射频消融与手术切除治疗老年性小肝细胞癌的疗效比较

Comparison of curative effect between radiofrequency ablation and surgical resection in treatment of elderly patients with small hepatocellular carcinoma

目的:评价射频消融(RFA)与手术切除治疗老年性原发性小肝细胞癌的临床疗效,为临床选择合适的治疗方法提供有益参考。方法:2004年1月—2010年12月本文作者收治127例老年性小肝细胞癌患者,按所接受的治疗方法分为RFA组76例与手术组51例,回顾性分析2组患者术后的住院时间、并发症发生率、生存率及复发率等临床资料,并进行对比研究。结果:RFA组患者平均住院时间为(14.7±4.8)d,手术组平均住院时间为(21.6±5.3)d,2组比较差异有统计学意义(P<0.001);RFA组患者术后并发症发生率为22.4%,手术组患者术后并发症发生率为74.5%,2组比较差异有统计学意义(P<0.001)。手术组术后1、2和3年累积生存率分别为90.2%、78.4%和70.6%,RFA组为92.1%、76.3%和69.7%,2组生存曲线经Log-rank检验,差异无统计学意义(P>0.05);手术组术后1、2、3年肝内肿瘤累积复发率分别为7.8%、21.6%和31.4%,RFA组为7.9%、19.7%和34.2%,2组同期复发率的比较差异无统计学意义(P>0.05)。结论:RFA治疗老年性小肝细胞癌的疗效与手术切除无明显差异,但在住院时间和并发症发生率方面优于手术切除。RFA治疗老年性肝癌安全、微创,疗效显著,可成为首选治疗方法之一。

Objective To compare the effectiveness of radiofrequency ablation（RFA） and surgical resection as an initial treatment for the elderly patients with small hepatocellular carcinoma and provide reference for selection of treatment methods in clinic.Methods From January 2001 to December 2005,127 patients who had undergone RFA treatment or surgical resection were analyzed retrospectively.The hospitalization time,the survival and recurrence rate after operation and incidence rate of complications were compared.Results After treatment,the average hospitalization time in RFA group was（14.7±4.8） d,and（21.6±5.3） d in surgical resection group,there was significant difference between two groups（P〈0.001）.The incidence rate of complications in RFA group（22.4%） was less than that in surgical resection group（74.5%）（P〈0.001）.The 1-,2-,3-year overall cumulative survival rates were 90.2%,78.4% and 70.6%,respectively in surgical resection group and were 92.1%,76.3% and 69.7%,respectively in RFA group,the difference between the two survival curves was not statistically significant（P=0.544）.The 1-,2-,3-year intrahepatic cumulative recurrence rates after RFA and surgical resection were 7.9%,19.7% and 34.2% versus 7.8%,21.6% and 31.4% respectively,the difference between the two intrahepatic recurrence curves was not statistically significant（P=0.546）.Conclusion RFA shows comparable results to surgical resection for the treatment of elderly patients with small hepatocellular carcinoma,but RFA has better effect than operation on hospitalization time and complications.It is safe to use RFA to cure elderly small hepatocellular carcinoma,and the method is micro-wound.RFA is one of the first choices for elderly liver cancer treatment.