经皮射频消融及手术切除治疗小肝癌效果比较

Comparative study on effect of radiofrequency ablation and operation for the treatment of small hepatocellular carcinoma

目的：观察三维图像重建及超声引导下经皮射频消融与手术切除治疗小肝癌的临床疗效。方法回顾性分析山西省肿瘤医院2009年1月至2012年3月收治的94例原发性小肝癌患者的临床资料，其中接受超声引导下经皮射频消融治疗45例（射频组），手术切除治疗49例（手术组），两组患者治疗前均进行CT三维图像重建。对比两组患者的肿瘤复发率、总生存率及并发症发生率等。结果射频组患者治疗后1、2、3年的总生存率分别为95.56%（43／45）、86.67%（39／45）、60.00%（27／45），与手术组的93.88%（46／49）、79.60%（39／49）、59.20%（29／49）比较，差异均无统计学意义（均P＞0.05）。两组患者1、2、3年肿瘤复发率比较，差异均无统计学意义（均P＞0.05）。射频组患者术后疼痛发生率为13.33%（6／45），手术组为100.00%（49／49），差异有统计学意义（χ2＝60.416， P＜0.05）。两组其余并发症发生率差异亦有统计学意义（P＜0.05）。截至2015年3月，射频组患者未发现针道种植转移。结论对直径小于3 cm的原发性小肝癌，在CT三维图像重建及超声引导下行射频消融治疗具有疗效好、创伤小、并发症少、费用低、可多次重复的优势，总体疗效与手术切除相近，可作为小肝癌的首选治疗手段。

Objective To comparison between radiofrequency ablation introduced by tri-dimension reconstruction and ultrasound and operation for the treatment of small hepatocellular carcinoma. Methods 94 patients with small hepatocellular carcinoma from Jan 2009 to Mar 25 in Shanxi Cancer Hospital were analyzed. 45 patients were both given CT examination to rebuild tri-dimension and radiofrequency ablation treatment. 49 patients were given excision. Both groups were given CT examination to rebuild tri-dimension before the treatment. The differences in recurrence rate, overall survival and complication ratio between the two groups were compared. Results After 1, 2 and 3 years radiofrequency ablation treatment, the survival rate in radiofrequency ablation group were 95.56 % （43/45）, 86.67 % （39/45）, 60.00 % （27/45） respectively, comparing with 93.88%（46/49）, 79.60%（39/49）, 59.20%（29/49） in operation group. The difference was not statistically significant （P〉0.05）. There was no statistical significance in 1-year, 2-year and 3-year recurrence rates between the two groups （P〉 0.05）. There were statistical significances in incidence of post-treatment pains [13.33%（6/45） vs 100.00%（49/49）,χ2=60.416, P〈0.05] and complication （P〈0.05） between the two groups. By Mar 25th, 2015, there was no needle tract implantation in the patients with radiofrequency ablation treatment. Conclusions For the small hepatocellular carcinoma with less than 3cm in diameter, introduced by CT tri-dimension image reconstruction and ultrasound, the radiofrequency ablation treatment excels in effect with fewer damages, infective complications, lower cost and can be applied many times. The overall effect is close to surgical removal, and therefore it can be used as the first line therapy for small hepatocellular carcinoma.