手术切除与开腹射频消融治疗大肝癌的疗效分析

2016-04-23徐博施红旗温州医科大学附属第一医院肝胆外科浙江温州325000

肝胆胰外科杂志 2016年2期

关键词：肝癌

徐博，施红旗（温州医科大学附属第一医院　肝胆外科，浙江　温州　325000）

手术切除与开腹射频消融治疗大肝癌的疗效分析

徐博，施红旗
（温州医科大学附属第一医院肝胆外科，浙江温州325000）

[摘要]目的比较手术切除与开腹射频消融治疗大肝癌的疗效。方法收集2012年1月至2015年9月我院原发性大肝癌患者58例，其中行开腹肝癌切除术35例，开腹射频消融术23例。比较两组患者术前及术后的相关临床指标及术后生存率。结果术前，开腹切除组肝功能分级（P=0.021）、凝血酶原时间（P=0.034）、总胆红素（P=0.016）和肝硬化程度（P=0.033）明显好于开腹射频消融组。而术中输血量（P=0.025）、术后第2天ALT（P=0.008）及AST（P=0.017）指标，开腹切除组显著差于开腹射频消融组。两组术后严重并发症发生率及术后生存率无明显差别（P=0.652）。结论对于肝功能稍差的大肝癌患者，开腹射频消融术有利于减小手术风险，控制术后并发症，医师可根据患者综合情况进行术式选择。

[关键词]肝癌；肝切除；开腹射频消融

Hepatectomy versus open radiofrequency ablation procedures for large liver cancer:analysis of the curative effect

XU Bo,SHI Hong-qi.Department of Hepatobiliary Surgery,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325000,China

Abstract objectiveTo compare the efficacy of hepatectomy and open radiofrequency ablation(RFA)procedure for large liver cancer.MethodsThe clinical data of 58 patients(23 patients underwent hepatectomy and 35 patients underwent open radiofrequency ablation procedure)with large liver cancer from Jan.2012 to Sep.2015 were collected and retrospectively analyzed.Survival curves were calculated and compared by the Logrank test.ResultsThe comparison results showed that,before the surgery,the hepatectomy group had better liver function classification(P=0.021); shorter prothrombin time(P=0.034),lower total bilirubin level(P=0.008),and lower degree of cirrhosis(P=0.033).But the amount of blood fransfusion was larger(P=0.025),the ALT and AST levels at day 2 post-operative were higer(P=0.008,P=0.017)in hepatectomy group.There was no significant difference between two groups in post-operative complications and overall survival rate(P=0.652).ConclusionFor large liver cancer patients with poor liver function,open radiofrequency ablation procedure can reduce surgical risk and post-operative complication rate.Operation choice should be carried out according to general condition of patients.

Key words liver cancer; hepatectomy; open radiofrequency ablation

随着肝癌治疗技术的迅速发展，其治疗方式推陈出新。肝部分切除和射频消融（radiofrequency ablation，RFA）治疗都是针对局部的治疗，但是可接受手术切除的肝癌患者不到30%，其中绝大部分都是大肝癌患者。因此，除了手术切除之外的开腹射频消融术成为治疗大肝癌的一种重要手段，但其疗效还有待进一步验证。我们通过比较我院58例手术切除与开腹射频消融治疗的大肝癌患者，初步评价其疗效，现报道如下。