小肝癌射频消融与手术切除的疗效比较

目的比较手术切除和射频消融治疗小肝癌（≤5cm）的临床疗效。方法88例小肝癌患者，手术切徐42例，射频消融46例，分析临床资料及随访结果。结果全组平均随访34．36（6～72）个月。手术组与射频组总1、3、5年无瘤生存率为85．4％、40．9％、29．2％vs82．6％、27．7％、16．4％，平均无瘤生存时间32．78个月vs29．39个月（P=0．51），总累积生存率为100％、63．7％、50．4％vs100％、66.3％、37．4％。平均生存时间50．78个月vs47．62个月（P=0．67）。肿瘤≤3cm组中，手术组与射频组1、3、5年无瘤生存率为85．7％、62．5％、37．5％vs85．0％、37．4％、29．9％（P=0．50），累积生存率为100％、78．8％、59．1％vs100％、78．8％、51．7％（P=0．87）。肿瘤3～5cm组中，手术组与射频组1、3、5年无瘤生存率为85．7％、30．6％、30．0％vs80．8％、21．8％、10．9％（P=0．58），累积生存率为100％、56．8％、45．4％vs100％、56．9％、29．1％（P=0．41）。Cox多因素分析显示肿瘤个数对总体生存期的影响有统计学意义（P=0．02），但消除各因素可能引起的影响后，手术和射频两组总体无瘤生存期和总体生存期差别均无统计学意义。结论对直径≤5cm的小肝癌射频消融安全、疗效确切，近远期疗效与手术切除相近，可以考虑作为小肝癌的首选治疗手段之一。

Comparison of radiofrequency ablation and surgical resection for small primary liver carcinoma

Objective To compare clinical results of surgical resection（SR） and radiofrequency ablation （RFA） for small primary liver earcinoma（≤5 cm）. Methods Eighty-eight patients received surgical resection （42 cases） and radiofrequency ablation（46 eases）, and the long-time results were analyzed. Results With mean follow-up time 34.36（6-72） months, the 1,3,5-year disease free survival rates in SR and RFA group were 85.4%, 40.9%, 29.2% vs 82.6%, 27.7%, 16.4%, the mean disease free survival time were 32.78 vs 29.39 months（P =0.51）. When the tumor diameter ≤ 3 cm, the 1,3,5-year disease free survival rates in SR and RFA group were 85.7%, 62.5%, 37.5% vs 85.0%, 37.4%, 29.9%（P =0.50）. when the tumor diameter in 3-5 cm, The 1,3,5-year disease free survival rates in SR and RFA group were 85.7%, 30.6%, 30.0% vs 80.8%, 21.8%, 10.9%（P=0.58）. The 1,3,5-year cumulative survival rates in SR and RFA group were 100%, 63.7%, 50.4% vs 100%, 66.3%, 37.4%, the mean cumulative survival time were 50.78 vs 47.62 months（P =0.67）. When the tumor diameter≤3 cm, The 1,3,5-year cumulative survival rates in SR and RFA group were 100%, 78.8%, 59.1% vs 100%, 78.8%, 51.7%（P=0.87）. When the tumor diameter in 3-5 cm, the 1,3,5-year cumulative survival rates in SR and RFA group were 100%, 56.8%, 45.4% vs 100%, 56.9%, 29.1%（P =0.41）. After balance the multiple factors＇ effect, Cox results showed the difference of disease free survival rates and cumulative survival rates between SR and RFA was statistically not significant, but the tumor number was significantly effect the survival time（P =0.02）. Conclusion Radiofreqency ablation is a safe and satisfactory treatment for small liver carcinoma（≤ 5 cm） with short and long-time results that similar to surgical resection, which can be selected to small liver carcinoma as one of the first-line treatments.