手术切除与射频消融治疗原发性肝癌患者预后比较

Postoperative complications and long-term prognosis in patients with primary liver cancer after surgical resection or radiofrequency ablation

目的比较手术切除与射频消融(RFA)治疗原发性肝癌患者预后比较。方法 2009年7月~2011年12月我院收治的原发性肝癌患者218例,其中106例实施手术切除肿瘤,另外112例实施RFA。比较两种不同方法治疗患者的预后情况。结果两组患者病灶清除率均为100%,但RFA组术中无输血患者,而4.7%手术组患者术中实施了输血(P<0.05),RFA组平均治疗时间为(30.5±7.4)min,平均住院时间为(7.3±0.9)d,均短于手术组的(146.2±30.4)min和(12.4±2.7)d(P<0.05);RFA组发生胸腔/腹腔积液比例为15.2%,血红蛋白(Hb)≤90g/L比例为15.2%,血清白蛋白(ALB)≤30g/L比例为17.0%,三种并发症比例均低于手术组(31.1%、35.8%和36.8%,均P<0.05);两组围术期出现体温>38℃患者比例和腹腔感染发生率差异无统计学意义;术后三个月经增强MRI检查两组患者病灶消失情况,显示5.4%RFA组患者存在病灶残留,手术组无病灶残留患者(P<0.05),RFA组病灶复发比例为9.8%,显著高于手术组的1.9%(P<0.05);RFA组1 a、3 a和5 a生存率分别为92.9%、39.3%和17.9%,而手术组为97.2%、56.6%和29.2%,其中3 a和5 a生存率存在组间显著差异(P<0.05);RFA组1 a、3 a和5 a复发转移率分别为39.3%、69.6%和98.2%,而手术组为29.2%、51.9%和86.8%,其中3 a和5 a复发转移率存在组间显著差异(均P<0.05)。结论 RFA治疗原发性肝癌可缩短手术时间,减少并发症发生,但容易有病灶残留,患者长期预后较手术组稍差。

Objective To explore the long-term prognosis in patients with primary liver cancer after surgical resection or radiofrequency ablation （RAF）. Methods Clinical data of 218 patients with primary liver cancer who received surgical resection or RAF between July 2009 and December 2011 were retrospectively analyzed. 106 cases among them received surgical resection,while the other 112 cases received RFA. The prognosis in the two groups was compared. Results Lesion clearance rates in the two groups were both 100.0%;No patients in RFA group needed blood transfusion,whereas 4.7% of patients in the operation group received blood transfusion （P〈0.05）;The average operation time in RFA group was shorter than that in surgical resection group [（30.5 ±7.4） min vs.（146.2 ±30.4） min,P〈0.05];The hospitalization stay in RFA group was also shorter than that in the surgical resection group [（7.3±0.9） d vs.（12.4±2.7） d,P〈0.05];40.2% of patients in RFA group, while 29.2% in surgical resection group had a body temperature higher than 38 ℃,without statistical difference （P〈0.05）;Abdominal infection occurred in 1.8% of patients in RFA group and 5.7% of patients in surgical resection group （P〈0.05）;The percentages of patients with pleural and/or peritoneal effusion,or hemoglobin （Hb） levels less than 90g/L or serum albumin （ALB） levels less than 30g/L in RFA group were 15.2%,15.2% and 17.0%,respectively,much lower than those in surgical resection group （31.1%,35.8% and 36.8%,respectively,P〈0.05 for all）;Enhanced MRI were conducted in all the patients to exam the lesion clearance,and 5.4% of patients in RFA group had tumor residue,while the full clearance was obtained in surgical resection group （P〈0.05）;The one year,three year and five year survival rates in RFA group were 92.9%,39.3% and 17.9%, respectively,which were lower than those in surgical resection group （97.2% ,56.6% and 29.2, respectively）;The one year,three year and five year recurrence and metastasis rates in RFA group were 39.3,69.6% and 98.2%,respectively,which were lower than those in surgical resection group （29.2%,51.9% and 86.8%,respectively）,with the three and five year recurrence and metastasis rates statistically significantly different between the two groups （P〈0.05 for both）. Conclusion RFA can reduce the operation time and postoperative complications,but it is discounted with the possibility of tumor residue and relatively poor long-term prognosis in treatment of patients with primary liver cancer.