射频消融与手术切除治疗肝癌并发症及生存率的临床对照研究

Clinical control study of radio frequency ablation and operation on complications and survival rate of liver cancer

目的探讨超声引导下射频消融治疗肝癌并发症、术后1年生存率的情况,并与传统开腹手术进行比较。方法原发性肝癌患者共159例,根据肿瘤直径大小以及肿块数目将患者分为2组:肿瘤直径≤4.0cm、单发肿瘤组44例,其中接受手术治疗29例,接受射频治疗15例;肿瘤直径>4.0cm、多发肿瘤组115例,其中接受手术治疗54例,接受射频治疗61例。手术治疗行肝叶规则或不规则切除术;射频治疗共88个肿瘤,超声引导下集束射频治疗针穿刺进入肿瘤中心,分点多次行射频治疗。应用癌症患者生活质量评估量表Quick-FLIC,信件或电话随访了解患者并发症、短期生存率及生活质量的情况。分别比较2组接受手术和射频治疗结果的差异。结果射频治疗并发症的发生率低于手术患者。肿瘤直径≤4.0cm、单发病灶组:射频和手术患者的1年生存率和生活质量没有明显差异;肿瘤直径>4.0cm、多发肿瘤组:射频治疗术后1年生存率及平均生存时间明显低于手术患者,但生存质量较手术组高。结论对于部分失去手术治疗机会或者不愿意进行手术治疗的PLC患者。

Objective To explore the complications and short-term survival rate of ultrasound-guided radio frequency ablation （RFA） in the treatment of liver cancer, and compare the results with conventional operation. Methods Totally 159 hepatocellular carcinoma patients were divided into 2 groups according to the diameter and number of their tumors. Among the 44 cases in the group of solo tumor with tumor diameter ≤4.0 cm, 29 cases received operation and 15 received RFA treatment. For the 115 cases of the diameter 〉4.0 cm or multiple tumors, 54 cases received operation and 61 received RFA treatment. The operations were hepatolobectomy or irregular resection. There were 88 tumor masses receiving RFA treatment. The bundled needles were punctured into the center of the tumors and the treatment was performed multiply at different spots under the guidance of ultrasound. The complications and short-term survival rate and quality of living were evaluated by life quality score （Quick-FLIC） by correspondence or telephone interview. Differences between the above mentioned data of patients receiving operation and RFA treatment within the 2 groups were compared. Results There were lesser complications in the patients receiving RFA treatment than in those receiving operation. In the group of solo tumor with tumor diameter ≤4.0 cm, there was no significant difference in survival rate after 1 year and quality of living between patients receiving these 2 approaches. But in the group with tumor diameter 〉 4.0 cm or multiple tumors, the survival rate after 1 year was lower in patients receiving RFA treatment than in those receiving operation, but their quality of living was better. Conclusion For solo tumor with diameter ≤ 4.0 cm, RFA has similar survival rate after 1 year and lower complications rate, higher post-operation quality of living and promising long-term treatment effect in comparison to operation group. For multiple tumors or the tumors with diameter 〉 4.0 cm, the extension living time and elevation survival rate were better in palliative surgery operation than RFA treatment. However, RFA treatment has lower complications rate and higher postoperation quality of living.