左侧单肺通气条件下经皮经肝射频消融治疗肝顶部癌的疗效和安全性

目的 总结左侧单肺通气条件下经皮穿刺射频消融治疗肝顶部癌(liver cancer of the hepatic dome,LCHD)的疗效和安全性,为拓宽经皮穿刺射频消融在LCHD病人中的应用提供理论依据.方法 回顾性总结作者在2006年1月至2009年1月间收治的肝细胞癌病人的临床资料,从中纳入31例在左侧单肺通气条件下应用射频消融治疗的LCHD病人,作为LCHD组;并在不属于LCHD的右肝细胞癌病人中,按癌灶距肝包膜、胆囊和第一肝门主要分支距离≥1.0 cm的条件,纳入45例作为对照组.两组病人的年龄、性别、基础肝病原因、肝功能状况、癌灶直径等方面无统计学差异(P>0.05).癌灶残留采用射频消融后1个月增强CT和(或)甲胎蛋白追踪判定,将完全消融至局部肿瘤生长间隔作为无瘤生存时间.用Mann-Whitney检验比较两组病人的年龄、癌灶直径和平均穿刺次数,用χ2检验比较并发症发生率和不完全消融率,用Kaplan-Meier's法计算局部无瘤生存率,采用log-rank检验比较.结果 LCHD组术后右肩部疼痛发生率明显高于对照组(87.1%比11.1%,P<0.01);两组的平均穿刺次数、治疗时间、住院日数以及完全消融率之间的差异无统计学显著性(P>0.05);LCHD组1年、2年和3年局部无瘤牛存率分别为85.5%、65.8%和36.4%,对照组分别为87.7%、62.3%和34.0%,两组差异无统计学显著性(P>0.05).结论 对于直径≤5 cm的LCHD,左侧单肺通气条件下经皮穿刺射频消融的近期疗效和安全性与非特殊位置肝癌相似,可以作为首选治疗方案之一.

Therapeutic efficacy and safety of percutaneous radiofrequency ablation with left single lung ventilation for liver cancer of hepatic dome

Objective To compare short-term therapeutic outcomes and the safety of percutane-ous radiofrequency ablation (PRFA) with left single lung ventilation (LSLV) for liver cancer of the hepatic dome (LCHD) and that of PRFA for right liver carcinoma in favorable location. Methods Thirty one patients with hepatocellular carcinoma (belonging to LCHD) receiving PRFA with LSLV (Group LCHD) between January 2006 and January 2009 in our hospital were selected, and 45 control patients with right lobe HCC ≥1 cm away from the liver capsule, gallbladder, and main portal bran-ches were also included. One month after PRFA, residual tumors were followed up with contrast en-hanced CT and alpha fetal protein and PRFA was repeated in the presence of residual foci. Tumor-free survival time was defined as the duration from complete ablation to diagnosed local tumor progression.The Mann-Whitney test was used to compare age, tumor diameter, and average number of punctures between LCHD patients and controls. A χ2 test was used for comparison of the incidence of complica-tions and incomplete tumor ablation rate. The Kaplan-Meier's method was used for calculation of local tumor-free survival rate compared with a log-rank test. Results The incidence of right shoulder pain was significantly higher in LCHD patients than in controls (87. 1% vs 11. 1%, P<0. 01). LCHD pa-tients showed no difference from controls in the average number of punctures (2. 8±. 5 vs 3. 2±. 5,P>0. 05). Meanwhile, there was no difference between the 2 groups in average duration of treatment and hospitalization, and the complete tumor ablation rate at first PRFA. No differences were observed in the 1-, 2- and 3-year local tumor-free survival rates between LCHD patients (85. 5% , 65. 8% , and 36. 4% ,respectively) and controls (87.7%, 62. 3% , and 34.0% , respectively). Conclusion PRFA with LSLV for LCHD seems to promise comparable short-term outcomes and safety to PRFA for right liver carcinoma of fa-vorable location and should be preferred as one of the therapeutic options for LCHD patients with tumor di-ameters≤5 cm regardless of its unique location.