超声引导下经皮射频消融术治疗原发性肝细胞小肝癌的临床研究

Therapeutic effect of ultrasound-guided percutaneous radiofrequency ablation on small primary hepatocellular carcinoma

目的探讨超声引导下经皮射频消融术治疗原发性肝细胞小肝癌的临床效果。方法选取2015年3月至2016年4月河北省承德市第三医院收治的100例经病理组织检查证实为原发性肝细胞小肝癌(直径≤3 cm)患者作为研究对象,按照随机数字表法分为对照组与观察组,各50例。对照组行手术切除治疗,观察组采用超声引导下经皮射频消融术治疗。记录2组患者平均手术时间、术中出血量及住院时间,分别于术前和术后第2、5天检测2组患者丙氨酸转氨酶(ALT)及天冬氨酸转氨酶(AST)水平。记录2组术后并发症,比较2组患者术后第1、2、3年复发率和生存率。结果观察组患者平均手术时间明显短于对照组[(23±6) min比(119±23) min],术中出血量明显少于对照组[(1. 02±0. 12) ml比(312. 96±125. 88) ml],住院时间明显短于对照组[(6. 5±2. 4) d比(12. 6±4. 2) d],差异均有统计学意义(均P <0. 001)。2组患者术后第2、5天ALT、AST水平均明显高于术前,术后第5天ALT、AST水平明显低于术后第2天,而观察组术后第2、5天ALT、AST水平均明显低于对照组,差异均有统计学意义(均P <0. 05)。观察组术后并发症发生率明显低于对照组[16. 0%(8/50)比38. 0%(19/50)],差异有统计学意义(P=0. 013)。2组患者术后第1、2、3年复发率和生存率比较,差异均无统计学意义(均P> 0. 05)。结论超声引导下经皮射频消融术治疗原发性肝细胞小肝癌(直径≤3 cm)效果显著,可减轻对患者的创伤,减少术后并发症,加速肝功能的恢复,缩短住院时间。

Objective To investigate the clinical effect of ultrasound-guided percutaneous radiofrequency ablation on small primary hepatocellular carcinoma. Methods From March 2015 to April 2016,100 patients with small primary hepatocellular carcinoma( diameter ≤ 3 cm) confirmed by pathological examination in the Third Hospital of Chengde City,Hebei Province were enrolled. They were randomly divided into control group and observation group,with 50 cases in each group. The control group underwent surgical resection. The observation group underwent ultrasound-guided percutaneous radiofrequency ablation. Operation time,intraoperative bleeding volume and hospitalization time were recorded. Levels of serum alanine aminotransferase( ALT) and aspartate aminotransferase( AST) were detected before operation and 2,5 days after operation. Postoperative complications,recurrence rate and survival rate at 1,2,3 years after operation were observed. Results Operation time in the observation group was significantly shorter,amount of blood loss was significantly less and hospitalization time was significantly shorter than those in the control group [( 23 ± 6) min vs( 119 ± 23) min,( 1. 02 ± 0. 12) ml vs( 312. 96 ± 125. 88) ml,( 6. 5 ± 2. 4) d vs( 12. 6 ± 4. 2) d]( all P < 0. 001). Levels of ALT and AST significantly increased at 2 and 5 days after operation and reached the peak at 2 days;the levels in the observation group were significantly lower than those in the control group( all P < 0. 05). Incidence of postoperative complications in the observation group was significantly lower than that in the control group[16. 0%( 8/50) vs 38. 0%( 19/50) ]( P =0. 013). There were no significant differences in the 1-,2-,3-year recurrence rates and survival rates between groups( all P > 0. 05). Conclusion Ultrasound-guided percutaneous radiofrequency ablation is effective in treating small primary hepatocellular carcinoma( diameter≤3 cm);it can reduce surgical trauma and postoperative complications,promote liver function recovery and shorten the length of hospital stay.