoscopic hepatectomy.

机构信息

Department of imaging, Aviation General Hospital, China Medical University, Beijing, 100012, China.

Department of hepatobiliary surgery, Affiliated Hospital of Yangzhou University, Yangzhou, 225012, China.

出版信息

BMC Surg. 2024 May 7;24(1):138. doi: 10.1186/s12893-024-02432-0.

DOI:10.1186/s12893-024-02432-0

PMID:38715071

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11075224/

Abstract

Laparoscopic-assisted microwave ablation (LAMWA), as one of the locoregional therapies, has been employed to treat hepatocellular carcinoma (HCC). This study aims to compare the efficacy and safety of LAMWA and laparoscopic hepatectomy in the treatment of small HCC.This study included 140 patients who met the inclusion criteria. Among them, 68 patients received LAMWA and 72 patients underwent laparoscopic hepatectomy. The perioperative condition, liver function recovery, the alpha fetoprotein (AFP) level, morbidities, hospitalization time, overall survival (OS), disease-free survival (DFS) and recurrence rate between the two groups were compared. The rate of complete elimination of tumor tissue was 100% and the AFP level was returned to normal within 3 months after surgery in both groups (P > 0.05). The mean alanine transaminase (ALT) and aspartate transaminase (AST) peak in the LAMWA group was lower than that in the laparoscopic hepatectomy group (259.51 ± 188.75 VS 388.9 ± 173.65, P = 0.000) and (267.34 ± 190.65 VS 393.1 ± 185.67, P = 0.000), respectively. The mean operation time in the LAMWA group was shorter than that in the laparoscopic hepatectomy group (89 ± 31 min VS 259 ± 48 min, P = 0.000). The blood loss in the LAMWA group was less than that in the laparoscopic hepatectomy group (58.4 ± 64.0 ml VS 213.0 ± 108.2 ml, P = 0.000). Compared with the laparoscopic hepatectomy group, patients in the LAMWA group had lower mean hospital stay (4.8 ± 1.2d VS 11.5 ± 2.9d, P = 0.000). The morbidities of the LAMWA group and the hepatectomy group were 14.7%(10/68) and 34.7%(25/72), respectively (P = 0.006). The one-, three-, and five-year OS rates were 88.2%, 69.9%, 45.6% for the LAMWA group and 86.1%, 72.9%, 51.4% for the laparoscopic hepatectomy group (P = 0.693). The corresponding DFS rates for the two groups were 76.3%, 48.1%, 27.9% and 73.2%, 56.7%, 32.0% (P = 0.958). Laparoscopic-assisted microwave ablation is a safe and effective therapeutic option for selected small HCC.

摘要

腹腔镜辅助微波消融（LAMWA）作为局部区域治疗方法之一，已被用于治疗肝细胞癌（HCC）。本研究旨在比较 LAMWA 和腹腔镜肝切除术治疗小 HCC 的疗效和安全性。

本研究纳入了符合纳入标准的 140 名患者。其中，68 名患者接受了 LAMWA 治疗，72 名患者接受了腹腔镜肝切除术。比较了两组患者的围手术期情况、肝功能恢复情况、甲胎蛋白（AFP）水平、并发症发生率、住院时间、总生存期（OS）、无病生存期（DFS）和复发率。两组患者的肿瘤组织完全消除率均为 100%，术后 3 个月内 AFP 水平均恢复正常（P>0.05）。LAMWA 组的平均丙氨酸转氨酶（ALT）和天冬氨酸转氨酶（AST）峰值均低于腹腔镜肝切除术组（259.51±188.75 VS 388.9±173.65，P=0.000；267.34±190.65 VS 393.1±185.67，P=0.000）。LAMWA 组的手术时间短于腹腔镜肝切除术组（89±31 min VS 259±48 min，P=0.000）。LAMWA 组的出血量少于腹腔镜肝切除术组（58.4±64.0 ml VS 213.0±108.2 ml，P=0.000）。与腹腔镜肝切除术组相比，LAMWA 组的平均住院时间更短（4.8±1.2 d VS 11.5±2.9 d，P=0.000）。LAMWA 组和肝切除术组的并发症发生率分别为 14.7%（10/68）和 34.7%（25/72）（P=0.006）。LAMWA 组和腹腔镜肝切除术组的 1、3、5 年 OS 率分别为 88.2%、69.9%、45.6%和 86.1%、72.9%、51.4%（P=0.693）。两组的相应 DFS 率分别为 76.3%、48.1%、27.9%和 73.2%、56.7%、32.0%（P=0.958）。腹腔镜辅助微波消融是一种安全有效的治疗小 HCC 的选择。