腹腔镜下射频消融治疗小肝癌的临床疗效分析
| 作者: |
1张发鹏,
1袁荣发,
1张引,
1余晓雯,
1王文龙,
1欧阳永鹏,
1伍明明,
1罗志强
1 南昌大学第二附属医院 肝胆外科，江西 南昌 330006 |
| 通讯: |
罗志强
Email: zqluo999@163.com |
| DOI: | 10.3978/.2018.01.006 |
| 基金: | 江西省科学技术厅科技计划基金资助项目（20133BBG70067）。 |
摘要
目的：探讨腹腔镜下射频消融（LRFA）治疗原发性小肝癌的临床效果。
方法：回顾性分析2011年8月—2013年10月南昌大学第二附属医院行LRFA治疗的30例小肝癌患者（LRFA组）以及同期行经皮射频消融（PRFA，PRFA组）和手术切除（手术切除组）各30例的小肝癌患者临床资料。比较3组患者的相关临床指标。
结果：3组患者术前一般资料具有可比性，所有患者均顺利完成手术。术后，3组AFP水平均较术前明显降低（均P<0.05），但3组间AFP水平无统计学差异（P>0.05）；3组肝功能指标均较术前明显升高（均P<0.05），但手术切除组较另两组升高程度大、恢复慢（均P<0.05）。在手术时间、术中出血量、围手术期并发症、住院时间方面，LRFA组与PRFA组均优于手术切除组（均P<0.05），而LRFA组手术时间长于PRFA组（80.7 min vs. 45.2 min，P<0.05），并发症发生率低于PRFA组（6.7% vs. 26.7%，P<0.05）；术后1个月，LRFA组和手术切除组肿瘤完全清除率均为100%，而PRFA组为86.7%，两组间差异有统计学意义（P<0.05）。LRFA组、PRFA组、手术切除组3年复发率分别为33.3%、60.0%、26.7%；3年无瘤生存率分别为66.7%、40.0%、73.3%；3年总生存率分别为86.7%、76.7%、90.0%，其中，PRFA组的3年无瘤生存率明显低于另两个组，复发率明显高于另两组（均P<0.05），而LRFA组和手术切除组之间无瘤生存率及复发率差异无统计学意义（均P>0.05）；3组患者3年总生存率差异无统计学意义（P=0.302）。
结论：对于原发性小肝癌，LRFA较PRFA消融率高，且远期疗效与开腹手术相当，同时具有微创、术后恢复快的优点，可作为小肝癌的首选治疗手段之一。
关键词：
癌，肝细胞；导管消融术；腹腔镜；预后
方法：回顾性分析2011年8月—2013年10月南昌大学第二附属医院行LRFA治疗的30例小肝癌患者（LRFA组）以及同期行经皮射频消融（PRFA，PRFA组）和手术切除（手术切除组）各30例的小肝癌患者临床资料。比较3组患者的相关临床指标。
结果：3组患者术前一般资料具有可比性，所有患者均顺利完成手术。术后，3组AFP水平均较术前明显降低（均P<0.05），但3组间AFP水平无统计学差异（P>0.05）；3组肝功能指标均较术前明显升高（均P<0.05），但手术切除组较另两组升高程度大、恢复慢（均P<0.05）。在手术时间、术中出血量、围手术期并发症、住院时间方面，LRFA组与PRFA组均优于手术切除组（均P<0.05），而LRFA组手术时间长于PRFA组（80.7 min vs. 45.2 min，P<0.05），并发症发生率低于PRFA组（6.7% vs. 26.7%，P<0.05）；术后1个月，LRFA组和手术切除组肿瘤完全清除率均为100%，而PRFA组为86.7%，两组间差异有统计学意义（P<0.05）。LRFA组、PRFA组、手术切除组3年复发率分别为33.3%、60.0%、26.7%；3年无瘤生存率分别为66.7%、40.0%、73.3%；3年总生存率分别为86.7%、76.7%、90.0%，其中，PRFA组的3年无瘤生存率明显低于另两个组，复发率明显高于另两组（均P<0.05），而LRFA组和手术切除组之间无瘤生存率及复发率差异无统计学意义（均P>0.05）；3组患者3年总生存率差异无统计学意义（P=0.302）。
结论：对于原发性小肝癌，LRFA较PRFA消融率高，且远期疗效与开腹手术相当，同时具有微创、术后恢复快的优点，可作为小肝癌的首选治疗手段之一。
Clinical efficacy of laparoscopic radiofrequency ablation in treatment of small primary hepatocellular carcinoma
CorrespondingAuthor:LUO Zhiqiang Email: zqluo999@163.com
Abstract
Objective: To investigate the clinical efficacy of laparoscopic radiofrequency ablation (LRFA) in treatment of small primary hepatocellular carcinoma (HCC).
