结直肠癌肝转移射频消融与手术切除疗效比较

Comparison of clinical efficacy between radiofrequency ablation and surgical resection for colorectal cancer liver metastasis

目的比较射频消融(RFA)与手术切除治疗结直肠癌肝转移的临床疗效。方法回顾性分析2010年1月至2013年12月中山大学附属第三医院收治的40例结直肠癌肝转移患者临床资料。根据治疗方法不同将患者分为RFA组与手术切除组。其中RFA组21例,男13例,女8例;平均年龄(58±10)岁。手术切除组19例,男10例,女9例;平均年龄(59±8)岁。患者均签署知情同意书,符合医学伦理学规定。两组患者肝转移灶直径≤5 cm,数目≤3个,且同期行结直肠癌根治术。观察两组患者的术后并发症发生、肿瘤复发和生存情况。率的比较采用χ~2检验或Fisher确切概率法。结果 RFA组术后腹痛3例,发热7例,腹腔出血1例;手术切除组术后胆漏2例,膈下脓肿1例,切口感染2例,腹腔出血1例,均经相应保守处理后痊愈出院。RFA组3年局部复发率为14%(3/21),手术切除组为5%(1/19),差异无统计学意义(P>0.05)。RFA组1、3年生存率分别为90%(19/21)、71%(15/21),手术切除组相应为89%(17/19)、74%(14/19),差异无统计学意义(χ~2=0.000,0.025;P>0.05)。结论对于直径≤5 cm、数目≤3个的结直肠癌肝转移灶患者RFA治疗是可行的,与手术切除相比疗效相当,但具有微创优势。

Objective To compare the clinical efficacy between radiofrequency ablation （RFA） and surgical resection for colorectal cancer liver metastasis （CLM）. Methods Clinical data of 40 patients with CLM who were admitted to the Third Affiliated Hospital of Sun Yat-sen University between January 2010 and December 2013 were retrospectively analyzed. According to the treatment methods, the patients were divided into the RFA group （n=21） and surgical resection group （n=19）. In the RFA group, 13 cases were males and 8 females, aged （58±10） years old on average. In the surgical resection group, 10 cases were males and 9 females, aged （59±8） years old on average. The informed consents of all patients were obtained and the local ethical committee approval was received. The diameter and number of the liver metastases in two group was respectively ≤ 5 cm and ≤ 3, and the patients underwent radical resection of colorectal cancer in the same period. The incidence of postoperative complications, tumor recurrence and survival were observed in two groups. The rate was compared using Chi-square test or Fisher＇s exact probability test. Results In the RFA group, postoperative abdominal pain was observed in 3 cases, fever in 7 and abdominal hemorrhage in 1. In the surgical resection group, postoperative bile leakage was observed in 2 cases, subphrenic abscess in 1, wound infection in 2 and abdominal hemorrhage in 1. All patients recovered and discharged after conservative therapy. The 3-year local recurrence rate was 14% （3/21） in the RFA group and 5% （1/19） in the surgical resection group, and no significant difference was observed （P〉0.05）. The 1-, 3-year survival rate was respectively 90% （19/21） and 71% （15/21） in the RFA group, 89% （17/19） and 74% （14/19） in the surgical resection group, and no significant differences were observed （X^2=0.000, 0.025;/9〉0.05）. Conclusions RFA is a feasible treatment for the CLM patients with the diameter of liver metastases ≤ 5 cm and the number ≤ 3. Compared with surgical resection, RFA has the same clinical efficacy and the advantage of minimal invasion.