规范性个体化射频消融术在原发性肝癌外科治疗中的作用

Role of standard and individualized procedures to radiofrequency ablation of primary liver cancer: a retrospective analysis of 562 cases

目的探讨规范性个体化的射频消融术在原发性肝癌外科治疗中的作用。方法对2004年6月至2012年6月间562例行射频消融术的原发性肝癌病例进行回顾性分析,并与同期行肝部分切除术的574例病例进行对照研究。观察术后恢复、手术并发症、术后肿瘤残余复发、术后总体生存率和术后无瘤生存率等。结果两组均无手术死亡病例,术后均恢复出院。术后平均住院日和平均住院费用射频消融组显著低于手术切除组(P<0.001,P=0.041),术后射频消融组无严重并发症,肝功能损害主要为轻中度,损害程度显著低于手术切除组(P<0.001)。术后1个月手术切除组无肿瘤残留,射频消融组23例共41个瘤灶发现肿瘤残留。两组术后1、3、5年总体生存率无差异,手术切除组术后1、3、5年无瘤生存率显著高于射频消融组(P=0.024)。结论射频消融能够完全毁损肿瘤实质,且术后恢复快,并发症少,治疗得当可达到与手术切除相近的治疗效果,但其术后无瘤生存率低于手术切除,因此规范性个体化的手术方案设计是提高射频消融治疗原发性肝癌近远期疗效的关键因素。

Objective To evaluate the effects of standard and individualized procedures to radiofrequency ablation （RFA） of primary liver cancer. Methods From June 2004 to June 2012, 562 patients with primary liver cancer treated with RFA were retrospectively analyzed. At the same time the clinic data of 574 cases about the partial hepatectomy were taken as control group. Postoperative recovery, surgical complications, tumor residual or recurrence, postoperative overall survival and postoperative tumor-free survival were observed. Results Two groups were no dead cases. RFA group was significantly lower than the surgical resection group in the mean postoperative hospital stay and the average cost of hospitalization （P〈0.001;P=0.041）. There were no serious complications in RFA group, and its liver dysfunction was mainly mild or moderate degree. Furthermore RFA group was signiifcantly lower in the level of liver function damages than surgical resection group （P〈0.001）. There were no residual tumor cases in surgical resection group after 1 month of operation, as well as 23 patients （41 tumors） was found residual tumors in RFA group. Two groups had no difference in postoperative 1-, 3-, and 5-year overall survival rate, and the surgical resection group was signiifcantly higher than the RFA group in postoperative 1, 3, and 5 year tumor-free survival rate （P=0.024）. Conclusions Not can only RFA completely destroy the tumor but it has also rapid postoperative recovery and fewer complications. RFA would have the similar effects with surgical resection if the treatment＆nbsp;is appropriate, but it has lower tumor-free survival rate than surgical resection. Therefore standard and individualized program is the key factor to improve RFA long-term efifcacy in treating primary liver cancer.