肝癌射频消融术与切除术分别联合脾切除治疗小肝癌伴脾亢进临床疗效对比分析

Comparison on the clinical efficacies of radiofrequency ablation and surgical resection combined with splenectomy in treatment of small hepatocellular carcinoma associated with hypersplenis

目的比较肝癌射频消融术与切除术分别联合脾切除治疗小肝癌伴脾亢进临床疗效。方法 127例小肝癌伴脾亢进患者根据患者手术方式分为射频消融组(n=62)和手术切除组(n=65),射频消融组患者采取肝癌射频消融术联合脾切除术,手术切除组患者采取手术切除术联合脾切除术。记录两组患者手术一般情况,比较两组患者术后12个月并发症发生情况,所有患者随访截止到2015年2月,比较两组患者术后1、3和5年生存情况,以及无肿瘤生存情况。结果射频消融组患者热缺血时间、手术时间和住院时间均短于手术切除组,术中失血量和输血量均少于手术切除组,差异均有统计学意义(P<0.05);射频消融组患者术后12个月总并发症发生率6.4%,显著低于手术切除组的41.5%,差异有统计学意义(P<0.05);射频消融组患者术后1、3、5年生存率分别为99.5%、74.8%和71.4%,手术切除组分别为96.9%、68.2%和66.3%,两组相比差异无统计学意义(P>0.05),射频消融组患者术后无肿瘤生存中位时间29.3个月,长于手术切除组的26.7个月,但差异无统计学意义(P>0.05)。结论射频消融联合脾切除术治疗小肝癌伴脾亢进,与手术切除联合脾切除术治疗效果相当,且可有效减少术后并发症发生,有利于患者术后恢复。

Objective To comparison on the clinical efficacies of radiofrequency ablation and surgical resection combined with splenec-tomy in treatment of small hepatocellular carcinoma associated with hypersplenis.Methods 127 cases of small hepatocellular carcino-ma associated with hypersplenis were divided into radiofrequency ablation group （n =62）and surgical resection group （n =65）,ac-cording to surgical methods.Cases in radiofrequency ablation group were taken radiofrequency ablation combined with splenectomy, while in surgical resection group were taken surgical resection combined with splenectomy.The general of the surgery of the two groups were recorded.The occurrences of complications after surgery 12 months in the two groups were compared.All patients were followed ended at February 2015,the 1,3 and 5 -year survival and tumor -free survival of the two groups were compared.Results The warm ischemia time,operative time and hospital stay of the patients in the radiofrequency ablation group were shorter than surgical resection group,and the volumes of intraoperative blood loss and transfusion were less than surgical resection group,the differences were statisti-cally significant （P 〈0.05）.The occurrence of complications after surgery 12 months in radiofrequency ablation group was 6.4%, which was significantly lower than 41.5% of the surgical resection group,the difference was statistically significant （P 〈0.05）.The 1,3,5 -year survival rates of radiofrequency ablation group were 99.5%,74.8% and 71.4%,while the surgical resection group were 96.9%,68.2% and 66.3%,the two groups showed no significant difference （P 〉0.05）.The median tumor -free survival time of radiofrequency ablation group was 29.3 months,which was longer than 26.7 months of the surgical resection group,but the differ-ence was not statistically significant （P 〉0.05）.Conclusions The treatment effect of radiofrequency ablation combined with splenec-tomy in treatment of small hepatocellular carcinoma associated with hypersplenis was quite with and surgical resection combined with splenectomy,and could effectively reduce postoperative complications and conducive to postoperative recovery.