293例原发性肝癌术后复发的综合治疗效果分析

目的评估以手术切除、局部消融(ablation)和经导管肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)为主的综合治疗对原发性肝癌手术后复发的有效性和安全性。方法回顾性分析华中科技大学同济医学院附属同济医院2010年1月至2012年12月确诊原发性肝癌复发病人293例的临床资料,其中手术再切除33例,TACE联合消融治疗89例,TACE118例,保守治疗53例。结果肝切除术后无严重并发症,均顺利出院;2例病人TACE术后发生肝功能不全,予以护肝治疗后肝功能恢复正常;1例病人经皮微波固化术后发生食管穿孔,经开胸食管修补术后治疗后痊愈。1、3、5年生存率手术组分别为72.72%、45.45%和32.14%,中位生存期为30个月;TACE联合局部消融组:62.92%、31.46%和17.14%,中位生存期为21个月;单纯行TACE组:47.46%、29.66%和8.42%,中位生存期为11.5个月;保守治疗组的1、3、5年生存率分别为20.75%、3.77%和0%,中位生存期为7.75个月。结论根据病人病情制定以手术切除联合TACE、局部消融的个体化综合治疗方案是复发性肝癌治疗的理想模式;能行手术切除的病人预后较好;肝癌术后定期复查是早发现、早治疗、提高复发性肝癌手术率的关键措施。

The comprehensive treatment for 293 cases of postoperative recurrent of primary hepatocellular carcinoma

Objective To evaluate the efficacy and safety of comprehensive treatment based on surgical resection,local ablation and transcatheter arterial chemoembolization (TACE) for postoperative recurrence of primary hepatocellular carcinoma (HCC).Methods The clinical data of 293 cases of postoperative HCC recurrence diagnosed in Tongji Hospital in 2010-2012 were analyzed retrospectively.Thirty-three patients underwent hepatectomy again and 89 were given TACE therapy plus local ablation,118 patients were treated with TACE therapy only and 53 received palliative treatment.Results All patients receiving hepatectomy discharged without serious complication.Two patients with hepatic dysfunction after TACE recovered after supportive liver protection therapy.One esophageal perforation occurred after PMCT,and repaired by thoracotomy surgery.The 1-,3-,and 5-year overall survival rate and median survival time were 72.72％,45.45％,32.14％ and 30 months in operative group,62.92％,31.46％,17.14％ and 21 months in TACE + local ablation group,47.46％,29.66％,8.42％ and 11.5 months in TACE alone group,and 20.75％,3.77％,0％ and 7.75 months in palliative treatment group,respectively.Conclusions Individualized comprehensive treatment based on surgical resection combined with local ablation and TACE was the best treatment modalities for postoperative recurrent HCC.Surgical resection is still the preferred treatment for recurrent HCC.Regular review after surgery was the most effective measures to improve the surgical resection rate and overall survival rate.