非解剖性肝切除与经皮射频消融治疗单发小肝癌的疗效分析

Therapeutic effect of non-anatomical hepatectomy and percutaneous radiofrequency ablation for single small hepatocellular carcinoma

目的探讨非解剖性肝切除与经皮射频消融治疗单发小肝癌的临床疗效。方法回顾性分析昆明医科大学第二附属医院2014年1月至2016年8月收治的51例单发小肝癌病人的临床资料。根据治疗方法的不同分为对照组和研究组,对照组23例行非解剖性肝切除术,研究组28例行经皮射频消融术,并记录两组病人的术后住院时间,术后3 d肝功能变化,术后3 d凝血功能指标,术后并发症情况以及随访术后1、2、3年的无瘤生存率及总体生存率等。结果研究组与对照组比较,病人术后3 d的血清丙氨酸转氨酶(ALT)与天冬氨酸转氨酶(AST)水平更低,凝血酶原时间(PT)和活化部分凝血酶原时间(APTT)波动更小,术后住院时间更短,术后并发症发生率更低,差异均有统计学意义(均P<0.05)。两组病人术后1、2、3年无瘤生存率:对照组为86.96%、69.57%、56.52%;研究组为85.71%、71.43%、60.71%。两组病人术后1、2、3年总体生存率:对照组为100%、91.30%、78.26%;研究组为100%、85.71%、75.00%,差异均无统计学意义(均P>0.05)。结论对于单发的小肝癌,经皮射频消融可以和非解剖性肝切除达到一样的效果,它具有更小的创伤性,对病人肝功能损伤及凝血功能影响更小,能有效降低术后并发症的发生,减少病人的住院时间,其远期的无瘤生存率及总体生存率对比无明显差异,值得临床推广。

Objective To explore the clinical efficacy of non-anatomical hepatectomy and percutaneous radiofrequency ablation in the treatment of single small hepatocellular carcinoma.Methods The clinical data of 51 patients with single small liver cancer admitted to the Second Affiliated Hospital of Kunming Medical University from January 2014 to August 2016 were retrospectively analyzed.The patients were divided into control group(23 cases)treated with non-anatomical hepatectomy and experimental group(28 cases)treated with radiofrequency ablation according to different treatment methods.Postoperative hospital stay,changes of liver function at 3 d after operation,coagulation function at 3 d after operation,postoperative complications,tumor-free survival rate and overall survival rate at 1,2 and 3 years after follow-up were recorded.Results Compared with the control group,the experimental group had lower serum ALT and AST levels,PT and APTT fluctuations with shorter postoperative hospital stay,and postoperative complications were significantly lower,and the difference was statistically significant(P<0.05).The disease-free survival rate at 1,2 and 3 years after operation in the two groups was 86.96%,69.57%and 56.52%in the control group and 85.71%,71.43%and 60.71%in the experimental group.The overall survival rate at 1,2 and 3 years after operation in the two groups was 100%,91.30%and 78.26%in the control group,and 100%,85.71%and 75.00%in the experimental group,and the differences had no statistical significance(P>0.05).Conclusion For a single small hepatocellular carcinoma,radiofrequency ablation can achieve the same effect as non-anatomical hepatectomy.It is less traumatic with less impact on patients'liver function damage and coagulation function,which can effectively reduce the incidence of postoperative complications,and shorten the length of hospital stay,there is no significant difference in the long-term tumor-free survival rate and overall survival rate,which is worthy of clinical promotion.