射频消融治疗复发性小肝癌的临床研究

Radiofrequency ablation in treatment of recurrent small liver cancer

目的:观察射频消融(RFA)治疗肝癌切除术后复发小肝癌的安全性和有效性。方法:回顾性分析2014年1月至2015年5月我院65例原发性肝癌切除术后复发小肝癌的患者的临床资料。其中对照组(30例)行再次手术切除复发的肝癌;观察组(35例)采用超声引导下经皮射频消融和腹腔镜辅助下射频消融对复发的肝癌进行原位消融毁损。结果:(1)观察组治疗对肝功的损害明显小于对照组;(2)对照组肝癌完全切除率为88.37%(38/43)、观察组肝癌的完全消融毁损率为89.58%(43/48);2组术中均无副损伤发生;观察组的术中出血量、术后漏胆发生率、术后住院时间均明显低于对照组(P<0.05);(3)2组的血清甲胎蛋白(AFP)与血管内皮生长因子(VEGF)浓度在术后第2周与术前1 d比较均明显降低(P<0.05),在术后第6个月、第12个月、第18个月行组间比较均无显著性差异(P>0.05);(4)观察组术后1个月复查CT,其所有癌灶的完全凝固性坏死率为85.41%;癌灶越大,完全性凝固性坏死率越低;(5)观察组的肝癌再次复发率在RFA术后第6个月、第12个月、第18个月与对照组比较均无显著性差异(P>0.05)。结论:射频消融治疗肝癌切除术后复发的小肝癌是微创、安全和有效的。

Objective： To evaluate the safety and efficacy of radiofrequency ablation in the treatment of recurrent small livercancer after the resection of liver cancer. Methods： The clinical data of 65 patients with recurrent small liver canof primary liver cancer from January 2014 to May 2015 in our hospital were retrospectively analyzedunderwent reoperation for resecting recurrent liver cancer. The observation group （ 35 cases） underwent ultrasound-guidedpercutaneous radiofrequency ablation and laparoscopic radiofrequency ablation for destroying recurrent liver cancer in situ. Results ： （1） The liver damage in the treatment group was significantly less than that in the control group. （ 2 ） The complete resection rate of liver cancer was 88. 37% （ 38/43 ） in the control group,and the complete ablation rate of liver cancer was 89. 58% （43/48 ） in the observation group; both groups had no subsidiary injury; the amount of bleeding, the incidence of bile leakage, postoperativehospitalization time were significantly lower or shorter in the observation group than those in both groups,serum AFP and VEGF concentrations two weeks after operation decreased significantly compared with those one daybefore operation （ P 〈 0. 05 ） ; however,they had no significant differences between the two groups on month after operation（ P 〉0. 05）. （4 ） The observation group received the reexamination of CT one showed that complete coagulation necrosis rate of all cancer foci was 85.41% ; the bigger the cancer was, the lower completecoagulation necrosis rate was; （5 ） On the sixth,twelfth,eighteenth month after operation,the recurrence rate no significant differencc between the observation group and the control group（P〉 0. 05 ）. Conclusion： Radiofrequency ablation inthe treatment of small liver caner after resection of liver cancer is minimally invasive,safe and effeective.