小肝癌的治疗:手术切除与局部消融治疗的选择

Management of small hepatocellular carcinoma:selection of surgical resection or local ablative therapies

虽然手术切除一直被认为是小肝细胞癌(直径≤5cm,以下简称小肝癌)的首选治疗手段,其5年存活率可达60%～72%。但是,近年来随着超声引导局部消融技术的快速发展,局部消融凭借其微创性、有效性及安全性的突出优势而被广泛应用于小肝癌的治疗,并取得了可与手术切除相媲美的远期疗效。到目前为止已有一些回顾性研究与临床随机对照研究比较手术切除与局部消融治疗小肝癌的疗效,总体来讲,两者远期存活率差异无统计学意义,但手术切除局部复发率要显著低于消融治疗。有关局部消融可否取代手术切除成为小肝癌的首选治疗是个争论激烈的课题,目前已有的资料仍难以定论。笔者对小肝癌治疗手段选择的观点是应视病人具体情况(包括肝储备功能、肿瘤的大小及部位、毗邻结构等)而定,不应一概而论。

Surgical resection has long been considered as treatment of choice for small hepatocellular carcinoma （HCC）, with a 5-year overall survival rate of 60% -72%. However, with rapid development of ultrasound-guided local ablative therapies, they have been extensively applied in management of small HCC due to advantages of minimally-invasiveness, efficacy and safety, and achieved a similar long-term outcome to surgical resection. So far there have been some retrospective studies and randomized control trials （RCTs） comparing surgical resection and local ablative therapies for management of small HCC. Taken together, there are no significant differences in overall survival rates between two modalities. But, surgical resection is associated with lower local tumor recurrence as compared with local ablative therapies. Whether local ablative therapies can replace surgical resection to become treatment of choice for small HCC is still highly controversial. The currently available data are not adequate to draw a solid conclusion. Our opinion is that selection of treatment modality for small HCC should depend on the patient＇ s conditions, including liver function status, tumor size and location, and adjacent structures.