超声引导下射频消融与腹腔镜肝切除术治疗直径≤5 cm尾状叶肝细胞癌的临床对比研究

Comparative study of ultrasound-guided radiofrequency ablation and laparoscopic caudate lobectomy for hepatocellular carcinoma in the caudate lobe with diameter≤5 cm

目的对比探究超声引导下射频消融(RFA)对直径≤5 cm尾状叶肝细胞癌的治疗效果,分析其临床应用的可行性及价值。方法回顾性选取2016年1月至2020年12月于本院肝胆外科接受治疗的直径≤5 cm尾状叶肝细胞癌患者44例,根据治疗方式分为消融组18例(行超声引导下RFA)和切除组26例(行腹腔镜肝尾状叶切除术)。评估RFA消融效果和完全消融率;对比两组围手术期指标、手术前后肝功能指标变化、术后并发症及随访生存情况。结果消融组术后一次完全消融率为83.3%(15/18),补充消融后的完全消融率为100.0%,消融次数为1~2(1.3±0.4)次。消融组手术时间、肝功能恢复时间、术后住院时间均少于切除组,差异有统计学意义(t=19.053、10.517、12.590,均P<0.001)。术后两组总胆红素(TBIL)、谷丙转氨酶(ALT)及天冬氨酸转氨酶(AST)水平呈先升后降趋势,其中消融组术后1、3、7 d时的TBIL、ALT、AST水平均低于同期切除组(P<0.05)。消融组术后发生Clavien-DindoⅠ~Ⅱ级并发症2例(11.1%),切除组发生Clavien-DindoⅠ~Ⅱ级5例(19.2%),Ⅲ~Ⅳ级2例(7.7%),两组术后并发症总发生率以及Clavien-Dindo分级比较差异无统计学意义。消融组术后1、3、5年累积无瘤生存率分别为94.4%、65.2%、34.2%,累积总生存率分别为94.4%、69.3%、50.6%;切除组术后1、3、5年累积无瘤生存率分别为88.5%、61.3%、30.4%,累积总生存率分别为92.3%、65.5%、46.3%。两组累积无瘤生存率与累积总生存率比较差异均无统计学意义(χ^(2)=0.030,P=0.862;χ^(2)=0.067,P=0.796)。结论超声引导下RFA治疗直径≤5 cm尾状叶肝细胞癌安全可行,总体疗效与手术切除相近,同时可减少患者创伤,促进术后肝功能恢复,缩短住院时间。

Objective To compare and explore the therapeutic effect of ultrasound-guided radiofrequency ablation(RFA)on hepatocellular carcinoma in the caudate lobe with diameter≤5 cm,and analyze the feasibility and value of its clinical application.Methods From January 2016 to December 2020,44 patients with hepatocellular carcinoma in the caudate lobe with diameter≤5 cm treated in Qionghai People’s Hospital were retrospectively selected.According to the treatment methods,the patients were divided into ablation group(18 cases,with RFA under ultrasound guidance)and resection group(26 cases,with laparoscopic caudate lobectomy).The RFA effect and complete ablation rate were evaluated.The perioperative indexes,changes of liver function indexes before and after operation,postoperative complications and follow-up survival were compared between the two groups.Results In the ablation group,the complete ablation rate was 83.3%(15/18),the complete ablation rate after supplementary ablation was 100.0%,and the number of ablation time were 1-2(1.3±0.4).The operation time,liver function recovery time and postoperative hospital stay in the ablation group were shorter than those in the resection group,and the differences were statistically significant(t=19.053,10.517,12.590;all P<0.001).The levels of total bilirubin(TBIL),alanine aminotransferase(ALT)and aspartate aminotransferase(AST)in the two groups increased at first and then decreased after operation.The levels of TBIL,ALT and AST in the ablation group at 1,3 and 7 days after operation were lower than those in the resection group contemporaneously(P<0.05).There were 2 cases(11.1%)of Clavien-Dindo gradeⅠ-Ⅱin the ablation group,5 cases(19.2%)of gradeⅠ-Ⅱand 2 cases(7.7%)of gradeⅢ-Ⅳin the resection group,with no significant differences in the total incidence of postoperative complications and Clavien-Dindo grade between the two groups.In the ablation group,the cumulative 1,3,5-year tumor free survival rates were 94.4%,65.2%,34.2%,and the cumulative overall survival rates were 94.4%,69.3%,50.6%,respectively.In the resection group,the cumulative 1,3,5-year disease-free survival rates were 88.5%,61.3%,30.4%,and the cumulative overall survival rates were 92.3%,65.5%,and 46.3%,respectively.There were no significant differences in the cumulative disease-free survival rate and cumulative overall survival rate between the two groups(χ^(2)=0.030,P=0.862;χ^(2)=0.067,P=0.796).Conclusion Ultrasound-guided RFA is safe and feasible for the treatment of hepatocellular carcinoma in the caudate lobe with diameter≤5 cm,which can reduce the trauma of patients,accelerate the recovery of postoperative liver function,shorten the length of hospital stay,and the overall efficacy is similar to that of surgical resection.