术后复发性小肝癌微波消融与再次手术切除的疗效比较

Efficacy of microwave ablation versus remedial hepatectomy for postoperative recurrent small hepatocellular carcinoma

目的比较经腹微波消融与再手术切除治疗复发性小肝癌（单个癌结节最大直径不超过3cm；多个癌结节数目不超过2个，其最大直径总和〈3cm）的疗效。方法回顾性分析2007年1月至2010年12月收治的75例复发性小肝癌患者的临床资料，其中34例患者行经腹微波消融（微波组），41例行肿瘤再手术切除（手术切除组）。比较两组患者手术情况、AFP值变化、并发症发生率、住院时间及总生存率和无瘤生存率。结果两组肿瘤均完全清除；AFP均于3个月内恢复正常。微波组平均手术时间短于手术组[（91±33）min比（156±51）min，t=-6．3995，P=0．000]；微波组术中出血量少于手术组[（87±62）ml比（254±134）ml，t=-6．6915，P=0．000]；微波组平均住院时间短于手术组[（7．5±2．2）d比（11．3±2．7）d，t=-6．5888，P=0．000]。微波组和手术切除组并发症发生率分别为2．9％（1／34）和22．0％（9／41），差异有统计学意义（χ^2=5．8127，P=0．016）。微波组和手术切除组1、3和5年总生存率分别为88．1％、68．8％、46．1％和86．1％、71．5％、50．2％（χ^2=0．16，P=0．692）：1、3和5年无瘤生存率分别67．1％、38．2％、16．1％和64．4％、45．5％、23．6％（χ^2=0．03，P=0．870）。结论微波消融治疗复发性小肝癌与再次手术治疗具有相同的生存率，且创伤小。

Objective To compare the efficacy of open microwave ablation and repeat hepatectomy for recurrent small hepatocellular carcinoma. Methods The clinical data of 75 patients with recurrent small HCC who were admitted to our hospital from January 2007 to December 2010 were retrospectively analyzed. 34 received microwave ablation （MWA group） and 41 received repeat hepatectomy （hepatectomy group ）. The perioperative condition, liver function recovery, the variation of AFP level, mobidities, hospitalization time and overall survival rate and disease-free survival rate were compared. Results The rate of complete elimination to tumor tissue was 100% and the AFP levels returned to normal within 3 months in both groups. The mean average operation time in MWA group was shorter than that in hepatectomy group [ （91 ±33） rain vs （156 ±51 ） min,t = -6. 399 5 ,P =0. 000]. The blood loss in MWA group was smaller than that in hepatectomy group [ （ 87 ± 62 ） ml vs （ 254 ± 134） ml, t = - 6. 691 5, P = 0. 000 ]. Patients in PFRA group had a shorter hospital stay [ （7.5 ±2. 2） d vs （11.3 ±2. 7） d, t = - 6. 588 8,P =0.000]. The mobidities of the MWA group and hepateetomy group were 2. 9% （1/34） and 22.0% （9/41）, respectively （χ^2 =5. 812 7,P=0. 016）. The overall survive rate of 1, 3 and 5-year were 88.1% , 68. 8% and 46. 1% in the MWA group, and 86. 1%, 71.5% and 50. 2% in the hepatectomy group （χ^2=0. 16,P =0. 692）. The disease free survival rate of 1, 3 and 5-year were 67. 1%, 38. 2% and 16. 1% in the MWA group, and 64.4%, 45.5% and 23.6% in the hepatectomy group （χ^2 = 0.03, P = 0.870）. Conclusions MWA can achieve survival benefits equivalent to hepatectomy for recurrent small HCC, and it is less traumatic.