经皮微波消融和二次手术治疗晚期复发型小肝癌的长期疗效观察

Long-term outcomes of percutaneous microwave ablation versus repeat hepatectomy for treatment of late recurrent small hepatocellular carcinoma： a retrospective study

目的 研究经皮微波消融和二次手术治疗手术后＞12个月复发（晚期复发）且直径≤5.0 cm肝癌的临床疗效.方法 回顾分析1998年4月至2010年12月华中科技大学同济医学院附属同济医院原发性肝癌首次手术患者,术后肝内晚期复发选择经皮微波消融或二次手术治疗,共66例,其中微波治疗组39例,二次手术组27例.分析微波消融后消融率、两组患者的生存时间与无瘤生存时间.结果 微波消融组完全消融率达94.9％;微波消融组和二次手术组1、3、5年总体生存率分别为86.2％、73.3％、62.2％和96.2％、76.9％、61.2％;1、3、5年无瘤总体生存率分别为65.8％、28.0％、14.0％和66.7％、50.7％、43.4％,两组差异均无统计学意义（P =0.471、P=0.323）.结论 经皮微波消融对晚期复发型小肝癌消融效果好,且与二次手术治疗有着相似的生存预后及无瘤生存预后.

Objective To compare the effectiveness of percutaneous microwave ablation with those of repeat hepatectomy in the treatment of late recurrent small hepatocellular carcinoma measuring ≤ 5 cm （interval of recurrence from initial hepatectomy was ＞ 12 months）.Methods 66 patients who underwent initial hepatectomy for primary liver cancer in April 1998 to December 2010,and subsequent initial recurrent hepatocellular carcinoma treated with percutaneous microwave ablation or repeat hepatectomy,were enrolled in the study.Among these patients 39 were treated with percutaneous microwave ablation and 27 were treated with repeat hepatectomy.Technique effectiveness was evaluated by means of contrast enhanced techniques one month after ablation.The overall survival and disease-free survival were evaluated by using the KaplanMeier method.Results The technique effectiveness rate determined one month after ablation was 94.9％.The 1,3,and 5 year overall survival rates were 86.2％,73.3％,and 62.2％,respectively,for the microwave ablation group and 96.2％,76.9％,and 61.2％,respectively,for the repeat hepatectomy group （P =0.471）.The corresponding recurrence-free survival rates were 65.8％,28.0％,and 14.0％,respectively,for the microwave ablation group and 66.7％,50.7％,and 43.4％,respectively,for the repeat hepatectomy group （P =0.323）.Conclusions In patients with late recurrent small hepatocellular carcinoma,Percutaneous microwave ablation was efficient,and showed similar long-term survival and recurrence-free survival compared with repeat hepatectomy.