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Analysis Of The Efficacy Of Microwave Ablation In The Treatment Of Early Hepatic Alveolar Echinococcosis:A Propensity Score Matching Based Study

Posted on:2023-04-09Degree:MasterType:Thesis
Country:ChinaCandidate:X DengFull Text:PDF
GTID:2544306848993689Subject:Surgery
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Objective:By comparing the basic clinical data of microwave ablation and radical hepatectomy for early-stage hepatic alveolar echinococcosis with lesions≤5 cm in diameter,we investigated whether there is any efficacy difference between the two treatment modalities.Methods:Patients diagnosed with HAE at the Affiliated Hospital of Qinghai University from June 2014 to January 2020 were retrospectively analyzed,and general clinical data of patients were collected according to inclusion and exclusion criteria.And propensity score matching(PSM)was used to balance all confounding factors in the two groups,which were matched 1:1 into the MWA group(n=20)and radical surgery group(n=20).The safety of the MWA treatment modality was evaluated by comparing the two groups of patients in terms of postoperative general laboratory indices,grading of postoperative complications and length of postoperative hospital stay.And the effectiveness of MWA was evaluated by analyzing the postoperative local progression rate of patients in both groups,using K-M survival curves.Results:Prior to PSM,there were statistical differences in age(P=0.031),BMI(P=0.006),gender(P=0.001),and lesion size(P=0.006)between the two groups of patients.However,there were no statistical differences in the confounding factors with PSM(age(P=0.635),BMI(P=0.646),gender(P=0.327),clinical symptoms(P=0.736),HBV(P=1.000),lesion diameter(P=0.544),and lesion location(P=0.524).The results showed that hospitalization costs were lower in the MWA ablation group than in the radical surgery(25.0(22.0,27.0)thousand RMB vs.35.7(29.5,43.0)thousand RMB,P<0.001).In terms of safety,the preoperative and postoperative changes in ALT were lower in the MWA group compared with radical surgery(85.00(28.00,136.00)U/L vs.172.50(80.75,247.00)U/L,P=0.009);the changes in WBC count were lower(3.10(1.20,4.47)10~9/L vs.9.19(5.23,10.95)10~9/L,P<0.001);no statistical difference in the magnitude of preoperative and postoperative changes in the remaining laboratory indices.There was 1 case of pleural effusion(Clavien-Dindo Ⅰ-Ⅱ)in the MWA ablation group.In contrast,one case of hypoproteinemia and one case of peritoneal effusion(Clavien-Dindo Ⅰ-Ⅱ)were observed in the radical surgery group.However,there was no statistical difference in the incidence of postoperative complications between the two groups(P=0.500).For postoperative hospital days,the length of postoperative hospital stay was shorter in the MWA group than in the radical surgery group(5(2,6)days vs.10(8,12)days,P<0.001).In terms of effectiveness,the efficiency of postoperative treatment was 100%in both groups.During the follow-up period(53.85(38.79,57.14)months and 54.62(43.08,68.36)months),one patient in the MWA group experienced a recurrence.By K-M survival curve analysis,there was no statistical difference in disease-free survival between the two groups(P=0.317).And there were no death cases in both groups during the follow-up period.Conclusion:There was no statistical difference between the MWA group and the radical surgery group in terms of the incidence of postoperative complications and the effectiveness of treatment.However,MWA was superior to the radical surgery group in terms of postoperative length of stay and total hospital costs.MWA can be considered a safe and effective means of treating HAE≤5 cm in diameter,providing a new therapeutic idea for the majority of clinicians in the treatment of HAE.
Keywords/Search Tags:Echinococcosis, Hepatic, Microwave ablation, Radical hepatectomy, Therapeutics
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