经腹腔镜引导射频消融术治疗肝细胞癌78例疗效分析  

Effect of laparoscopic radiofrequency ablation for 78 cases with hepatocellular carcinoma

作　　者：陈楷[1] 薛平[1] 曹良启[1] 蒋小峰[1] 卢海武[1] 郑强[1] 温子龙[1] 

机构地区：[1]广州医科大学附属第二医院肝胆外科,510260

出　　处：《中华普通外科学文献（电子版）》2013年第6期23-27,共5页Chinese Archives of General Surgery(Electronic Edition)

基　　金：广东省科技计划项目(2010B031600141)

摘　　要：目的探讨经腹腔镜射频消融术(LRFA)治疗肝细胞癌的临床应用并评价疗效。方法回顾性分析2009年2月至2011年2月间收治的78例肝细胞癌(HCC)患者的临床资料。将符合纳入标准的病例分为LRFA组32例,经皮射频消融术(PRFA组)21例和手术切除组25例。检测各组术前和术后肝功能和AFP的变化,应用视觉模拟评分法(VAS)评价患者术后疼痛缓解程度,进行术后KPS功能状态评分,观察术后并发症发生率和肝内复发率、无瘤生存率、总生存率,并进行生存分析。结果 (1)术后3月时,3组的ALT、AST、GGT、ALP、AFP各指标明显低于术前(P<0.05);ALB术后1周下降明显,至术后1月逐渐恢复正常(P<0.05);3组的TBIL指标差异无统计学意义。(2)LRFA组和PRFA组术后3级疼痛明显低于手术切除组;3组VAS疼痛评价结果差异有统计学意义(P<0.05)。(3)LRFA组的并发症发生率低于其他两组(P=0.012,0.007),手术切除组的伤口感染发生率与LRFA组比较,差异有统计学意义(χ2=7.015,P=0.008)。(4)术后6月前,手术切除组的KPS评分低于LRFA组和PRFA组,而后各时间点3组评分相近。(5)3组术后6、12、18、24个月的肝内复发率、无瘤生存率和总生存率差异无统计学意义,LRFA组的生存曲线均高于PRFA组和手术切除组。(6)手术切除组平均手术时间、住院时间和费用明显高于LRFA组(P<0.05),LRFA组与PRFA组差异无统计学意义。结论 LRFA治疗HCC兼具腹腔镜和射频消融的优点,术后肝功能和AFP的恢复程度与PRFA、手术治疗方法相当。该方法有助于患者术后疼痛缓解,并发症少,肝内复发率低,无瘤生存率、总生存率高,是一种安全微创、疗效确切的肝癌治疗方法,值得临床广泛推广。Objective To investigate the clinical application and effect of laparoscopic radiofrequency ablation（LRFA） in treating hepatocellular carcinoma. Methods The clinical data of 78 patients with HCC treated in the Second Affiliated Hospital to Guangzhou Medical University were collected and retrospectively analyzed from February 2009 to February 2011. The patients were divided into 3 groups,LRFA group（n=32）,PRFA group（n=21）,and surgery group（n=25）. The changes of liver function and AFP in every group were detected before and after the surgery. Visual analogue scale（VAS） was used to assess the degree of pain release and KPS was used to evaluate the whole function after the operation. Moreover,the complications and the related survival rates of the three groups were observed and analyzed after operations.Results（1） ALT,AST,GGT,ALP,and AFP of the three groups all decreased apparently three months after the surgery（P0.05）. ALB descended one week after surgery,then rose gradually to normal in one month（P0.05）. TBIL had no statistical difference in each group.（2） The pain degree of group LRFA and PRFA was obviously lower than the surgery group,and had statistical differences（P0.05）.（3） The rate of complications of the LRFA group was lower than the other two groups（P=0.012,0.007）. The wound infection between open surgery group and LRFA group showed statistical differences（χ2=7.015,P=0.008）.（4） 6 months after the surgery,KPS score in the surgery group was lower,but in the following time,the three groups got similar scores.（5）The intrahepatic recurrence rate,tumor-free survival rate,and overall survival rate of the three groups had no statistical differences 6-,12-,18-,and 24-month after the operation. Survival curve of group LRFA was relatively higher.（6） The average surgery time,length of hospital stay,and hospital costs of the operation group were all much higher in the three groups（P0.05）,while the other two groups had no statistical differences. Conclus

关 键 词：腹腔镜 射频消融 肝细胞癌 疗效分析 

分 类 号：R735.7[医药卫生—肿瘤]