氩气刀与普通电刀在肝硬化背景肝细胞癌根治性肝切除中的疗效与安全性比较

Efficacy and safety of argon plasma coagulation compared with conventional electrosurgical knife in radical hepatectomy for hepatocellular carcinoma with cirrhosis

摘要:

背景与目的 在肝硬化背景下行肝细胞癌（HCC）根治性切除术时，肝断面止血方式可能影响围手术期安全性及远期预后。本研究比较氩气刀与普通电刀处理肝断面对术后并发症及生存结局的影响。方法 回顾性分析2013年1月—2020年1月于中国人民解放军联勤保障部队第九〇〇医院行根治性肝切除的肝硬化背景HCC患者204例。根据术中肝断面处理方式分为氩气刀组（n=103）和普通电刀组（n=101）。比较两组围手术期指标、术后并发症发生情况以及总生存期（OS）和无复发生存期（RFS）。结果 两组患者基线资料差异无统计学意义（均P>0.05）。与普通电刀组相比，氩气刀组术后肝切除术后肝功能衰竭（PHLF）发生率显著降低（0.0% vs. 5.9%，P=0.036），术中输血率亦明显下降（12.6% vs. 23.8%，P=0.039）。两组术后第1天肝功能指标、总体并发症发生率及严重并发症发生率差异均无统计学意义（均P>0.05）。生存分析显示，氩气刀组1、3、5年OS和RFS率均显著高于普通电刀组（OS：P=0.034；RFS：P=0.003）。复发模式分析显示，氩气刀组未见切缘复发，而普通电刀组发生8例（P=0.011）。结论 在肝硬化背景下行HCC根治性肝切除术时，采用氩气刀处理肝断面可降低PHLF和术中输血发生率，并与OS和RFS改善相关，在保证围手术期安全性的同时具有潜在肿瘤学获益，值得进一步推广和通过前瞻性研究加以验证。

Abstract:

Background and Aims In cirrhotic patients undergoing radical hepatectomy for hepatocellular carcinoma (HCC), the technique used for hepatic transection may influence perioperative outcomes and long-term prognosis. This study compared argon plasma coagulation (APC) with a conventional electrosurgical knife (EK) in terms of postoperative complications and survival outcomes.Methods A retrospective analysis was conducted on 204 cirrhotic HCC patients who underwent radical hepatectomy in the 900th Hospital of PLA Joint Logistic Support Force between January 2013 and January 2020. Patients were divided into an APC group (n=103) and an EK group (n=101) according to the method used for hepatic transection. Perioperative outcomes, postoperative complications, overall survival (OS), and recurrence-free survival (RFS) were compared between groups.Results Baseline characteristics were comparable between the two groups (all P>0.05). The incidence of post-hepatectomy liver failure was significantly lower in the APC group than that in the EK group (0.0% vs. 5.9%, P=0.036), as was the intraoperative transfusion rate (12.6% vs. 23.8%, P=0.039). No significant differences were observed in postoperative day 1 liver function parameters, overall complications, or severe complications (all P>0.05). Survival analysis demonstrated significantly higher 1-, 3-, and 5-year OS and RFS rates in the APC group compared with the EK group (OS: P=0.034; RFS: P=0.003). Recurrence pattern analysis showed that no margin recurrence was observed in the APC group, whereas eight cases occurred in the EK group (P=0.011).Conclusion In cirrhotic patients undergoing radical hepatectomy for HCC, APC is associated with reduced PHLF and intraoperative transfusion without increasing perioperative morbidity, and is correlated with improved OS and RFS. These findings suggest that APC may provide oncological and safety advantages, warranting further validation in prospective multicenter studies.