Methods: The clinical data of 30 patients with small HCC undergoing LRFA (LRFA group) during August 2011 to October 2013 along with 30 patients undergoing percutaneous radiofrequency ablation (PRFA, PRFA group) and 30 patients undergoing surgical resection for small HCC during the same period in the Second Affiliated Hospital of Nanchang University were retrospectively analyzed. The main clinical variables among the three groups of patients were compared.
Results: The preoperative data of the three groups of patients were comparable, and operations in all patients were successfully completed. After operation, the AFP levels in all the three groups were significantly decreased compared with their preoperative values (all P<0.05), while AFP levels showed no significant difference among the three groups (P>0.05); the liver function parameters in all the three groups were significantly increased compared with their preoperative values (all P<0.05), but their increasing amplitudes were greatest and recoveries were slowest in surgical resection group than those in the other two groups (all P<0.05). Both LRFA group and PRFA group were superior to surgical resection group in terms of operative time, intraoperative blood loss, perioperative complications and length of hospital stay (all P<0.05), while the operative time was longer and incidence of complications was lower in LRFA group than those in PRFA group (80.7 min vs. 45.2 min; 6.7% vs. 26.7%, both P<0.05). At one month after operation, rate of complete tumor removal in either LRFA group or surgical resection group was 100%, while in PRFA group was 86.7%, and the difference had statistical significance (P<0.05). The 3-year recurrence rates were 33.3%, 60% and 26.7%, the 3-year disease-free survival rates were 66.7%, 40.0% and 73.3%, and the 3-year overall survival rates were 86.7%, 76.7% and 90.0% for LRFA group, PRFA group and surgical resection group, respectively, where, the 3-year disease-free survival rate was lower and the 3-year recurrence rate was higher in PRFA group than those in the other two groups (all P<0.05), but they showed no significant difference between the latter groups (both P>0.05); there was no statistically significant difference in 3-year overall survival rate among the three groups (P=0.302).
Conclusion: For small HCC, LRFA has higher ablation rate than that of PRFA, and similar long-term efficacy to surgical resection, and meanwhile has advantages of minimal invasiveness and fast postoperative recovery. So, it can be used as one of the first treatment options for small HCC.
Keywords：
Carcinoma
Hepatocellular; Catheter Ablation; Laparoscopes; Prognosis
Methods: The clinical data of 30 patients with small HCC undergoing LRFA (LRFA group) during August 2011 to October 2013 along with 30 patients undergoing percutaneous radiofrequency ablation (PRFA, PRFA group) and 30 patients undergoing surgical resection for small HCC during the same period in the Second Affiliated Hospital of Nanchang University were retrospectively analyzed. The main clinical variables among the three groups of patients were compared.
Results: The preoperative data of the three groups of patients were comparable, and operations in all patients were successfully completed. After operation, the AFP levels in all the three groups were significantly decreased compared with their preoperative values (all P<0.05), while AFP levels showed no significant difference among the three groups (P>0.05); the liver function parameters in all the three groups were significantly increased compared with their preoperative values (all P<0.05), but their increasing amplitudes were greatest and recoveries were slowest in surgical resection group than those in the other two groups (all P<0.05). Both LRFA group and PRFA group were superior to surgical resection group in terms of operative time, intraoperative blood loss, perioperative complications and length of hospital stay (all P<0.05), while the operative time was longer and incidence of complications was lower in LRFA group than those in PRFA group (80.7 min vs. 45.2 min; 6.7% vs. 26.7%, both P<0.05). At one month after operation, rate of complete tumor removal in either LRFA group or surgical resection group was 100%, while in PRFA group was 86.7%, and the difference had statistical significance (P<0.05). The 3-year recurrence rates were 33.3%, 60% and 26.7%, the 3-year disease-free survival rates were 66.7%, 40.0% and 73.3%, and the 3-year overall survival rates were 86.7%, 76.7% and 90.0% for LRFA group, PRFA group and surgical resection group, respectively, where, the 3-year disease-free survival rate was lower and the 3-year recurrence rate was higher in PRFA group than those in the other two groups (all P<0.05), but they showed no significant difference between the latter groups (both P>0.05); there was no statistically significant difference in 3-year overall survival rate among the three groups (P=0.302).
Conclusion: For small HCC, LRFA has higher ablation rate than that of PRFA, and similar long-term efficacy to surgical resection, and meanwhile has advantages of minimal invasiveness and fast postoperative recovery. So, it can be used as one of the first treatment options for small HCC.