| Background:hepatocellular carcinoma(HCC)is one of the most common malignant tumors of the digestive tract,which seriously threatens the life and health of Chinese people.At present,the radical treatment of HCC mainly includes surgical resection,liver transplantation and ablation.However,due to poor liver function reserve,many complications,extrahepatic and extrahepatic tumor metastasis,and lack of donor,only a small number of patients have the opportunity to receive surgical resection or liver transplantation.Thermal ablation technology has become one of the available treatment options because of its advantages of minimal invasion,definite efficacy and maximum preservation of tumor surrounding tissues.Compared with radiofrequency ablation(RFA),microwave ablation(MWA)has been widely promoted because of its better high temperature heating efficiency and less influence by the "heat sink effect".The current study shows that the survival rate of patients with early HCC after percutaneous microwave ablation is comparable to that of surgical resection.However,it also has certain limitations.For example,it is usually difficult to achieve complete ablation of tumor tissues in special sites,and the incidence of a series of complications caused by percutaneous microwave ablation is high.The emergence of laparoscopic-assisted microwave ablation to a certain extent makes up for the shortcomings of percutaneous microwave ablation.However,how to improve the complete ablation rate,reduce the incidence of postoperative complications,and improve the survival prognosis of patients are still the difficulties of MWA treatment for HCC patients.Many researchers have tried various methods to improve the complete ablation rate of tumors,including microwave ablation by blocking the hepatic hilum during ablation,in order to improve the prognosis of patients.In 2006,Li Xin-guo et al.tried to use laparoscopic-assisted porta hepatis occlusion for microwave ablation in the treatment of liver cancer,and found that the complete ablation rate of tumor after laparoscopic porta hepatis occlusion microwave ablation was higher than that of laparoscopic microwave ablation alone,and the recurrence rate was lower,with no obvious complications.In recent years,we have used laparoscopy-assisted Pringle maneuver for intermittent Pringle maneuver,followed by microwave ablation for liver cancer in our hospital.Laparoscopic porta hepatis microwave ablation is a safe,minimally invasive and effective surgical method.However,there are few reports on the clinical application of microwave ablation with laparoscopic hepatic portal occlusion in the treatment of liver cancer at home and abroad.Therefore,it is necessary to conduct a comparative study of laparoscopic microwave ablation with hepatic hilum occlusion and percutaneous microwave ablation in the treatment of liver cancer,and to further explore the safety and efficacy of laparoscopic microwave ablation with hepatic hilum occlusion in the treatment of liver cancer.Research Objective:To compare the clinical efficacy of laparoscopic microwave ablation and percutaneous microwave ablation in the treatment of hepatocellular carcinoma(HCC),and to evaluate the safety and effectiveness of the two surgical methods.Research Method:The clinical data of patients who were diagnosed with HCC and treated with MWA in the Second People’s Hospital of Yibin City(Yibin Hospital of West China Hospital of Sichuan University)from January 2014 to December 2019 were collected.Then the patients who met the requirements were divided into two groups according to the different intraoperative surgical methods.They were divided into laparoscopic group(laparoscopic hepatic portal occlusion microwave ablation)and percutaneous group(percutaneous microwave ablation).Clinical data of the two groups were collected,including:gender,age,hemoglobin(HGB),alpha fetoprotein(AFP),aspartate transaminase(AST),alanine transaminase(alanine transaminase),and hemoglobin(HGB).ALT),liver function score(liver function Child-Pugh score),the number of patients with tumors in special sites(large blood vessels,adjacent organs),the number of patients with comorbidities(hypertension,diabetes,chronic hepatitis B,hepatitis C),the number of tumors and tumor diameter.Propensity score matching(PSM)method was used to select 62 patients from the laparoscopic group and 62 patients from the percutaneous group.To compare the short-term and long-term efficacy of laparoscopic hepatic portal