【摘要】：目的:通過經(jīng)皮微波消融與手術切除治療直徑3-5cm孤立性結直腸癌肝轉移灶的療效對比,對其治療方式的選擇進行深入探討。方法:以遼寧省腫瘤醫(yī)院肝膽外科于2010年9月至2013年11月期間住院行手術治療的74例直徑3-5cm孤立性結直腸癌肝臟轉移病人為研究對象,進行為期36個月的隨訪,對全部隨訪資料進行回顧性研究。本研究根據(jù)選擇的手術治療方式的不同,將74例研究對象分成經(jīng)皮微波消融組和手術切除組,分別包括31例和43例研究對象。收集74例患者的性別、年齡、肝臟轉移灶最大徑長度、ChildPugh肝功能分級、肝臟轉移時間、原發(fā)灶部位、原發(fā)灶分化程度等基本資料。經(jīng)皮微波消融組:采用冷循環(huán)微波消融治療儀對患者進行微波消融治療,術中采用彩超進行實時監(jiān)控,以保證轉移灶根治性治療。手術切除組:在保證切緣陰性的前提下,肝部分切除方式的選擇包括規(guī)則性肝段、肝葉切除和不規(guī)則性肝轉移灶切除。術中根據(jù)轉移灶位置、預計出血量多少進行半肝阻斷或肝門阻斷。通過對兩組患者臨床資料和隨訪結果進行分析,分別對經(jīng)皮微波消融組和手術切除組在局部治療效果、累積生存率、復發(fā)率、術后并發(fā)癥、術中處理轉移灶耗費時間的長短、從入院到離院時間的長短、病人住院期間的醫(yī)療費用方面進行比較。對于計量資料以?X±S(均數(shù)±標準差)表示,組間比較用t檢驗;計數(shù)資料以率(%)表示,組間比較采用?2檢驗,生存分析方法采用Kaplan-Meier法,采用log-rank檢驗比較生存曲線的差異。P0.05差異有統(tǒng)計學意義。結果:本研究中,兩組病人局部治療效果對比:經(jīng)皮微波消融組31例患者中30例肝轉移灶經(jīng)過消融治療達到完全消融,1例肝轉移灶消融不全,首次完全消融率達96.8%,手術切除組43例患者中41例肝轉移灶完全切除,2例出現(xiàn)原位復發(fā),根治性切除率為95.3%,P0.05,差異無統(tǒng)計學意義。兩組病人累積生存率及復發(fā)率比較:經(jīng)皮微波消融組術后12、24、36個月的累積生存率及復發(fā)率分別為96.8%、78.9%、47.4%,9.7%、29.6%、52.0%。手術切除組術后12、24、36個月的累積生存率及復發(fā)率分別為95.3%、71.7%、49.6%,11.6%、27.0%、56.8%,P值分別為0.759、0.567、0.515,0.790、0.819、0.712。因此兩組患者術后12、24、36個月累積生存率、復發(fā)率間的差別無統(tǒng)計學意義(P0.05)。術后兩組病人并發(fā)癥出現(xiàn)概率方面:胸腔積液(微波消融組1例、手術切除組3例),切口感染(微波消融組1例、手術切除組3例),肝膿腫(微波消融組1例、手術切除組2例),而在肺部感染、腹腔出血、肝衰竭這些并發(fā)癥中,微波消融組未發(fā)生一例,手術切除組分別出現(xiàn)2例、2例、1例。經(jīng)皮微波消融組和手術切除組并發(fā)癥發(fā)生率分別為9.7%、30.2%,兩組患者不同類型并發(fā)癥發(fā)生率有顯著差別,經(jīng)皮微波消融組發(fā)生率顯著低于手術切除組,且P=0.034,差異有統(tǒng)計學意義(P0.05)。在術中處理轉移灶耗費時間長短方面,經(jīng)皮微波消融組平均手術時間(46.5±16.7)min,顯著短于手術切除組(163.0±53.4)min,(P0.05);住院時間方面,經(jīng)皮微波消融組和手術切除組平均住院時間分別為(6.1±1.9)d、(12.1±7.1)d(P0.05),兩組差異顯著。治療費用方面,經(jīng)皮微波消融組為(3.1±0.6)萬元,顯著少于手術切除組(5.9±0.9)萬元(P0.05)。結論:1、對于直徑3-5cm孤立性結直腸癌肝臟轉移病人,經(jīng)皮微波消融與手術切除近期療效相當。2、經(jīng)皮微波消融治療直徑3-5cm孤立性結直腸癌肝臟轉移病人相較手術切除治療,患者的手術時間較短、并發(fā)癥發(fā)生率較低、住院時間較短、經(jīng)濟負擔較輕。3、臨床可考慮將經(jīng)皮微波消融治療作為于直徑3-5cm孤立性結直腸癌肝轉移患者根治性治療的首選治療手段之一。
[Abstract]:Objective:To compare the therapeutic effects of percutaneous microwave ablation and surgical resection for hepatic metastases of 3-5 cm in diameter from solitary colorectal cancer.Methods:74 cases of 3-5 cm in diameter of solitary colorectal cancer were operated on in the Department of Hepatobiliary Surgery of Liaoning Cancer Hospital from September 2010 to November 2013. 74 patients with liver metastases were divided into percutaneous microwave ablation group and surgical resection group, including 31 patients and 43 patients. Seventy-four patients were selected for sex, age, and treatment. In the percutaneous microwave ablation group, the patients were treated by microwave ablation with cold circulation microwave ablation apparatus, and the patients were monitored by color Doppler ultrasound during the operation to ensure the radical treatment of the metastases. Resection group: On the premise of negative resection margin, the choice of partial hepatectomy includes regular hepatic segment, lobectomy and irregular hepatic metastasis resection. Hemi-hepatic or hepatic portal occlusion was performed according to the location of the metastasis and the estimated amount of bleeding. The results of local treatment, cumulative survival