射频消融与腹腔镜肝切除治疗小肝癌的临床应用分析

Clinical analysis of radiofrequency ablation and laparoscopic hepaterectomy for small hepatocellular carcinoma

目的探讨射频消融与腹腔镜肝切除术(laparoscopic hepaterectomy,LH)治疗小肝癌的临床疗效和安全性。方法回顾性分析2016年3月至2021年3月解放军总院海南医院肝胆外科78例小肝癌患者106个肿瘤结节,根据治疗方法不同分为射频消融组39例62个肿瘤结节、LH组39例44个肿瘤结节。术后随访5年,比较两组的手术时间、出血量、住院时间、术后并发症、无瘤生存率及总生存率。结果射频消融组的手术时间、出血量、住院时间及术后并发症优于LH组,差异有统计学意义(P<0.05)。射频消融组1、3、5年无瘤生存率分别为76.15%、45.12%、38.15%,1、3、5年总生存率分别为93.73%、58.54%、38.46%。LH组1、3、5年无瘤生存率分别为77.35%、46.12%、41.02%,1、3、5年总生存率分别为94.73%、59.24%、43.58%,两组1、3、5年无瘤生存率及总生存率比较,差异无统计学意义(P>0.05)。结论与LH比较,射频消融治疗小肝癌的并发症发生率较低,安全性高,在治疗特殊部位小肝癌具有优势,与LH疗效相近,可根据具体情况选择运用。

Objective To investigate the clinical efficacy and safety of radiofrequency ablation(RFA)and laparoscopic hepaterectomy in the treatment of small hepatocellular carcinoma.Methods Retrospective analysis was conducted on 106 tumor nodules in 78 patients with hepatocellular carcinoma in Hainan Affiliated Hospital of PLA General Hospital from Mar.2016 to Mar.2021,according to the different treatment methods,39 cases of 62 tumor nodules were divided into radiofrequency ablation group,39 cases of 44 tumor nodules in laparoscopic hepaterectomy group.The patients were followedup for 5 years to compare the operative time,intraoperative blood loss,hospitalization days,postoperative complications,tumor-free survival rate and overall survival rate of the two groups.Results Radiofrequency ablation group was superior to laparoscopic hepaterectomy group in operation time,intraoperative blood loss,hospitalization days and complications,the difference between the two groups was statistically significant(<0.05).The survival rate of 1,3 and 5 years tumor-free survival in radiofrequency ablation group was 76.15%,45.12%and 38.15%,the overall survival rate in 1,3 and 5 years was 93.73%,58.54%and 38.46%respectively.The survival rate of 1,3 and 5 years tumor-free survival in laparoscopic hepaterectomy group was 77.35%,46.12%and 41.02%,the overall survival rate in 1,3 and 5 years was 94.73%,59.24%and 43.58%respectively,there was no statistically significant difference in 1,3 and 5 yeasr tumor-free survival rate and overall survival rate between the two groups.Conclusions Compared with laparoscopic hepaterectomy,radiofrequency ablation has a low incidence of complications and high safety in the treatment of small hepatocellular carcinoma.It has advantages in the treatment of small hepatocellular carcinomar in special parts,and is similar to that of laparoscopic hepaterectomy,and can be used according to specific conditions.