occlusion microwave ablation and percutaneous microwave ablation in the treatment of hepatocellular carcinoma,to investigate the safety and efficacy of microwave ablation under laparoscopic hilar occlusion in the treatment of HCC.Kaplan-Meier survival analysis is used to draw the survival curve,and Cox proportional hazards regression model is used for survival analysis to explore the independent risk factors affecting the overall survival time(OS)of HCC patients after microwave ablation.Result:1.Before PSM,there are significant differences in age,HGB,liver function grade and chronic hepatitis B between laparoscopic microwave ablation group and percutaneous microwave ablation group(P<0.05).After PSM,there are 62 patients in each group,and there is no significant difference in baseline data between the two groups(P>0.05).It is comparable.2.After PSM,there are 62 patients in each group.The median operation time is 75(56,80)min in the percutaneous group and 80(71,90)min in the laparoscopic group,and the difference between the two groups is statistically significant(P<0.001).The proportion of patients with postoperative intrahepatic hematoma,liver capsule and(or)abdominal bleeding in the percutaneous group and the laparoscopic group is 15%(9/62)and 3%(2/62),and the difference between the two groups is statistically significant(P<0.001).Diaphragmatic injury occurred in 8 patients(13%)in the percutaneous group and 1 patient(2%)in the laparoscopic group.The difference between the two groups is statistically significant(P=0.016).The number of patients with skin burns in the percutaneous group and the laparoscopic group accounted for 13%(8/62)and 2%(1/62),and the difference between the two groups is statistically significant(P=0.016).3.There are 62 patients in each group after PSM.The complete ablation rate is 94%(58/62)in the laparoscopic group and 81%(50/62)in the percutaneous group,and the difference between the two groups is statistically significant(P=0.033).The 1-year,2year and 3-year overall survival rates in the percutaneous group are 87%,81%and 71%,respectively;the 1-year,2-year and 3-year overall survival rates in the laparoscopic group are 93%,85%and 74%,respectively;the 1-year,2-year and 3-year survival rates in the percutaneous group are lower than those in the laparoscopic group,but the difference is not statistically significant(P>0.05).4.According to the results of univariate Cox proportional hazard regression model,the number of tumors(multiple/single,HR=2.53,95%CI 1.398-4.594,P=0.002),combined hypertension(with/without,HR=1.88,95%CI 1.038-3.397,P=0.037),intrahepatic hematoma,hepatic capsule and/or abdominal hemorrhage(yes/no,HR2.78,95%CI 1.555-4.978,P=0.001),pleural effusion(Yes/no,HR=6.21,95%CI 1.461-26.356,P=0.013),diaphragmatic injury(yes/no,HR=6.21,95%CI 1.461-26.356,P=0.013),HR=2.58,95%CI 1.091-6.111,P=0.031),local tumor progression(yes/no,HR=3.28,95%CI 1.735-6.193,P<0.001),distant intrahepatic recurrence(yes/no,HR=4.18,95%CI 1.766-9.879,P=0.001)is the risk factor for OS in patients with liver cancer after microwave ablation(HR95%are greater than 1).Complete ablation(yes/no,HR=0.28,95%CI 0.111-0.725,P=0.009)is a protective factor for OS,and the above indicators are statistically significant(P<0.05).5.According to the results of multivariate Cox proportional hazards regression model analysis,postoperative local tumor progression(yes/no,HR=9.62,95%CI 2.302-40.164,P=0.002)was an independent risk factor affecting the OS of patients with liver cancer after MWA(HR95%>1).The above indicator is statistically significant(P<0.05).6.Kaplan-Meier survival analysis showes that the survival probability of patients in the percutaneous group decreases rapidly with time,but there is no significant difference between the percutaneous group and the Laparoscopic group(P=0.570).Conclusion:1.Laparoscopic hepatic portal occlusion microwave ablation and percutaneous microwave ablation are safe and effective surgical methods for hepatocellular carcinoma.2.Compared with percutaneous microwave ablation,the complete tumor ablation rate is higher,and the incidence of intra-hepatic hematoma,subcapsular and/or abdominal hemorrhage and diaphragm injury is lower after laparoscopic microwave ablation under hepatic portal occlusion.3.Local tumor progression is an independent risk factor affecting the overall survival time of patients with hepatocellular carcinoma after microwave ablation. |
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