经皮射频消融术与腹腔镜肝切除术治疗原发性小肝癌的疗效及预后比较

目的:比较经皮射频消融术与腹腔镜肝切除术治疗原发性小肝癌的疗效及预后。方法:回顾性分析2012年1月—2014年12月间收治的140例原发性小肝癌患者资料,其中80例行射频消融术(消融组),60例行腹腔镜肝切除术(腔镜组)。比较两组患者术后血清肝功能指标与肿瘤标志物水平的变化、并发症发生率、根治率、复发率及生存率。结果:术前两组的基线资料、肝功能指标及肿瘤标志物水平均无统计学差异(均P0.05)。术后消融组肝功能指标先升后降,腔镜组则呈持续降低,消融组术后短期内丙氨酸氨基转移酶、天门冬氨酸氨基转移酶水平均明显高于腔镜组(均P0.05);两组术后肿瘤标志物水平均逐渐降低,两组间差异无统计学意义(均P0.05)。消融组术后并发症发生率明显低于腔镜组(3.75%vs. 20.00%,P=0.002)。两组根治率、复发率以及1、2、3年总生存率和无瘤生存率均无统计学差异(均P0.05)。结论:两种手术方式对原发性小肝癌的疗效及预后无统计学差异,射频消融术后并发症较少,但对短期肝功能存在一定损害。

Efficacy and prognosis comparison of percutaneous radiofrequency ablation and laparoscopic hepatectomy in treatment of small hepatocellular carcinoma

Objective: To compare the efficacy and prognosis of percutaneous radiofrequency ablation and laparoscopic hepatectomy in treatment of small hepatocellular carcinoma (HCC). Methods: The clinical data of 140 patients with small HCC treated from January 2012 to December 2014 were retrospectively analyzed. Of the patients, 80 cases underwent percutaneous radiofrequency ablation (ablation group) and 60 cases underwent laparoscopic hepatectomy (laparoscopic group). The changes in postoperative serum liver function parameters and tumor markers and incidence of postoperative complications, as well as the radical cure rate, and the recurrence and survival rates were compared between the two groups of patients.Results: There were no significant differences in baseline data and levels of liver function parameters and tumor markers between the two groups of patients before operation (all P>0.05). After operation, the liver function parameters in ablation group first rose and then fell, and declined continuously in laparoscopic group, and in the ablation group, the levels of alanine aminotransferase and aspartate aminotransferase were significantly higher than those in laparoscopic group for a short period of time after the operation (all P<0.05); the levels of tumor markers were gradually reduced in both groups, which showed no significant differences between the two groups (all P>0.05). The incidence of postoperative complications in ablation group was significantly lower than that in laparoscopic group (3.75% vs. 20.00%, P=0.002). There were no significant differences concerning the radical cure rate and the recurrence rate, and the 1-, 2- and 3-year survival rates between the two groups (all P>0.05). Conclusion: There is no evident difference in efficacy and prognosis between the two treatment methods in treatment of small HCC. Radiofrequency ablation is associated with fewer complications, but with short-term injury to liver function.