超声引导下射频消融与大功率微波消融治疗中晚期肝癌的疗效对比研究

Comparative study of radiofrequency ablation under ultrasound guidance and high power microwave ablation in the treatment of intermediated or advanced-staged liver cancer

目的:比较超声引导下经皮射频消融(RFA)与大功率微波消融(MWA)在治疗中晚期原发性肝癌中的临床疗效。方法:选择符合入组标准的60例原发性肝癌确诊患者,采用数表法将其随机分为射频治疗组(RFA组)和微波治疗组(MWA组),每组30例。比较两组患者术后病灶完全缓解率、1年生存率、1年无进展生存率及术后不良反应、并发症情况。结果:RAF组和MWA组术后总完全缓解率分别为66.7%和76.7%,两组比较差异有统计学意义(x^2=3.776,P<0.05);当病灶≥5 cm时RFA组和MWA组的完全缓解率分别为41.7%和63.6%,两组比较差异有统计学意义(x^2=4.231,P<0.05);当病灶在3~5 cm时RFA组和MWA组完全缓解率分别为75.0%和81.2%,两组比较差异无统计学意义(x^2=0.976,P>0.05)。RAF组术后并发症3例,MWA组术后并发症5例,两组比较差异有统计学意义(x^2=3.373,P<0.05);两组术后均未出现与治疗相关的死亡病例。RAF组1年总生存率和无进展生存率分别为90.0%和53.3%,MWA组分别为86.7%和60.0%,两组比较差异无统计学意义(x^2=0.877,P>0.05)。结论:对于较大病灶或多发病灶的中晚期原发性肝癌,大功率MWA治疗后的病灶完全缓解率优于RAF,但两者1年内总生存率和无进展生存率无明显差异,且大功率MWA组的术后不良反应发生率高于RAF组。

Objective： To compare the clinical efficacy of percutaneous radiofrequency ablation （RFA） under ultrasound guidance and high power microwave ablation （MWA） in the treatment of intermediated or advanced-staged primary liver cancer. Methods： 60 patients with primary liver cancer who were in accordance with the inclusion criteria were divided into radiofrequency ablation group （RFA group, 30 cases） and microwave ablation group （MWA group, 30 cases）. A series indicators, such as postoperative complete remission rate of lesion, 1 year survival rate, 1 year progression-free survival rate, postoperative adverse reaction and postoperative complication, for these patients of two groups were compared and analyzed. Results： The total complete remission rate of the RAF group and the MWA group were 66.7% and 76.7%, respectively, and the difference between them was significant （x^2=3.776, P〈0.05）. When the lesion was larger than 5 cm, the complete remission rate of RFA group and MWA group were 41.7% and 63.6%, respectively, and the difference between them was significant （x^2=4.231, P〈0.05）. When the lesion was between in 3-5 cm, the complete remission rate of RFA group and MWA group were 75.0% and 81.2%, respectively, while the difference between them was no significant （x^2=0.976, P〉0.05）. For postoperative complication, there were 3 cases in RAF group while there were 5 cases in MWA group, and the difference between them was significant （x^2=3.373, P〈0.05）. There was no death case that was related with treatment in the two postoperative groups. The 1 year survival rate and 1 year progression-free survival rate of RAF group were 90.0% and 53.3%, respectively, and that of MWA group were 86.7% and 60.0%, and the difference between them was no significant （x^2=0.877, P〉0.05）. Conclusion： For intermediated or advanced-staged primary liver cancer with the larger or multiple lesions, complete remission rate of high-power MWA group is better than that of RAF. But there was no significant difference for 1 year total survival rate and 1 year progression-free survival rate between the two groups, respectively. And the postoperative adverse reaction of high-power MWA group was higher than that of RAF group.