超声引导下射频消融术与激光消融术治疗小肝癌疗效比较

Comparison of effect between ultrasound-guided radiofrequency ablation and laser ablation in the treatment of small liver carcinoma

目的比较超声引导下射频消融术(RFA)与激光消融术(LA)治疗小肝癌的临床效果。方法选择2017年6月至2019年6月新乡医学院第一附属医院收治的146例小肝癌患者为研究对象,根据治疗方法将患者分为RFA组和LA组,每组73例。RFA组患者给予超声引导下RFA治疗,LA组患者给予超声引导下LA治疗。记录2组患者手术时间和病灶范围(即可手术病灶的直径);分别于术后1、3、12个月进行二维超声及超声造影检查观察患者的病灶大小及动态增强情况,参照修订版实体瘤疗效评价标准评定患者临床疗效。结果RFA组和LA组患者的手术时间分别为(25.95±1.88)、(15.62±0.88)min,LA组患者手术时间显著短于RFA组(t=43.082,P<0.05)。RFA组和LA组患者的病灶范围分别为(16.47±1.87)、(16.38±2.46)mm,2组患者病灶范围比较差异无统计学意义(t=0.390,P>0.05)。术后1、3个月及1 a,RFA组患者的肿瘤完全消除率分别为98.84%(85/86)、76.74%(66/86)、74.42%(64/86),肿瘤部分消除率分别为1.16%(1/86)、23.26%(20/86)、25.58%(22/86);LA组患者的肿瘤完全消除率分别为97.70%(85/87)、91.95%(80/87)、89.66%(78/87),肿瘤部分消除率分别为2.30%(2/87)、8.05%(7/87)、10.34%(9/87);术后1个月2组患者的肿瘤消除情况比较差异无统计学意义(χ^(2)=0.330,P>0.05);术后3个月及术后1 a,LA组患者的肿瘤消除情况显著优于RFA组(χ^(2)=7.601、6.826,P<0.05)。2组患者腹腔出血、腹水发生率比较差异无统计学意义(χ^(2)=0.118、0.207,P>0.05);LA组患者恶心呕吐、发热、腹泻、气胸的发生率显著低于RFA组(χ^(2)=32.257、22.649、3.865、5.177,P<0.05)。2组患者的并发症经临床对症治疗后均完全治愈。结论与RFA比较,LA治疗小肝癌具有手术时间短、肿瘤消除率高及并发症发生率低等优势。

Objective To compare the clinical effect of ultrasound-guided radiofrequency ablation(RFA)and laser ablation(LA)in the treatment of small liver carcinoma.Methods A total of 146 patients with small liver carcinoma admitted to the First Affiliated Hospital of Xinxiang Medical University from June 2017 to June 2019 were selected as the research subjects,and the patients were divided into RFA group and LA group according to the treatment methods,with 73 cases in each group.The patients in the RFA group were treated with ultrasound-guided RFA,and the patients in the LA group were treated with ultrasound-guided LA.The operation time and lesion range(the diameter of operable lesions)of patients in the two groups were recorded.At 1,3 and 12 months after operation,the size and dynamic enhancement of lesions were observed by two-dimensional ultrasound and contrast-enhanced ultrasound,and the clinical effect was evaluated according to the revised response evaluation criteria in solid tumors.Results The operation time of patients in the RFA group and LA group was(25.95±1.88)and(15.62±0.88)min,respectively.The operation time of patients in the LA group was significantly shorter than that in the RFA group(t=43.082,P<0.05).The lesion range of patients in the RFA group and the LA group was(16.47±1.87)and(16.38±2.46)mm,respectively.There was no significant difference in the lesion size of patients between the two groups(t=0.390,P>0.05).At 1,3 months and 1 year after operation,the complete tumor elimination rate of patients in the RFA group was 98.84%(85/86),76.74%(66/86)and 74.42%(64/86),respectively;and the partial tumor elimination rate was 1.16%(1/86),23.26%(20/86)and 25.58%(22/86),respectively.The tumor complete elimination rate of patients in the LA group was 97.70%(85/87),91.95%(80/87)and 89.66%(78/87),respectively;and the partial tumor elimination rate was 2.30%(2/87),8.05%(7/87)and 10.34%(9/87),respectively.There was no significant difference in tumor elimination between the two groups at one month after surgery(χ^(2)=0.330,P>0.05).The tumor elimination of patients in the LA group was significantly better than that in the RFA group at three months and one year after operation(χ^(2)=7.601,6.826;P<0.05).There was no significant difference in the incidence of intraabdominal hemorrhage and ascites of patients between the two groups(χ^(2)=0.118,0.207;P>0.05).The incidences of nausea,vomiting,fever,diarrhea and pneumothorax of patients in the LA group were significantly lower than those in the RFA group(χ^(2)=32.257,22.649,3.865,5.177;P<0.05).The complications of patients in both groups were completely cured after clinical symptomatic treatment.Conclusion Compared with the RFA,the LA in the treatment of small liver carcinoma has the advantages of shorter operation time,higher tumor elimination rate and lower complication rate.