腹腔镜下肝癌切除术与射频消融术治疗肝细胞癌的疗效观察

Clinical efficacy of laparoscopic hepatectomy versus radiofrequency ablation for hepatocellular carcinoma

目的探讨腹腔镜下肝癌切除术(LH)与射频消融术(RFA)治疗肝细胞癌(HCC)的临床疗效。方法选取2015年1月至2017年12月间成都三六三医院收治的76例HCC患者,根据不同手术方式分为LH组和RFA组,每组38例。LH组患者采用LH治疗,RFA组患者采用RFA治疗,比较两组患者临床疗效、术前术后肝功能、免疫功能变化、术后疼痛程度及并发症。结果 RFA组患者总生存率为84. 2%,LH组为86. 8%,RFA组无瘤生存率为63. 2%,LH组为57. 9%,差异均无统计学意义(P> 0. 05)。术后7d,两组患者AST、ALT和TBil水平均降低,且RFA组患者均低于LH组,差异均有统计学意义(均P <0. 05)。术后7d,两组患者CD3^+、CD4^+和CD8^+水平均降低,且RFA组患者均优于LH组,差异均有统计学意义(均P <0. 05)。RFA组患者术后VAS评分为(2. 15±0. 35)分,LH组为(3. 28±0. 42)分,两组比较,差异有统计学意义(t=12. 74,P=0. 00)。RFA组患者术后并发症发生率为7. 9%,LH组为15. 8%,差异无统计学意义(P> 0. 05)。结论RFA与LH治疗HCC临床效果相当,并发症少,但RFA在改善肝功能和提升机体免疫功能方面较LH更有优势,且术后疼痛较轻,值得推广。

Objective To investigate the clinical efficacy of laparoscopic hepatectomy(LH)versus radiofrequency ablation(RFA)in the treatment of hepatocellular carcinoma(HCC).Methods A total of76 patients with HCC admitted at Chengdu 363 Hospital from January 2015 to December 2017 were enrolled.The patients were divided into LH group and RFA group according to different surgical methods,with 38 patients in each group.The clinical efficacy,the changes in liver function and immune function before and at 7 d after the operation,the postoperative pain degree and incidence of complications were compared between the two groups.Results After 12 months of follow-up,the overall survival rate and tumorfree survival rate was 84.2%and 63.2%,respectively in the RFA group and 86.8%and 57.9%,respectively in the LH group(P>0.05).At 7 d after operation,preoperative aspartate aminotransferase(AST),alanine aminotransferase(ALT)and total bilirubin(TBil)levels decreased in both groups with the above levels lower in the RFA group than in the LH group(all P<0.05).At 7 d after the operation,the levels of CD3^+,CD4^+,CD8^+decreased in both groups with the RFA group better than the LH group(all P<0.05).Visual analogue score(VAS)was 2.15±0.35 in RFA group and 3.28±0.42 in LH group after the operation(P<0.05).The incidence of complications was 7.9%in RFA group and 15.8%in LH group(P>0.05).Conclusion RFA and LH have similar clinical effects and fewer complications in the treatment of HCC,but RFA is superior to LH in improving liver and immune function and RFA causes little pain after operation,which is worthy of promotion.