三维重建联合超声引导下射频消融治疗肝癌的疗效分析

Efficacy analysis of radiofrequency ablation of hepatocellular carcinoma guided by ultrasound combined with preoperative three-dimensional reconstruction

目的 探讨术前三维重建联合B超引导下RFA治疗肝癌的疗效.方法 回顾性分析广州医科大学附属肿瘤医院2009年1月至2012年12月收治的96例肝癌患者的临床资料.将肿瘤单发,直径3～5 cm,接受术前CT检查三维重建联合B超引导下RFA治疗的43例患者作为射频组;选取同期收治的53例接受手术治疗的小肝癌患者作为手术组,比较两组患者的疗效.采用门诊和电话进行随访,随访时间截至2014年3月31日.计数资料比较采用x2检验或Fisher确切概率法,Kaplan-Meier法绘制生存曲线,生存率比较采用Log-rank检验.结果 射频组43例患者完全消融率达到95.3％ （41/43）.手术组53例患者中行肝楔形切除术32例、局部肿瘤剔除术17例、肝叶规则切除术4例.射频组患者严重并发症发生率为4.7％（2/43）,手术组患者严重并发症发生率为24.5％（13/53）,两组比较,差异有统计学意义（x2=2.385,P＜0.05）.截至最后随访日期,射频组失访1例,手术组失访3例.射频组患者未发现肿瘤针道种植.射频组和手术组患者l、2、3年肿瘤复发率分别为21.8％和26.4％、44.9％和36.8％、50.4％和49.4％,两组患者术后3年肿瘤复发率比较,差异无统计学意义（x2=0.000,P＞0.05）.射频组和手术组患者1、2、3年总体生存率分别为90.6％和88.5％、76.1％和73.4％、57.9％和65.3％,两组患者3年总体生存率比较,差异无统计学意义（x2=0.000,P＞0.05）.结论 对于直径3～5 cm的小肝癌,术前CT检查三维重建联合B超引导下RFA肿瘤完全消融率高,安全易行,可达到与手术切除相近的疗效.

Objective To investigate the efficacy of radiofrequency ablation （RFA） of hepatocellular carcinoma （HCC） guided by ultrasound combined with preoperative three-dimensional reconstruction.Methods The clinical data of 96 patients with HCC who were admitted to the Affiliated Tumor Hospital of Guangzhou Medical University from January 2009 to December 2012 were retrospectively analyzed.All the 96 patients were with solitary tumor,and the diameters of the tumor ranged between 3 and 5 cm.Forty-three patients received RFA of HCC guided by ultrasound combined with preoperative three-dimensional reconstruction and were in the RFA group ; 53 patients with small HCC who received surgical resection were in the resection group.The efficacy of the treatment in the 2 groups was compared.Patients were followed up by out-patient examination or phone call till March 31,2014.The count data were analyzed using the chi-square test or Fisher exact probability,the survival curve was drawn by Kaplan-Meier method,and the survival rates of the 2 groups were compared using the Log-rank test.Results The complete ablation rate of the RFA group was 95.3% （41/43）.Of the 53 patients in the resection group,32 received wedge resection,17 received local resection of the tumor and 4 received anatomical lobectomy.The incidences of severe complications in the RFA group and the resection group were 4.7% （2/43） and 24.5% （13/53）,with no significant differences between the 2 groups （x2 =2.385,P 〈 0.05）.One patient in the RFA group and 3 in the resection group missed the follow-up.Needle tract implantation was not observed in the RFA group.The 1-,2-,3-year tumor recurrence rates were 21.8%,44.9% and 50.4% in the RFA group,and 26.4%,36.8% and 49.4% in the resection group.There was no significant difference in the 3-year tumor recurrence rate between the 2 groups （x2 =0.000,P 〉 0.05）.The 1-,2-,3-year overall survival rates were 90.6%,76.1% and 57.9% in the RFA group,and 88.5%,73.4% and 65.3% in the resection group.There was no significant difference in the 3-year overall survival rate between the 2 groups （x2 =0.000,P 〉 0.05）.Conclusions For small HCC with diameter ranged between 3 and 5 cm,RFA guided by ultrasound combined with preoperative three-dimensional reconstruction could improve the success rate of complete ablation rate with less complications,and the efficacy is similar to that of surgical resection.