Ryu M, Watanabe K, Yamamoto H
Division of Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba, 277 Japan.
J Hepatobiliary Pancreat Surg. 1998;5(2):184-91. doi: 10.1007/s005340050031.
From 1984 through 1994, 99 consecutive patients with hepatocellular carcinoma (HCC) underwent hepa-tectomy with microwave tissue coagulation (MTC). We performed limited resection (Hr0) in 28 patients, subsegmentectomy (HrS) in 25 patients, segmentectomy (Hr1) in 21 patients, and lobectomy or extended lobectomy (Hr2) in 25 patients. The patients were divided into two groups: group A, 86 patients with tumors smaller than 1 kg and no tumor thrombi in the main portal trunk; and group B, 13 patients with a tumor 1 kg or larger, or with macroscopic tumor thrombi in the main portal trunk. In group A, mean blood loss was 838 ml for Hr0, 1948 ml for HrS, 1765 ml for Hr1, and 1325 ml for Hr2. The mean operative time in group A ranged from 3 h 43 min for Hr0 to 4 h 57 min for Hr2. In group B, the mean operative time was 6 h 3 min and mean blood loss was 6053 ml. Our MTC method was associated with an in-hospital mortality rate of 3% and a major complication rate of 13.1%. The 5-year survival and disease-free survival rates were 43.4% and 25.4%, respectively. The 5-year survival rate of patients without portal tumor thrombi (50.9%) was significantly better than that of patients with portal tumor thrombi (11.9%) (P < 0.001). The 5-year survival rate of patients who underwent curative resection (58.1%) was significantly better than that of patients who underwent noncurative resection (22.9%) (P < 0.001). The 5-year survival rates of patients in group A without portal tumor thrombi did not differ between those who had cancer-negative margins (54.0%) and those with cancerpositive margins (49.6%) at resection. Recurrence and local recurrence rates did not differ in patients with cancer-positive margins (63.6% and 7.3%, respectively) and patients with cancer-negative margins (56.5% and 8.7%, respectively). These results suggested that microscopic residual cancer in the resected margin was coagulated by MTC. Blood loss, operative time, and clinical outcome in this series of 99 consecutive hepatectomies were comparable with values in earlier reports in which such hemostatic methods as the Pringle maneuver were used. We conclude that hepatectomy with MTC is useful and safe and produces consistent results.
1984年至1994年期间，99例连续的肝细胞癌（HCC）患者接受了微波组织凝固（MTC）肝切除术。我们对28例患者进行了局限性切除术（Hr0），25例患者进行了亚段切除术（HrS），21例患者进行了段切除术（Hr1），25例患者进行了肝叶切除术或扩大肝叶切除术（Hr2）。患者分为两组：A组，86例肿瘤小于1 kg且主门静脉无肿瘤血栓的患者；B组，13例肿瘤1 kg或更大或主门静脉有肉眼可见肿瘤血栓的患者。在A组中，Hr0的平均失血量为838 ml，HrS为1948 ml，Hr1为1765 ml，Hr2为1325 ml。A组的平均手术时间从Hr0的3小时43分钟到Hr2的4小时57分钟不等。在B组中，平均手术时间为6小时3分钟，平均失血量为6053 ml。我们的MTC方法的院内死亡率为3%，主要并发症发生率为13.1%。5年生存率和无病生存率分别为43.4%和25.4%。无门静脉肿瘤血栓患者的5年生存率（50.9%）明显高于有门静脉肿瘤血栓患者（11.9%）（P < 0.001）。接受根治性切除患者的5年生存率（58.1%）明显高于接受非根治性切除患者（22.9%）（P < 0.001）。A组无门静脉肿瘤血栓患者中，切除时切缘癌阴性者（54.0%）和切缘癌阳性者（49.6%）的5年生存率无差异。切缘癌阳性患者（分别为63.6%和7.3%）和切缘癌阴性患者（分别为56.5%和8.7%）的复发率和局部复发率无差异。这些结果表明，切除边缘的微小残留癌通过MTC被凝固。这99例连续肝切除术的失血量、手术时间和临床结果与早期报告中使用诸如Pringle手法等止血方法时的值相当。我们得出结论，MTC肝切除术是有用且安全的，并能产生一致的结果。
