背景:为了确保临床疗效并延长患者生存期,手术和微波消融(MWA)等治疗方法用于早期肝癌。MWA是优选的,因为它有效地保留正常肝组织并引起局部肝肿瘤细胞的短暂性凝固坏死。然而,由于技术限制,癌性肝组织不能完全消融;因此,局部肿瘤复发的概率较高。
目的:探讨超声引导下经皮MWA治疗小肝癌的临床疗效和安全性。
方法:选取2018年1月至2019年4月永州市中心医院收治的小肝癌患者118例。66例患者接受了超声引导下经皮MWA(MWA组),52例患者接受了腹腔镜手术(腹腔镜组)。操作时间,失血,住院,对两组患者的医疗费用进行统计分析。血清丙氨酸转氨酶(ALT),天冬氨酸转氨酶(AST),总胆红素(TBIL),白蛋白(ALB),甲胎蛋白(AFP),癌胚抗原(CEA),术前和术后评估外周血调节性T淋巴细胞(Treg)水平。对消融前后测得的肿瘤横截面积进行统计学分析;比较两组患者手术并发症的治疗效果,2年无进展生存率,和总生存率。
结果:手术时间,失血,住院,MWA组的医疗费用低于腹腔镜组,差异有统计学意义(P<0.05);各参数,ALT,AST,TBIL,术前比较两组的ALB水平,差异无统计学意义(P>0.05)。操作时间,失血,住院,以及手术后2天和1周的医疗费用,MWA组的ALT和AST低于腹腔镜组,差异有统计学意义(P<0.05)。操作时间,失血,住院,和医疗费用,和血清AFP,CEA,术前、术后4周和8周测量Treg水平,两组比较差异无统计学意义(P>0.05)。与术前水平相比,血清AFP,CEA,两组Treg水平均降低(P<0.05)。MWA组术前病变的最大面积分别为4.86±0.90cm2、1.24±0.57cm2和0.31±0.11cm2,术后1和3个月,分别。其中58个实现了完全响应,8个实现了部分响应。经过2年的随访,MWA组无进展生存率和总生存率分别为37.88%和66.67%,分别,与腹腔镜组的44.23%和76.92%相比,差异无统计学意义(P>0.05)。
结论:超声引导下经皮MWA治疗小肝癌的效果与腹腔镜手术相似。然而,消融引起较少的创伤和肝功能障碍。
BACKGROUND: To ensure clinical efficacy and prolong patient survival, treatments such as surgery and microwave ablation (MWA) are used for early liver cancer. MWA is preferred because it effectively preserves the normal liver tissue and causes transient coagulation necrosis of local liver tumor cells. However, due to technical limitations, the cancerous liver tissue cannot be completely ablated; therefore, the probability of local tumor recurrence is high.
OBJECTIVE: To investigate the clinical efficacy and safety of ultrasound-guided percutaneous MWA in the treatment of small liver cancer.
METHODS: A total of 118 patients treated for small liver cancer in The Central Hospital of Yongzhou from January 2018 to April 2019 were selected. Sixty-six patients received ultrasound-guided percutaneous MWA (MWA group) and 52 received laparoscopic surgery (laparoscope group). The operation time, blood loss, hospital stay, and medical expenses of both groups were statistically analyzed. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), albumin (ALB), alpha fetal protein (AFP), carcinoembryonic antigen (CEA), and peripheral blood regulatory T lymphocytes (Treg) levels were evaluated pre- and post-operatively. The cross-sectional area of tumors measured before and after ablation was analyzed statistically; the therapeutic effect was compared between both groups in terms of surgical complications, 2-year progression-free survival rate, and overall survival rate.
RESULTS: The operation time, blood loss, hospital stay, and medical expenses in the MWA group were lower than those of the laparoscope group, and the differences were significant (P < 0.05); these parameters, and ALT, AST, TBIL, and ALB levels were compared preoperatively between both groups, and there was no significance (P > 0.05). The operation time, blood loss, hospital stay, and medical expenses for 2 d and 1 wk after surgery, the ALT and AST of the MWA group were lower than those of the laparoscope group, and the difference was significant (P < 0.05). The operation time, blood loss, hospital stay, and medical expenses, and serum AFP, CEA, and Treg levels were measured preoperatively and 4 and 8 wk postoperatively, and there were no significant differences between the two groups (P > 0.05). Compared with preoperative levels, serum AFP, CEA, and Treg levels in both groups were decreased (P < 0.05). The lesion in the MWA group had a maximum area of 4.86 ± 0.90 cm2, 1.24 ± 0.57 cm2, and 0.31 ± 0.11 cm2 preoperatively, 1 and 3 mo postoperatively, respectively. Fifty-eight of them achieved complete response and eight achieved a partial response. After 2 years of follow-up, the progression-free and overall survival rates in the MWA group were 37.88% and 66.67%, respectively, compared with 44.23% and 76.92% in the laparoscope group, with no significant difference (P > 0.05).
CONCLUSIONS: The effects of ultrasound-guided percutaneous MWA in the treatment of small liver cancer are similar to those of laparoscopic surgery. However, ablation causes less trauma and liver dysfunction.