手术切除与射频消融治疗小肝癌的疗效比较

Surgical resection versus radiofrequency ablation in treatment of small hepatocellular carcinoma

目的比较小肝癌手术切除与射频消融(RFA)初治后疗效及复发情况。方法收集吉林大学白求恩第一医院2002年1月至2008年12月接受手术或RFA初治的97例小肝癌患者资料,并对治疗后满2年的患者进行随访,共随访到63例,手术和RFA治疗分别为34和29例,回顾性分析两种方法治疗小肝癌患者的预后复发情况。计量资料采用χ2检验,利用Cox回归分析比较影响患者复发相关的危险因素,并应用Log-rank进行两种无瘤生存率检验。结果手术与射频消融治疗小肝癌3个月、1、2 a复发率分别15%、38%、64%,21%、35%、45%,两者差异无统计学意义。初治后复发与治疗方法、性别、年龄、Child-Pugh分级、肿瘤大小、结节数目、是否合并有肝硬化、甲胎蛋白水平相关性差异无统计学意义,两者无瘤生存率差异无统计学意义。结论 RFA与肝癌切除术在治疗小肝癌取得相近的治疗效果,RFA有望成为替代手术治疗的一种理想的治疗方法。

Objective To compare clinical efficacy and recurrence between surgical resection and radiofrequency ablation（RFA） in the treatment of small hepatocellular carcinoma（HCC）.Methods The clinical data of 97 patients with small HCC,who underwent surgical resection or RFA as the initial treatment in The First Hospital of Jilin University from January 2002 to December 2008,were collected.Sixty-three cases,who survived 2 years after treatment,were followed up;of the 63 cases,34 underwent surgical resection,and 29 underwent RFA.The recurrence of these patients was analyzed retrospectively.The measurement data were analyzed by chi-square test.The Cox regression analysis was used for determining the risk factors for recurrence.The log-rank test was used for disease-free survival（DFS） difference analysis.Results The 3-month,1-year,and 2-year intrahepatic recurrence rates for the patients who underwent surgical resection were 15%,38%,and 64%,respectively,versus 21%,35%,and 45% for those who underwent RFA,without significant differences between the two groups of patients.The intrahepatic recurrence after initial treatment was not significantly associated with treatment method,sex,age,Child-Pugh grade,tumor size,number of nodules,presence of cirrhosis,and alpha-fetoprotein level.There was no significant difference in DFS between the two groups of patients.Conclusion RFA produces a comparable outcome to that by surgical resection in the treatment of small HCC.RFA holds promise as a substitute for surgical resection.