超声引导下经皮射频消融与手术切除治疗尾状叶肝细胞癌的疗效比较

Comparison of ultrasound-guided percutaneous radiofrequency ablation and surgical resection in the treatment of hepatocellular carcinoma of caudate lobe

目的比较超声引导下经皮射频消融与手术切除两种方式对尾状叶肝细胞癌的治疗效果。方法纳入2005年1月至2015年1月入院接受治疗的尾状叶肝细胞癌患者34例,其中接受超声引导下经皮射频消融患者(消融组)12例,男性10例,女性2例,年龄(56.7±6.8)岁;接受手术切除患者(手术组)22例,男性15例,女性7例,年龄(57.9±10.2)岁。计量资料以(±s)表示,t检验作分析;计数资料以绝对值表示,卡方检验作分析。Kaplan-Meier法作生存分析,比较时如生存曲线无交叉采用Log Rank检验,生存曲线存在交叉采用Breslow检验。结果消融组患者手术时间为(50.6±15.4)min,术中出血量为(22.8±9.6)mL;手术组患者手术时间为(178.4±35.2)min,术中出血量为(402.8±98.4)mL;两组患者手术时间、术中出血量均存在显著差异(P<0.05)。消融组患者术后第1、2、3年肿瘤复发率分别是8.3%(1例)、25.0%(3例)及41.7%(5例),术后第1、2、3年总体生存率是91.6%(11/12)、83.3%(10/12)及66.7%(8/12);手术组患者术后第1、2、3年肿瘤复发率分别是9.1%(2例)、27.3%(6例)及40.9%(9例),术后第1、2、3年总体生存率是90.9%(20/22)、77.3%(17/22)及68.2%(15/22);两组患者第1、2、3年肿瘤复发率及总体生存率均无明显统计学差异(P>0.05)。消融组并发症发生率为16.7%(2/12),手术组并发症发生率为31.8%(7/22),差异具有统计学意义(P<0.05)。结论超声引导下经皮射频消融治疗尾状叶肝细胞癌总体疗效与手术切除相近,同时能够减少患者创伤、降低围手术期并发症的发生。

Objective Comparison of ultrasound-guided percutaneous radiofrequency ablation and surgical resection in the treatment of hepatocellular carcinoma of caudate lobe.Methods Thirty-four patients with caudate lobe hepatocellular carcinoma admitted to hospital from January 2005 to January 2015 were included,including 12 patients who underwent ultrasound-guided percutaneous radiofrequency ablation(ablation group),including 10 males and 2 females.The age was(56.7±6.8)years old;There were 22 patients who underwent surgical resection(operation group),including 15 males and 7 females,aged(57.9±10.2)years.The measurement data are expressed as(x±s),the t-test is analyzed,the counting data is expressed as absolute value,and the chi-square test is used for analysis.Kaplan-Meier method was used for survival analysis.Log Rank test was used to compare the survival curve,and Breslow test was used to test the cross of survival curve.Results The operative time of the ablation group was(50.6±15.4)min,and the intraoperative bleeding volume was(22.8±9.6)ml;.The intraoperative bleeding time of the patients in the ablation group was(178.4±35.2)min,and the intraoperative bleeding volume was(402.8±98.4)ml;.There were significant differences in operation time and intraoperative bleeding between the two groups(P<0.05).In the ablation group,the tumor recurrence rates at 1,2 and 3 years after operation were 8.3%(1 case),25.0%(3 cases)and 41.7%(5 cases),respectively.The 1-,2-and 3-year overall survival rates were 91.6%(1112),83.3%(10)and 66.7%(8),respectively.In the operation group,the tumor recurrence rates at 1,2 and 3 years after operation were 9.1%(2 cases),27.3%(6 cases)and 40.9%(9 cases),respectively.The 1-,2-and 3-year overall survival rates were 90.9%(2022),77.3%(17/22)and 68.2%(15/22),respectively.There was no significant difference in tumor recurrence rate and overall survival rate between the two groups(P>0.05).The incidence of complications was 16.7%(2)in the ablation group and 31.8%(7/22)in the operation group(P<0.05).Conclusion Ultrasound-guided percutaneous radiofrequency ablation is similar to surgical resection in the treatment of caudate lobe hepatocellular carcinoma.At the same time,it can reduce the trauma of patients and reduce the incidence of perioperative complications.