经皮微波和射频消融治疗肝细胞性肝癌的临床比较研究

A clinical comparison of ultrasound-guided percutaneous microwave and radiofrequency ablation for treatment of hepatocellular carcinoma

目的探讨经皮微波和射频消融治疗肝癌临床效果的差异。方法以相同的纳入标准,回顾性比较了肝细胞性肝癌经超声引导经皮微波消融49例98个结节和射频消融53例72结节的局部疗效、并发症和远期生存率。结果微波组与射频组比较,肿瘤完全消融率分别为94.9%(93/98)和93.1%(67/72)(P=0.75),局部复发率为11.8%(11/93)和20.9%(14/67)(P=0.12)。主要并发症发生率分别为8.2%(4/49)和5.7%(3/53)(P=0.71)。1、2、3年无瘤生存率微波组分别为45.9%、26.9%和26.9%,射频组为37.2%、20.7%和15.5%(P=0.53)。1、2、3、4年累积生存率微波组分别为81.6%、61.2%、50.5%和36.8%,射频组为71.7%、47.2%、37.6%和24.2%(P= 0.12)。结论经皮微波和射频消融治疗肝癌的局部疗效、并发症和远期生存率无显著差别,均为安全有效的肝癌治疗手段。

Objective To investigate the difference of treatment efficacy between percutaneous microwave ablation and radiofrequency ablation for treatment of hepatoeellular carcinoma. Methods Under the same inclusion criteria, 98 nodules of hepatoeellular carcinoma in 49 patients were percutaneously treated with microwave ablation and 72 nodules in 53 patients with radiofrequency ablation under ultrasound guidance. The local tumor control, complication related to treatment and long-term results of the two modalities were compared retrospectively. Results The complete ablation rates were 94.9% （93/98） using microwave ablation versus 93.1% （67/72） using radiofrequency ablation （P= 0.75）, and the local recurrent rates were 11.8% （11/93） versus 20. 9% （14/67） （P=0.12）. The occurring rate of major complications associated with microwave ablation and radiofrequency ablation were 8.2% （4/49） versus 5.7% （3/53） （P=0.71）. The distant recurrent rates were 69.4% （34/ 49） in the microwave ablation group versus 75.6% （40/53） in the radiofrequency ablation group （P= 0.49）. The disease-free 1-, 2-, and 3-year survival rates in microwave ablation group were 45.9%, 26.9%, and 26.9%, respectively, and those in radiofrequency ablation group were 37.2%, 20.7% and 15.5%, respectively （P=0.53）. The 1-, 2-, 3- and 4-year cumulative survival rates in patients receiving microwave ablation were 81.6%, 61.2%, 50.5% and 36.8%, respectively, and in patients undergoing radiofrequency ablation were 71. 7%, 47. 2%, 37. 6% and 24. 2%, respectively （P= 0.12）. Conclusions The local tumor control, complications related to treatment, and long-term survivals between pereutaneous microwave ablation and radiofrequency ablation are equivalent, and both modalities are safe and effective for treatment of hepatocellular carcinoma.