CT引导下微波消融对肝癌术后复发应用价值及术后复发危险因素分析

目的:探讨CT引导下微波消融对肝癌术后复发应用价值以及术后复发危险因素分析。方法:选取2015年1月至2017年1月在我院接受肝癌切除术术后复发患者30例（复发组），同时选取肝癌切除术术后未复发患者30例作为对照组，复发组患者给予CT引导下微波消融，观察治疗效果。同时比较复发组和对照组患者临床病理资料差异。结果:30例患者经消融治疗后1个月复查，CR患者25例；总不良反应发生率为26.67%，主要为疼痛伴低热、乏力等；中位总体生存时间为15个月，1年、2年总体生存率分别为70.00%和22.70%；治疗后CD4+水平为（40.03±6.22）%，明显高于治疗前（P<0.05）；治疗后CD8+和α-L-岩藻糖苷酶分别为（25.59±4.12）%和（25.20±5.11） U/L，明显低于治疗前（P<0.05）；复发组首次手术肿瘤数量＞1个、邻近大血管比例，明显高于对照组（P<0.05）；Logistic回归分析显示首次手术肿瘤数量＞1个、邻近大血管是肝癌切除术术后复发的危险因素（OR=2.330和3.357，P<0.05）。结论:CT引导下微波消融治疗肝癌术后复发有较好的效果；肝癌切除术术后复发的危险因素包括肿瘤数量，是否邻近大血管。

Application value of CT guided microwave ablation for postoperative recurrence of hepatocellular carcinoma and risk factors of postoperative recurrence

Objective:To investigate the value of CT guided microwave ablation for postoperative recurrence of hepatocellular carcinoma and the risk factors for postoperative recurrence.Methods:From January 2015 to January 2017，30 cases of recurrence after hepatectomy were selected in our hospital，and 30 patients without recurrence after hepatectomy were selected as the control group.Patients in recurrent group were treated with microwave ablation guided by CT，and the therapeutic effect was observed.The clinicopathological data were compared between the recurrent group and the control group.Results:In 30 patients at 1 month after ablation，CR patients had 25 cases.The total incidence of adverse reactions was 26.67%，mainly for pain，low fever，fatigue and so on.The median overall survival time was 15 months，and the 1- and 2-year overall survival rates were 70.00% and 22.70%，respectively.After treatment，the level of CD4+ was (40.03±6.22)%，significantly higher than that before treatment (P<0.05).After treatment，CD8+ and α-L-fucosidase were (25.59±4.12)% and (25.20±5.11) U/L，were significantly lower than that before treatment (P<0.05).The number of first surgical tumors > 1 and the ratio of adjacent large vessels in the recurrent group，which were significantly higher than that in the control group (P<0.05).The Logistic regression analysis showed that the number of first surgical tumors > 1，adjacent large vessels were risk factors for recurrence after hepatectomy (OR=2.330 and 3.357，P<0.05).Conclusion:CT guided microwave ablation has a good effect on the recurrence of liver cancer.The risk factors for recurrence after hepatectomy include the number of tumors and the adjacent large vessels.