腹腔镜下射频消融术对原发性肝癌的远期生存及安全性评价

Evaluation of the Long-term Survival and Safety of Laparoscopic Radiofrequency Ablation for Primary Hepatic Carcinoma

目的探讨腹腔镜下射频消融术(LRFA)对原发性肝癌的远期生存的影响及安全性。方法将2008年3月至2010年3月汉中市中心医院收治的70例原发性肝癌患者按照随机数字表法分为B型超声引导下经皮射频消融术(PRFA)组(35例)和LRFA组(35例)。PRFA组采用PRFA,LRFA组行LRFA。术后患者随访5年,比较两组患者治疗情况、并发症发生率及远期生存率,并比较两组患者手术前、后外周血T淋巴细胞亚群水平。结果两组患者完全消融率、甲胎蛋白下降率比较差异无统计学意义(P>0.05),PRFA组复发率显著高于LRFA组[40.0%(14/35)比17.1%(6/35),P<0.05];PRFA组严重并发症发生率显著高于LRFA组[11.4%(4/35)比0,P=0.039]。两组患者手术后CD+3、CD+4、CD+4/CD+8较治疗前显著升高[PRFA组:(71±7)%比(65±7)%,(35±6)%比(29±5)%,(1.4±0.6)比(1.1±0.3);LRFA组:(70±8)%比(64±8)%,(34±7)%比(29±6)%,(1.5±0.6)比(1.1±0.5)],CD+8较治疗前显著降低[PRFA组:(26±4)%比(33±5)%;LRFA组:(26±6)%比(34±7)%],差异有统计学意义(P<0.05);手术后,两组间各T淋巴细胞水平相比差异无统计学意义(P>0.05)。PRFA组中位生存期为23个月,LRFA组为25个月,两组中位生存期比较差异无统计学意义(P>0.05)。结论 PRFA与LRFA对原发性肝癌疗效相当,然而LRFA复发率和严重并发症发生率较低,安全性更高。

Objective To explore the long-term survival and safety of laparoscopic radiofrequency ablation for primary hepatic carcinoma. Methods A total of 70 cases of primary hepatic carcinoma patients treated in Hanzhong Central Hospital from Mar. 2010 to Mar. 2008 were randomly divided into percutaneous radio frequency ablation（ PRFA） group of 35 cases and laparoscopic radiofrequency ablation（ LRFA） group of 35 cases. PRFA group was treated with percutaneous radio frequency ablation,while LRFA group underwent laparoscopic radiofrequency ablation. The patients were followed up for 5 years to compare the therapeutic effect,complication incidence and long-term survival rate of the two groups,and the T lymphocyte subsets levels of the two group before and after treatment were compared too. Results The total ablation rate and AFP decrease rate of the two groups had no significantly difference（ P〉0. 05）,the recurrence rate in the PRFA group was significantly higher than the LRFA group[40. 0%（ 14 /35） vs 17. 1%（ 6 /35）,P〈0. 05],the incidence of severe complications in the PRFA group was significantly higher than the LRFA group[11. 4%（ 4 /35） vs 0,P = 0. 039]. After treatment CD＋3,CD＋4,CD＋4/ CD＋8of both groups were significantly increased than before treatment[PRFA group：（ 71 ± 7） % vs（ 65 ± 7） %,（ 35 ± 6） % vs（ 29 ± 5） %,（ 1. 4 ± 0. 6） vs（ 1. 1 ± 0. 3）; LRFA group：（ 70 ± 8） % vs（ 64 ± 8） %,（ 34 ± 7） % vs（ 29 ± 6） %,（ 1. 5 ± 0. 6） vs（ 1. 1 ± 0. 5） ],CD＋8level was significantly decreased from before treatment[PRFA group：（ 26 ± 4） % vs（ 33 ± 5） %; LRFA group：（ 26 ± 6） % vs（ 34 ± 7） % ]（ P〈0. 05）; the T lymphocyte level of the two groups after treatment had no statistically significant difference（ P〉0. 05）. The median survival of PRFA group was 23 months,of the LRFA group was 25 months,which had no statistically significant difference（ P〉0. 05）. Conclusion The PRFA and LRFA have similar therapeutic effect in treatment primary hepatic carcinoma,however,LRFA has lower recurrence and serious complications incidence and higher safety.