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目的比较经皮原位射频消融与手术切除治疗肝脏肿瘤的疗效。方法1999年11月至2004年6月,中山大学肿瘤防治中心共收治434例肝功能Child A级的小肝癌(单个肿瘤、直径≤5.0cm)病人。其中手术切除183例,射频消融治疗251例。结果手术切除组1、3、5年存活率分别为91.18%、70.18%、55.51%,射频消融组存活率分别为91.92%、74.41%、58.22%,两组之间差异无统计学意义(P=0.6253);分层分析显示,对于直径≤3.0cm肿瘤,手术切除组1、3、5年存活率分别为95.87%、73.69%、62.45%,射频消融组1、3、5年存活率分别为95.46%、80.15%、72.79%,两组之间差异无统计学意义(P=0.5641);对于直径3.1~5.0cm肿瘤,手术切除组1、3、5年存活率分别为88.07%、67.63%、51.18%,射频消融组1、3、5年存活率分别为80.16%、60.63%、32.34%,两组之间差异无统计学意义(P=0.1256);多因素分析显示肿瘤大小和总胆红素(serum bilirubin)是影响存活率的独立危险因素。结论对于肝功能较好的单个肿瘤的小肝癌病人,射频消融与手术切除效果相近,可达到根治性效果,可代替部分开腹手术切除。

Percutaneous radiofrequency ablation and surgical resection for small hepatocellular carcinoma:a comparative study

??Objective:To compare the effectiveness of percutaneous radiofrequency ablation (PRFA) and surgical resection as an initial treatment for patients with small hepatocellular carcinoma (HCC). Methods:Between November 1999 and June 2004,434 patients with a solitary HCC (diameter less than 5cm) and well??preserved liver function (Child??pugh class A ) received PRFA or surgical resection (SR) in Sun Yat??sen University Cancer Center.Among them,183 patients received SR and 251 patients received PRFA. Results:The overall 1??year,3??year and 5??year survival rates for SR group were 91.18%,70.18%,55.51% respectively,and for PRFA group were 91.92%,74??41%,58.22% respectively.In patients with tumor diameter ≤3cm,the overall 1??year,3-year and 5-year survival rates for SR group were 95??87%,73??69%,62??45% respectively,and for PRFA group were 95.46%,80.15%,72.79% respectively.In patients with tumor diameter from 3.0m to 5.0cm, the overall 1??year,3-year and 5-year survival rates for SR group were 88.07??,67.63??,51.18?? respectively,and for PRFA group were 80.16%,60.63??,32.34?? respectively.Survival of patients treated with PRFA were dependent on tumor size and serum bilirubin. Conclusion:PRFA is as effective as surgical resection in the group of solitary and small HCC.PRFA can be used instead of surgical resection in proper situations.