经皮射频消融与手术切除治疗小肝癌的疗效比较

Comparison of effects of percutaneous radiofrequency ablation and surgical resection on small hepatocellular carcinoma

目的比较经皮射频消融术与手术切除治疗小肝癌的疗效。方法采用临床随机对照研究,对2000年3月至2003年6月共112例临床分期属于Ia期和Ib期的小肝癌随机分为手术切除组和射频消融组,分别予以全麻下开腹行肝切除术或经皮射频消融作为首次治疗方法。结果手术切除组65例的术后第1、2和3年的肝内累积复发率分别是107%、184%和246%。术后1、2和3年的生存率分别为932%、857%和673%。射频消融组47例的术后第1、2和3年的肝内累积复发率分别是85%、191%和234%。术后1、2和3年的生存率分别为928%、820%和645%,两组的生存率比较差异无显著性意义(P=07534)。按临床分期进一步分组比较,Ia期两组的生存率相近,射频消融组略优,但差异无显著性意义(P=01253);Ib期时,手术切除组的术后1、2和3年的生存率略优,其差异亦无显著性意义(P=04617)。结论经皮射频消融为小肝癌根治性治疗提供了一种新的手段,其疗效与手术切除相近,特别是对肿瘤直径≤3cm的Ia期小肝癌,近期疗效优于手术切除,达到了根治性效果,在条件许可和技术上有保证的情况下,可部分代替开腹手术切除。

Objective To compare the effectiveness of percutaneous radiofrequency ablation (PRFA) and surgical resection as an initial treatment for patients with small hepatocellular carcinoma (HCC).Methods Between March 2000 and June 2003, 112 patients with small HCC (with single nodule less than 5 cm in diameter) were divided at random into two groups: resection group (n=65) and PRFA group (n=47) to undergo surgical resection or PRFA respectively.Results The 1-, 2-and 3-year recurrence rates were 10.7%, 18.4%, and 24.6% respectively in the 65 patients of the resection group and were 8.5%, 19.1%, and 23.4% respectively in the 47 patients of the PRFA group. The 1-, 2-, and 3-year survival rates were 93.18%, 85.69%, and 67.26% respectively in the 65 patients of the resection group and were 92.79%, 82.03%, and 64.46% respectively in the 47 patients of the PRFA group (P=0.7534). The 1-, 2-and 3-year survival rates of the patients with tumor less than 3 cm in diameter were slightly higher in the PRFA group than in the resection group, however, insignificantly (P=0.1253). The 1-, 2-and 3-year survival rates of the patients with tumor 3.1 to 5 cm in diameter were higher in the resection group than in the PRFA group, however, insignificantly (P=0.4617). The 1, 2, and 3-year survival rates of the patients at stage Ia were slightly higher in the PRFA group than in the resection group, however, insignificantly (P=0.1253). The 1, 2, and 3-year survival rates of the patients at stage Ib were slightly higher in the resection group than in the PRFA group, however, insignificantly (P=0.4617).Conclusion PRFA treatment is a less invasive form of treatment for small HCC than surgical resection and is equally effective as the more invasive surgical resection. PRFA is superior to surgical resection when used in the treatment of patients with HCC less than 3 cm in diameter. PRFA can be used instead of surgical resection in proper situations.