陈志军

摘 要 目的：對比经皮射频消融术与传统手术切除术治疗小肝癌的效果。方法：将采用经皮射频消融术处理的肝癌87例纳入消融组、传统手术处理的105例纳入手术组。对比近远期疗效指标。结果：射频组与手术组的近期疗效、24个月存活率、无瘤存活率差异无统计学意义（P>0.05）。射频组手术时间、卧床时间、住院时间、术后72 h ALT、AST、ALB变化率低于手术组，术后12个月AFP、术后24个月后的AFP与CEA高于手术组（P<0.05）。结论：经皮射频消融术有明显的微创性，对肝功能损伤更轻，但术后的恶性肿瘤标志物水平更高。

关键词 小肝癌 手术切除 经皮射频消融术 临床疗效

中图分类号：R735.7； R730.56 文献标志码：A 文章编号：1006-1533（2018）23-0085-04

Comparative study on the effects of percutaneous radiofrequency ablation and traditional surgical resection for small hepatocellular carcinoma

CHEN Zhijun*

（Department of Surgery， the Central Hospital of Weishi County， Henan Weishi 475500， China）

ABSTRACT Objective： To compare the effect of percutaneous radiofrequency ablation and traditional surgical resection in the treatment of small hepatocellular carcinoma. Methods： Eighty-seven cases of liver cancer treated with percutaneous radiofrequency ablation were selected as a radiofrequency group and 105 cases treated with traditional operation as an operation group. The short- and long-term curative effect indexes were compared. Results： There were no significant differences between the two groups in short-term curative effect， 24 months survival rate and survival rate without tumor （P>0.05）. The operation time， bed rest time， hospitalization time and the change rate in ALT， AST and ALB at postoperative 72 hours were lower and the AFP level at postoperative 12 months and the AFP and CEA levels at postoperative 24 months were higher in the radiofrequency group than the operation group （P<0.05）. Conclusion： Percutaneous radiofrequency ablation has obviously minimally invasive effect and less injury to liver function， but the levels of postoperative malignant tumor markers are higher.

KEY WORDS small hepatocellular carcinoma； surgical resection； percutaneous radiofrequency ablation； clinical efficacy

社会大众谈癌色变，恶性肿瘤成为居民死亡的常见病因之一。肝癌是我国发生率和死亡率最高的十大恶性肿瘤之一，保守估计年新增患者（15～18）万例，年死亡（12～15）万例，因肝硬化等相关疾病发生率上升、高病毒性肝炎发生率上升、人口年龄的增长、环境污染等原因，肝癌发生率快速上升[1-2]。小肝癌预后相对较好，手术是首选的治疗方法。可供选择的治疗方法包括经皮射频消融术与传统手术切除术，目前关于不同手术的疗效仍然存在争议。本文采用回顾性分析，评价经皮射频消融术的优势和利弊。

1 资料及方法

1.1 一般资料

采用回顾性分析2012年1月—2015年12月笔者所在医院收治的小肝癌患者。纳入标准：①临床资料完整；②小肝癌，病灶直径≤3 cm，单发肿瘤，无肝外转移、临近器官侵犯、脉管癌栓、恶性腹水；③肝功能Child-pugh A～B级，可耐受；④知情同意。排除标准：①手术禁忌证，如凝血功能异常；②无法进行手术切除；③临床资料不完整；④随访时间≤24个月。其……