原发性中小肝癌手术与射频消融治疗的疗效分析

Comparison of the efficacy of radiofrequency ablation and surgical resection for the treatment of small primary hepatocellular carcinoma

目的:比较射频消融(radiofrequency ablation,RFA)治疗与手术切除治疗(surgical resection,SR)对于原发性小肝癌的疗效。方法:2003年1月到2009年6月共收治经甲胎蛋白(AFP)联合影像学(MRI或CT)证实的原发性中小肝癌患者125例:RFA组60例(B超引导下经皮射频消融51例,腹腔镜下射频消融6例,CT定位经皮射频消融3例),SR组65例:采用常规手术切除治疗(肿瘤局部挖出48例,肝段切除12例,肝叶切除5例)。评估并比较两组治疗效果。结果:RFA组和SR组术后第1、2和3年生存率分别为88.33%、71.67%、58.33%和93.85%、80.00%和72.31%,两者的生存曲线采用Kaplan-Meier检验有统计学意义(P=0.043)。RFA组和SR组术后第1、2和3年的肿瘤复发率分别为15.00%、31.67%、56.67%和10.77%、24.62%和36.92%,两组比较,复发率差异有统计学意义(P=0.034)。结论:射频消融治疗虽具有术后恢复快、出血量少、住院日短、花费少等微创特点,但在肿瘤复发率和术后生存率方面不如传统手术切除治疗。

Objective：To compare the efficacy of radiofrequency ablation（RFA） and surgical resection（SR） for the treatment of small primary hepatocellular carcinoma（SHCC）.Methods：From January 2003 to June 2009,one hundred and twenty-five SHCC patients who had diagnosed by alpha fetoprotein combined with magnetic resonance imaging（MRI） or computer tomography（CT） were analyzed retrospectively.60 SHCC patients were undergone RFA treatment and 65 SHCC patients were undergone SR treatment.The number of RFA by guided B ultrasound,laparoscopy and CT were fifty-five,six and three cases.The number of SR by local tumor resection,hepatic segments resection and hepatic lobectomy were forty-eight,twelve and five cases.Comparison of the treatment effects of two groups was evaluated and compared.Results：The overall survival rates was significantly higher in patients treated with SR than RFA at 1,2 and 3 years（93.85%,80.00%,72.31% versus 88.33%,71.67%,58.33%）.The difference between the survival curves was statistically significant（P = 0.043）.The 1,2,and 3 years recurrence rate after RFA and SR were 15.00%,31.67%,56.67% and 10.77%,24.62%,36.92%,respectively.The recurrence rate between the two groups was statistically significant（P = 0.034）.Conclusion：Though radiofrequency catheter ablation has faster postoperative recovery,less bleeding,shorter hospital stay,less cost and so on,RFA was inferior to SR in terms of overall survival rates and recurrence rates at 1,2,and 3 years.