射频消融治疗肝癌肝移植术后肿瘤肝内复发的临床分析

Radiofrequency ablation in the treatment of intrahepatic recurrence of hepatocellular carcinoma after li-ver transplantation

目的探讨射频消融(radiofrequency ablation,RFA)治疗原发性肝细胞癌(肝癌)肝移植术后肿瘤肝内复发的疗效及其安全性。方法肝癌肝移植术后肿瘤肝内复发患者33例,其中26例采用RFA治疗者为RFA组,7例采用手术切除治疗者为手术组。观察与比较两组患者的手术时间、出血量、输血量、复发率、生存率、住院时间、临床转归情况,记录RFA组的术后并发症和不良反应。结果RFA组和手术组的手术时间分别为(91±12)min、(242±27)min,出血量分别为0、(227±113)ml,输血量分别为0、(114±101)ml,住院时间分别为(6.0±1.4)d、(18.4±6.1)d,比较差异均有统计学意义(均为P<0.05)。RFA组26例中死亡7例,手术组7例中5例死亡。RFA组和手术组的中位生存时间分别为13个月、10个月,两组的中位生存时间比较差异有统计学意义(P<0.05),两组的术后复发率分别为81%(21/26)、2/7,比较差异无统计学意义(P>0.05)。RFA组近期并发症为肝包膜下出血(31%);常见不良反应为发热(92%)、疼痛(100%)、胃肠道症状(42%),经对症处理可耐受。结论RFA治疗肝移植术后肝癌肝内复发疗效较好,而且并发症少、患者耐受良好。

Objective To investigate the effect and safety of the radiofrequency ablation （RFA） in the treatment of intrahepatic recurrence of hepatocellular carcinoma （HCC） following liver transplantation. Methods Twenty-six patients with HCC who received RFA for intrahepatic recurrence following liver transplantation were allocated to RFA group. Seven patients undergoing resection after intrabepatie recurrence were allocated to resection group. All patients were followed up each month. All variables including operating time, hemorrhage volume, blood transfusion volume, recurrence rate, survival data, hospital stay, clinical outcome, complications and adverse reactions of all cases were recorded and compared. The analysis of recurrence rate of HCC and prognostic factors of RFA were performed. Results All cases in the RFA group had shorter operating time, less hemorrhage and blood transfusion volume compared with the resection group （ P 〈 0. 05 ）. Nine of 26 eases were dead in RFA group, and 5 of 7 cases were dead in control group. The median survival time of RFA group was longer than that of the control group （P 〈0. 05）. There was no significant difference in the recurrence rate of the two groups （P 〉0. 05 ）. Liver subcapsular hemorrhage was a common postoperative complication occurred in RFA group （31%）. The frequent adverse reaction in RFA group includes fever （92%）, pain （100%）, gastrointestinal symptoms （42%） and all patients could tolerate the discomfort. Conclusion The treatment of RFA is a safe and minimally invasive procedure which is strongly recommended for intrabepatic recurrence of hepatocellular carcinoma following liver transplantation.