经腹腔镜引导射频消融术治疗肝细胞癌的临床研究

目的观察经腹腔镜引导射频消融术治疗肝细胞癌近期临床疗效。方法采用随机数字表法，将经明确诊断为肝细胞癌的患者98例分为观察组49例和对照组49例，观察组采用经腹腔镜引导射频消融术治疗，对照组采用肝切除术治疗，观察两组术后情况及近期疗效等指标。结果治疗1个月后CT复查肿瘤情况，观察组总有效率为73．46％、AFP阳性下降率63．41％，对照组总有效率为77．55％、AFP阳性下降率56．41％，两组总有效率、阳性下降率比较差异无统计学意义（P〉0．05）。两组首次治疗肿瘤的清除率比较差异有统计学意义（P〈0．05）。观察组并发症发生率为10．20％（5／49），对照组并发症发生率为24．48％（12／49），两组并发症发生率比较差异有统计学意义（P〈0．05）。观察组手术时间、术后平均住院时间、平均出血量均少于对照组，具有统计学意义（P〈0．05）。两组AST、ALT均较治疗前明显明显升高（P〈0．05），且对照组较观察组升高显著（P〈0．05）。两组均随访12～43月，两组复发率比较差异有统计学意义（P〉0．05）。结论腹腔镜下射频消融治疗肝细胞癌安全可靠，对于直径〈5cm的肿瘤效果好，可以作为小肝细胞癌首选治疗手段。

Clinical study on laparoscopic radiofrequency ablation therapy for hepatocellular carcinoma

Objective To evaluate the clinical effects of laparoscopic radiofrequency ablation （RFA） therapy for hepatocellular carcinoma （HCC）. Methods By the digital table method, 98 patients were diagnosed as HCC by clinic, and randomly divided into observation group （n=49） and control group （n=49）. The control group was treated with surgical resection, the observation group was treated with laparoseopic radiofrequency ablation therapy. The clinical curative effects, recurrence rates and postoperative complications were analyzed. Results CT cheeks and following up regular visits 1 month after operation, showed the effective rate and rate of descend of serous AFP value in observation Group （73.46% and 63.41%） were not statistically significantly different from those in control group （77.55% and 56.41%） （P 〉 0.05）, while the complete tumor elimination rates after first-time treatment in observation group and control group had statistical significant difference （P 〈 0.05）. For postoperative complications, the postoperative complications rate in observation group （10.20%） was lower than that in control group （24.48%）, with statistical significant differences （P 〈 0.05）. The days of postoperative hospitalization, length of operation and the average amount of bleeding in observation group were lower than those in control group（P 〈 0.05）. AST, ALT of two groups were significantly increased （P 〈 0.05）, and those of the control group increased significantly compared with the observation group （P 〈 0.05）. During a mean follow-up period of 31 months （12-43 months）, the recurrence rate of the two groups was not statistically significant （P 〉 0.05）. Conclusion Laparoscopic RFA therapy is safe and effective in the treatment of HCC lesions （ ≤ 5 cm）, which can be used as the preferred treatment method for small hepatoeellular carcinoma.