rate, recurrence rate, postoperative complications, time spent in the treatment of metastases, time spent from admission to discharge, and medical costs of patients during hospitalization were compared between the microwave ablation group and the surgical resection group. The difference of survival curves was compared by Kaplan-Meier method and log-rank test. Results: In this study, the local therapeutic effects of the two groups were compared: 30 liver metastases were ablated in 31 patients of the percutaneous microwave ablation group. The first complete ablation rate was 96.8%. Of the 43 patients in the resection group, 41 were completely resected and 2 had recurrence in situ. The radical resection rate was 95.3% and P 0.05 respectively. There was no significant difference in cumulative survival rate and recurrence rate between the two groups. The cumulative survival rate and recurrence rate at 12, 24 and 36 months after operation were 96.8%, 78.9%, 47.4%, 9.7%, 29.6% and 52.0%, respectively. The cumulative survival rate and recurrence rate at 12, 24 and 36 months after operation were 95.3%, 71.7%, 49.6%, 11.6%, 27.0%, 56.8%, P values were 0.759, 0.567, 0.515, 0.790, 0.819, 0.712, respectively. Postoperative complications were pleural effusion (1 case in microwave ablation group, 3 cases in surgical resection group), incision infection (1 case in microwave ablation group, 3 cases in surgical resection group), liver abscess (1 case in microwave ablation group, 2 cases in surgical resection group), and pulmonary infection, abdominal hemorrhage, liver failure. Of these complications, there was no case in the microwave ablation group, 2 cases in the surgical resection group, 1 case in the surgical resection group. The incidence of complications in the percutaneous microwave ablation group and the surgical resection group were 9.7% and 30.2%, respectively. The incidence of different types of complications in the two groups was significantly different. The incidence of complications in the percutaneous microwave ablation group was significantly lower than that in the surgical resection group, and P=0.034. The average operation time in the percutaneous microwave ablation group was (46.5 (+ 16.7) min, significantly shorter than that in the surgical resection group (163.0 (+ 53.4) min, (P 0.05). The average hospitalization time in the percutaneous microwave ablation group and the surgical resection group was (6.1 (+ 1.9) d, (12.1 (+ 7.1) D (P The cost of percutaneous microwave ablation was (3.1 0.6) million yuan, significantly less than that of surgical resection (5.9 0.9) million yuan (P 0.05). Conclusion: 1. Percutaneous microwave ablation has the same short-term effect as surgical resection in the treatment of solitary colorectal cancer with hepatic metastasis with a diameter of 3-5 cm. Compared with surgical resection, patients with liver metastasis from colorectal cancer have shorter operation time, lower complication rate, shorter hospitalization time and less economic burden.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.34

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