超声引导下经皮微波消融与手术切除治疗原发性肝癌的疗效比较

Comparative study of efficacy between ultrasound-guided percutaneous microwave ablation and surgical resection in the treatment of primary hepatocellular carcinoma

目的对比探讨超声引导下经皮微波消融与手术切除治疗CNLC 1期原发性肝癌的疗效。方法收集2017年1月-2020年12月无锡市人民医院收治的107例行超声引导下经皮微波消融或手术切除治疗CNLCI期肝癌患者的临床资料,其中微波消融(MWA)组56例,手术切除(SR)组51例。比较两组术后检验学指标、术后并发症、短期疗效及短期生存率,探讨两组病人的生存影响因素。两组间的计数资料用卡方检验比较,计量资料采用Mann-Whi tney比较。采用Kaplan-Meier和Cox回归分析影响患者术后生存的相关因素。结果术后SR组患者LDH(P-0.036),PT(P=0.006)及INR(P=0.007)均高于NWA组,术后疼痛发生率显著高于MWA组(P<0.001)。MWMA组患者半年、1年,2年的生存率分别为98.2%、89.3%、53.6%,SR组患者半年、1年、2年的生存率分别为100%、92.2%、58.8%,两组患者术后生存率比较,差别无统计学意义(P=0.681).于NWA患者而言,肿瘤多发为主要危险因素;于SR患者而言,肿瘤直径及术前LDH为主要危险因素。结论超声引导下经皮微波消融或手术切除治疗CNLC I期肝癌的短期疗效无明显差异,但经皮微波消融所带来的并发症更少。

Objective To rompare trealmenl efficacy between altrasound-guidecl perrulaneous microwave ablation and surgical resection for CNLC 1 stage primary hepatocellular rarrinoma(HCC).Methods A tolal of 107 patients with CNLC 1 stage hepatocellular rarrinoma Ireatecl in Wuxi People's Hospital Affiliated to Nanjing Medical University from January 2017 to Derember 2020 were enrolled in this study.56 patients undenvenl microwave ablation(MWA group),51 patients undenvenl surgiral resection(SR group).Postoperative hiologiral Hata,postoperative complications,short-term treatment effirary and survival rate between two groups were compared.Factors associated with postoperative survival were also explored.Chi-square test was fondurled for rategoriral variables,while ronlinuous variables were analyzed using Mann-Whitney U test.Kaplan-Meier and Cox regression analyses were perfoimed to explore predicative paramelers of survival.Resu I ts In postoperative biological data.SR patients had higher LDH levels.PT time and INR values than MWA patients.Also,SR patients were more likely to undergo postoperative pain.In MWA rohoi1,0.5-.l-and 2-year sunival rates were 98.2%,89.3%and 53.6%.In SR cohort.0.5-.I-and 2-year survival rates were 100%,92.2%anfl 58.8%.respertively.There were no significant differenres between two groups in postoperative survival.For MWA patients,multiple tumor numbers were associated worse survival.While for SR patients,larger tumor diameters ancl higher preoperalive LDH levels were predirtive factors of worse survival.Conc I us i on There are no significant differences between ultrasound-guided perrulaneous mirrowave ablation and surgiral resertion in the Ireatmenl of CNLC 1 stage hepatocellular rarrinoma,but perrutaneous microwave ablation brought fewer oompliratinns than surgical resection.