肝癌手术治疗中双极射频凝固器与单极射频消融的应用

目的分析及比较在肝癌手术治疗中使用双极射频凝固器辅助肿瘤切除与单极射频消融治疗肿瘤的临床应用情况。方法回顾性收集2008年6月1日至2012年5月30日4年间首都医科大学宣武医院普通外科住院治疗的肝癌患者的临床资料,根据手术中应用射频技术的不同分为双极射频凝固器辅助肿瘤切除手术组（简称双极射频凝固器组）及直接单极射频消融治疗肿瘤组（简称单极射频消融组）,非随机对照研究其应用范围、临床效果、安全性和卫生经济学指标的差异。结果纳入患者56例,男女比例1.95∶1,年龄23～86岁,肝硬变患者占85.7%（48/56）,多发肿块患者占12.5%（7/56）,腹腔镜手术占16.1%（9/56）。双极射频凝固器组22例,单极射频消融组34例。双极射频凝固器组肿瘤直径≥5 cm肿瘤患者比例大于单极射频消融组（P=0.000）,多发肿块比例和腹腔镜手术比例与单极射频消融组比较差异无统计学意义（P〉0.05）。术中出血量：双极射频凝固器组患者术中出血量多于单极射频消融组（P=0.000）,双极射频凝固器组有2例患者采取了肝门阻断措施,并有3例患者术中输血治疗,输血量为400、400及600 mL。手术时间：双极射频凝固器组手术时间比单极射频消融组延长（P=0.021）,但进一步比较直径≥5 cm亚组的肿瘤患者手术时间差异无统计学意义（P=0.191）。围手术期死亡和并发症情况：全部患者无围手术期死亡。双极射频凝固器组和单极射频消融组的手术并发症比较,差异无统计学意义〔18.2%（4/22）比11.8%（4/34）,P=0.780〕,并发症全部治愈。卫生经济学指标：双极射频凝固器组的住院时间明显长于单极射频消融组（P=0.001）,住院费用明显多于单极射频消融组（P=0.004）。治疗效果：2例肿瘤直径≥5 cm射频消融患者,术后肝动脉介入造影发现射频肿瘤边缘存在碘油沉积,考虑肿瘤残余。结论在肝癌手术治疗中,使用双极射频凝固器与单极射频消融都是安全、有效的。对直径小于3 cm的肝癌、多发肿瘤和有条件微创手术中使用直接单极射频消融治疗在术中出血、微创比例、住院时间、住院费用等方面较双极射频凝固器有优势,但在直径≥5 cm肝癌的治疗中双极射频凝固器辅助肿瘤切除可能是更好的选择。

Treatment for Liver Cancer by Operation with Bipolar Radiofrequency-Assisted Device or Monopolar Radiofrequency-Assisted Ablation

Objective To analyze the application of bipolar radiofrequency-assisted device or monopolar radiofrequency-assisted ablation in treatment for liver cancer by operation.Methods From June 2008 to May 2012,56 patients with liver cancer underwent operation with bipolar radiofrequency-assisted device（Habib group,n=22）or monopolar radiofrequency-assisted ablation（mRFA group,n=34）were selected retrospectively.The operation time,postoperative morbidity,hospital stay,hospital costs,intraoperative bleeding,and therapeutic effects were compared in two groups.Results The percentage of patients with liver cirrhosis was 85.7%（48/56）,with multiple tumors was 12.5%（7/56）,underwent laparoscopic operation was 16.1%（9/56）.Patients with the tumor diameter greater than 5 cm in the Habib group were more than that in the mRFA group（P=0.000）,the laparoscopic surgery proportion had no significant difference in two groups（P=0.074）.① The intraoperative bleeding in the Habib group was more than that in the mRFA group（P=0.000）.Two patients were adopted a hepatic portal blocking and 3 patients with intraoperative blood transfusion in the Habib group.② The operation time in the Habib group was longer than that in the mRFA group（P=0.021）,but there was no difference of the operation time in two groups patients with tumor diameter greater than 5 cm（P=0.191）.③ The postoperative morbidity had no obvious difference in two groups〔18.2%（4/22）versus 11.8%（4/34）,P=0.780〕.④ The hospital stay and the hospital costs in the Habib group were significantly more than those in the mRFA group（P=0.001,P=0.004）.⑤ The tumor residuals were found in two patients with tumor diameter greater than 5 cm.Conclusions Treatment for liver cancer by operation with bipolar radiofrequency-assisted device or monopolar radiofrequency-assisted ablation is safe and effective.The monopolar radiofrequency-assisted ablation has advantages of less intraoperative bleeding,more minimal invasion proportion,less hospital stay and hospital costs for liver cancer patients with small tumor（diameter 3 cm）,multifocal tumors and minimal invasion conditions as compared with bipolar radiofrequency-assisted device.Operation with bipolar radiofrequency-assisted device in patients with larger tumors（diameter ≥5 cm）resection might be a better choice.