经皮与开腹射频治疗肝癌的合理选择

Appropriate choice of percutaneous or intraoperative radiofrequency ablation in treatment of liver cancer

目的 探讨射频 (RFA)治疗肝癌不同途径的合理选用。方法 41例肝癌病人分为 2组进行经皮射频 (PRFA)治疗和开腹射频 (IRFA )治疗 ,并对结果进行比较。结果 PRFA治疗 18例病人共 32个肿瘤结节 ,IRFA治疗 2 3例病人共 43个结节 ,PRFA和IRFA并发症率分别为 33.3%和 4.3% (P <0 .0 5 )。随访平均 10个月 ,PRFA组 7个病灶复发 ( 4个病人 ) ,复发率 2 1.9% ( 7/32 ) ,而IRFA组仅 1个结节复发 ,复发率 2 .3% ( 1/43,P <0 .0 2 5 )。结论 RFA治疗肝癌途径的选用应根据病变位置、结节的大小和肝硬化程度等综合考虑而定 ,IRFA并发症少 ,治疗彻底 ,效果优于PRFA。

Objective To investigate appropriate use of radiofrequency thermal ablation (RFA) in treatment of liver cancer.Methods Fouty-one patients with hepatic cancer were entered into two trials. The liver tumors were treated with percutaneous radiofrequency ablation (PRFA) or intraoperative radiofrequency ablation (IRFA). All patients were followed up postoperatively to assess complications, treatment response, and local recurrence of tumor.Results PRFA and IRFA were performed on 32 tumors in 18 patients and 43 tumors in 23 patients, respectively. Treatment-related complications occurred in 6 of the 18 patients treated with PRFA (33.3%). In contrast, there was only 1 complication after IRFA (4.3%, P<0.05). With a median follow up of 10 months in both groups, tumor has recurred in 1 of 43 lesions treated with IRFA (2.3%), versus 7 of 32 tumors treated with PRFA (21.9%, P<0.025). Conclusions The choice of RFA depends on the location,size of liver tumor and degree of liver cirrhosis. The therapeutic effect of IRFA for hepatic cancer is much better than that of PRFA alone.