射频消融术和手术治疗原发性肝癌对照分析

Clinical Analysis of the Radiofrequency Ablation for Primary Hepatic Carcinoma

目的：研究射频消融术治疗原发性肝细胞癌的临床疗效及并发症发生情况。方法：通过回顾性分析贵州省人民医院肝胆外科在2008年3月至2013年3月间61例病理明确诊断为原发性肝细胞癌并行射频消融术患者的临床资料,统计患者术后1年、2年和3年生存率,观察患者术后疼痛、发热、腹腔出血、感染和胸腔积液等术后并发症的发生情况。与同期55例行手术切除的原发性肝癌病例进行对照研究,分析二组患者术后生存时间,术后1年、2年和3年生存率的差异,比较二组患者术后并发症的发生情况。结果：术后生存率情况,射频消融组术后1年、2年和3年生存率分别为77.1%、62.3%和45.9%。各亚组之间,在肿瘤大小〈3cm组,1年、2年和3年生存率分别为94.7%、84.2%和68.4%。在肿瘤大小3～5cm组,1年、2年和3年生存率分别为87.0%、65.2%和52.2%。在肿瘤大小5～10cm组,1年、2年和3年生存率分别为61.5%、53.8%和23.1%。在肿瘤大小〉10cm组,1年、2年和3年生存率分别为16.7%、0.0%和0.0%,生存曲线经Log-Rank检验发现,肿瘤大小〈3cm组和3～5cm组术后生存时间总体均明显长于5～10cm组,差异具有统计学意义（P〈0.05）。术后并发症情况,61例患者中,29例术后需止痛处理,33例术后出现发热,1例出现腹腔内出血,1例出现肺部感染,1例出现胸腔积液。与肝切除术患者比较,随访结果进行单因素的预后分析,射频消融组与手术切除组术后生存率相近,生存曲线经Log-Rank检验发现,差异没有统计学意义（P〉0.05）。进一步在各亚组之间分析表明,肿瘤大小〈3cm、3～5cm和肿瘤大小〉10cm组,射频消融和手术切除术后生存时间没有明显的差别,差异没有统计学意义（P〉0.05）,在肿瘤大小5～10cm组,手术切除组术后生存时间总体明显长于射频消融组,生存曲线经Log-Rank检验发现,差异具有统计学意义（χ2=8.341,P=0.03）。术后并发症情况,疼痛：手术切除组术后疼痛有52例患者需止痛等对症处理,与射频消融组比较差异有统计学意义（P〈0.01）。发热：手术切除组术后发热26例,二组之间没有明显差别（P〉0.05）。腹腔出血：手术切除组有24例术后出现腹腔出血,二组之间有明显差别（P〈0.01）。感染：手术切除组切口感染4例,肺部感染17例,二组之间比较差异有统计学意义（P〈0.01）。胸腔积液：手术切除组出现胸腔积液15例,二组之间比较差异有统计学意义（P〈0.01）。结论：肿瘤大小〈5cm,射频消融术疗效明显优于肿瘤〉5cm;射频消融治疗〈5cm的肿瘤可达到手术切除的根治性治疗,二者预后没有明显差别;肿瘤大小在5～10 cm,手术切除预后优于射频消融治疗;肿瘤大小〉10cm,两种治疗预后都不佳。与手术切除相比,肝癌射频消融术具有对患者创伤小、并发症少、风险小的优点,在肝癌治疗中有重要的应用价值。

Purpose： To study the clinical effect and complications of radiofrequency ablation （RFA） for primary hepatic carcinoma. Methods： The clinical data of 61 cases of primary hepatocellular carcinoma （HCC） treated by radiofrequency ablation between March 2008 and March 2013 in Department of hepatobiliary surgery of Guizhou People＇s Hospital were retrospectively analyzed. All cases were diagnosed with pathological results. The survival rate of 1 years, 2 years and 3 years after operation was calculated. Postoperative complications such as pain, fever, abdominal bleeding, infection and pleural effusion were observed. These data were compared with 55 cases of HCC treated by hepatic resection （RES） in the same period. Results： The 1 years, 2 years and 3 years survival rates were 77.1%, 62.3%, and 45.9 % in the RFA group. In the tumor size 〈3cm group, the 1 years, 2 years and 3 years survival rates were 94.7 %, 84.2%, and 68.4 %. In the tumor size 3-5cm group, the 1 years, 2 years and 3 years survival rates were 87.0 %, 65.2%, and 52.2%. In the tumor size 5-10cm group, the 1 years, 2 years and 3 years survival rates were 61.5 %, 53.8%, and 23.1%. In the tumor size 〉10cm group, the 1 years, 2 years and 3 years survival rates were 16.7 %, 0.0%, and 0.0 %. The Log-Rank test of the survival curves showed that in the tumor size 〈3cm group, the survival time was significantly longer than that in the tumor size 3-5cm group （P〈0.05）. For the postoperative complications, 29 cases of RAF group need pain relieving treatment after operation, 33 cases were with postoperative fever, 1 case occurred abdominal bleeding, 1 case occurred pulmonary infection, and 1 case occurred pleural effusion. Compared with cases of HCC treated by hepatic resection （RES）, the survival rate of the radiofrequency ablation group was similar to that of the surgical resection group, and the survival curve was with no statistical significant difference by Log-Rank test （P〉0.05）. The Log-Rank test of survival curves showed that in the tumor size 〈3cm group, 3-5cm group and 〉10cm group, there was no significant difference in survival time between RAF group and RES group （P〉0.05）. In the tumor size 5-10cm group, the survival time of the RES group was significantly longer than that of the RAF group0（2=8.341,P=0.03）. For the postoperative complications, 52 cases of RAF group need pain relieving treatment after operation, 26 cases occurred postoperative fever, 24 cases occurred abdominal bleeding, 17 cases occurred pulmonary infection, 4 cases occurred incision infection, and 15 case occurred pleural effusion, the difference between the two groups was with statistical significant （P〈0.05）. Conclusion： For tumor size 〈5cm group, the efficacy of radiofrequency ablation is better than that tumor size 〉5cm group. Radiofrequency ablation for treatment of hepatocellular carcinoma with size 〈5cm can achieve radical treatment as surgical resection. There is no obvious difference between the radiofrequency ablation and surgical resection for treatment of tumor with size 3-5cm. For tumor with size 5-10cm, surgical resection is better than radiofrequency ablation. For tumor with size 〉10cm, the prognosis of these two treatments was not good. Compared with surgical resection, radiofrequency ablation for primary hepatic carcinoma has the advantages of less damage, less complications and less risk, radiofrequency ablation has important application value in the treatment of liver cancer.