小肝癌射频消融与经腹腔镜切除治疗的近期疗效及成本效果分析

背景与目的:射频消融术(RFA)与腹腔镜肝切除术均为治疗原发性小肝癌的重要方法,两种治疗方法都有各自的适应证和优缺点,这也是文献报道的重点,但对于两种治疗方法的近期疗效特别是卫生经济学成本的研究还相对缺乏。本研究通过比较RFA与腹腔镜肝切除术治疗原发性小肝癌的近期疗效及医疗相关经济学成本的差别,以期为临床原发性小肝癌治疗方式的选择提供帮助。方法:回顾性分析2017年8月-2019年7月收治的80例原发性小肝癌患者(肿瘤直径≤5 cm)资料,其中40例行经皮RFA(RFA组),40例行腹腔镜肝切除术(腔镜组)。比较两组患者相关临床指标与医疗成本。结果:两组患者术前的基本资料、肝功能指标及甲胎蛋白(AFP)水平均无统计学差异(均P>0.05)。术后,RFA组的肝功能指标先升高后降,腔镜组则呈持续降低,RFA组肝功能指标在术后3 d均明显高于腔镜组ALT:(65.72±25.61)U/L vs.(45.26±23.36)U/L,AST:(77.27±12.51)U/L vs.(53.29±11.24)U/L,TBIL:(25.12±6.06)μmol/L vs.(22.26±4.39)μmol/L,均P<0.05],但两组术后1个月肝功能指标均无统计学差异(均P>0.05);两组术后AFP水平均逐渐降低,且两组间同时间点差异无统计学意义(均P>0.05)。RFA组的手术时间、术中出血量、住院时间和术后并发症发生率均明显少于腔镜组(62.6±11.7)min vs.(155.2±27.5)min,(5.2±0.5)mL vs.(76.2±11.3)mL,(4.3±1.2)d vs.(6.3±1.8)d,5.0%vs.17.5%,均P<0.05];两组肿瘤清除率均为100%。直接医疗成本构成中,RFA组的手术相关费用、药品费和住院费均明显低于腔镜组(11526.46±941.08)元vs.(14277.25±938.46)元,(1825.33±179.5)元vs.(2614.19±222.4)元,(476.30±67.71)元vs.(712.03±87.52)元,均P<0.05],但两组检验检查费和其他费用无统计学差异(均P>0.05);RFA组的直接医疗成本、间接医疗成本和总的医疗成本均明显低于腔镜组(17446.78±1465.24)元vs.(21270.62±1612.38)元,(782.23±66.80)元vs.(1654.67±120.47)元,(18228.01±1539.72)元vs.(22924.35±1922.67)元,均P<0.05]。结论:RFA与腹腔镜肝切除治疗对原发性小肝癌的近期疗效相当,但RFA治疗的手术时间与住院时间较短,术后并发症发生率也较低,因此,其所产生的直接医疗成本和医疗总成本也低于腔镜手术。

Analysis of short-term efficacy and cost-effectiveness of percutaneous radiofrequency ablation and laparoscopic hepatectomy in treatment of small hepatocellular carcinoma

Background and Aims:Radiofrequency ablation(RFA)and laparoscopic hepatectomy are important treatment modalities for small hepatocellular carcinoma(HCC),and both method have their indications,advantages and limitations,which also are the main themes addressed by existing literature.However,there are relatively scarce data regarding the short-term efficacy especially the health economic costs of the two methods.Therefore,this study was conducted to determine the differences in short-term efficacy outcomes and medical costs between percutaneous RFA and laparoscopic hepatectomy in treatment of small HCC,so as to provide help for the selection of treatment options for small HCC in clinical practice.Methods:The clinical data of 80 patients with small HCC(tumor diameter≤5 cm)treated from August 2017 to July 2019 were retrospectively analyzed.Of the patients,40 cases underwent percutaneous RFA(RFA group)and the other 40 cases underwent laparoscopic hepatectomy(laparoscopic group).The main clinical variables and medical costs were compared between the two groups of patients.Results:There were no signi?cant differences in preoperative baseline data and levels of liver function parameters andα-fetoprotein(AFP)between the two groups(all P>0.05).The liver function parameters were initially increased and then decreased in RFA group,and were continuously declined laparoscopic group after operation.The liver fuction parameters on postopertive 3 d were significantly higher in RFA group than those in laparoscopic groupALT:(65.72±25.61)U/L vs.(45.26±23.36)U/L,AST:(77.27±12.51)U/L vs.(53.29±11.24)U/L,TBIL:(25.12±6.06)μmol/L vs.(22.26±4.39)μmol/L,all P<0.05],but showed no significant differences on postoperative one month between the two groups(all P>0.05).The AFP levels were gradually reduced in both groups after operation,which showed no signi?cant differences between the two groups in the same time points(both P>0.05).The operative time,intraoperative blood loss,length of hospital stay and incidence of postoperative complications in RFA group were signi?cantly less than those in laparoscopic group(62.6±11.7)min vs.(155.2±27.5)min,(5.2±0.5)mL vs.(76.2±11.3)mL,(4.3±1.2)d vs.(6.3±1.8)d,5.0%vs.17.5%,all P<0.05].The tumor removal rates were 100%in both groups.In the direct medical cost components,the costs for surgery-related care,medications and hospitalization in RFA group were significantly lower than those in laparoscopic group(11526.46±941.08)yuan vs.(14277.25±938.46)yuan,(1825.33±179.5)yuan vs.(2614.19±222.4)yuan,(476.30±67.71)yuan vs.(712.03±87.52)yuan,allP<0.05],but no significant differences were noted in the testing and examination and other costs between the two groups(both P>0.05);the direct and indirect medical costs as well as the total medical costs in RFA group were significant lower than those in laparoscopic group(17446.78±1465.24)yuan vs.(21270.62±1612.38)yuan,(782.23±66.80)yuan vs.(1654.67±120.47)yuan,(18228.01±1539.72)yuan vs.(22924.35±1922.67)yuan,all P<0.05].Conclusion:RFA and laparoscopic hepatectomy have similar the short-term efficacy in treatment of small HCC.However,RFA is associated with shortened operative time and hospital stay as well as decreased incidence of postoperative complications,so the direct and total medical costs incurred by RFA are aslo lower than those by laparoscopic hepatectomy.