原位射频消融与手术治疗小肝癌对比研究

Percutaneous radiofrequency ablation and surgical resection for small hepatocellular carcinoma:a comparative study

目的比较经皮原位射频消融与手术切除治疗肝脏肿瘤的疗效。方法1999年11月至2004年6月，中山大学肿瘤防治中心共收治434例肝功能ChildA级的小肝癌（单个肿瘤、直径≤5．0cm）病人。其中手术切除183例，射频消融治疗251例。结果手术切除组1、3、5年存活率分别为91．18％、70．18％、55．51％，射频消融组存活率分别为91．92％、74．41％、58．22％，两组之间差异无统计学意义（P=0．6253）；分层分析显示，对于直径≤3．0cm肿瘤，手术切除组1、3、5年存活率分别为95．87％、73．69％、62．45％，射频消融组1、3、5年存活率分别为95．46％、80．15％、72．79％，两组之间差异无统计学意义（P=0．5641）；对于直径3．1～5．0cm肿瘤，手术切除组1、3、5年存活率分别为88．07％、67．63％、51．18％，射频消融组1、3、5年存活率分别为80．16％、60．63％、32．34％，两组之间差异无统计学意义（P=0．1256）；多因素分析显示肿瘤大小和总胆红素（serumbill—rubin）是影响存活率的独立危险因素。结论对于肝功能较好的单个肿瘤的小肝癌病人，射频消融与手术切除效果相近，可达到根治性效果，可代替部分开腹手术切除。

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 November 1999 and June 2004,434 patients with a solitary HCC （ diameter less than 5cm） and well-preserved liver function （ Childpugh class A ） received PRFA or surgical resection （SR） in Sun Yat-sen University Cancer Center. Among them, 183 patients received SR and 251 patients received PRFA. Results The overall 1-year,3-year and 5-year survival rates for SR group were 91.18% ,70. 18% ,55.51% respectively, and for PRFA group were 91.92% ,74.41% ,58. 22% respectively. In patients with tumor diameter ≤3cm,the overall 1-year,3-year and 5-year survival rates for SR group were 95. 87% , 73. 69% ,62. 45% respectively, and for PRFA group were 95.46%, 80. 15%, 72. 79% respectively. In patients with tumor diameter from 3.0m to 5.0cm, the overall 1-year,3-year and 5-year survival rates for SR group were 88.07% , 67.63% ,51.18% respectively,and for PRFA group were 80. 16% ,60. 63% ,32. 34% respectively. Survival of patients treated with PRFA were dependent on tumor size and serum bilirubin. Conclusion PRFA is as effective as surgical resection in the group of solitary and small HCC. PRFA can be used instead of surgical resection in proper situations.