小肝癌的临床治疗

目的探讨小肝癌（≤5cm）优化的个体治疗方案。方法回顾性分析了2000年1月-2004年12月在我院接受治疗的849例小肝癌患者的临床资料,分为手术切除组（n=406）和微创治疗组（n=443）,比较两组患者的生存率、复发率和治疗后并发症。结果手术切除组患者术后3年生存率为72．1％,其中262例肿瘤≤3cm患者的3年生存率为73．3％,144例肿瘤3—5cm患者的3年生存率为70．5％,两组相比差异无显著性（P=0．46）;术后1、2和3年复发率分别为13．5％、29．9％和39．8％。微创治疗组患者治疗后3年生存率为73．8％,其中136例肿瘤≤3cm患者的3年生存率为74．7％,307例肿瘤3-5cm的患者3年生存率为72．2％,两组相比差异无显著性（P=0．45）;治疗后1、2和3年复发率分别为12．6％、28．7％和40．4％。微创治疗组中肿瘤≤3cm患者治疗后3年生存率明显高于手术切除组中肿瘤≤3cm的患者（P〈0．05）。手术切除组患者治疗后并发症发生率明显高于微创治疗组患者（30．8％vs6．1％,P〈0．01）。结论微创治疗与传统手术切除治疗小肝癌患者的疗效相当,包含微创治疗的综合治疗手段将有助于提高小肝癌患者的生存率和生活质量。

Clinical treatment of small hepatocellular carcinoma

OBJECTIVE: To evaluate the suitable treatment methods of small hepatocellular carcinoma (SHCC). METHODS: From 2000 to 2004, 849 cases of SHCC (< or = c5 cm) were enrolled and divided into two groups: resection group (n = 406) and minimally invasive treatment (MIT) group (n = 443). The survival rates, recurrence rates, and post-treatment complications were compared retrospectively. RESULTS: The 3-year survival rate in the resection group was 72.1%. The 3-year survival rates in tumor < or = 3 cm and tumor 3-5 cm of resection group were 73.3% and 70.5% (P = 0.46), respectively. The 1-year, 2-year, and 3-year recurrence rates in resection group were 13.5%, 29.9%, and 39.8%, respectively. The 3-year survival rates in MIT group was 73.8%. The 3-year survival rates in tumor < or = 3 cm and tumor 3-5 cm of MIT group were 74.7% and 72.2% (P = 0.45), respectively. The 1-year, 2-year, and 3-year recurrence rates in MIT group were 12.6%, 28.7%, and 40.4%, respectively. The 3-year survival rate was significantly different between these two group in tumor < or = 3 cm (P < 0.05). The post-treatment complication rates of these two group were 30.8% and 6.1% (P < 0.01), respectively. CONCLUSIONS: MIT is as effective as the traditional resection in SHCC. However, MIT is superior to the traditional resection in terms of minimal invasion and less post treatment complication rate. The recurrence rate of HCC was still high after treatment. Comprehensive therapies, including MIT, may increase the survival rate and life quality in SHCC patients.