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目的探讨复发性小肝癌的外科治疗方法。方法回顾性分析2004年1月—2007年12月第1次手术后复发的小肝癌47例患者的临床资料。分为再次手术组和消融栓塞组,比较两组术后3年生存及复发情况。结果再次手术组24例,均行局部切除加肝动脉化疗泵植入行化疗栓塞。消融栓塞组23例,均行局部射频消融治疗加股动脉穿刺肝动脉插管化疗栓塞。再次手术组3年无瘤存活率(66.7%,16/24)高于消融栓塞者(47.8%,11/23)(P<0.05),手术切除肿瘤局部复发率(25.0%,6/24)低于消融栓塞(34.8%,8/23)(P<0.05)。直径<3 cm的肿瘤,采用手术或消融栓塞治疗者3年生存率和复发率差异无统计学意义(P>0.05)。但3～5 cm肿瘤采用手术治疗者3年生存率高于消融栓塞治疗,复发率低于消融栓塞治疗(均P<0.05)。结论临床医生在为复发性小肝癌患(<3 mm)者提供治疗方案时应当根据患者的具体情况并充分考虑患者意愿。对肿瘤为3～5 mm者则以手术为宜。
Objective To investigate the surgical treatment of recurrent small hepatocellular carcinoma. Methods The clinical data of 47 patients with small hepatocellular carcinoma who recurred after the first operation from January 2004 to December 2007 were retrospectively analyzed. Divided into re-operation group and ablation embolization group, compared the two groups after 3 years of survival and recurrence. Results In the reoperation group, 24 cases were treated with local excision and hepatic artery chemotherapy pump for chemoembolization. In the embolization group, 23 patients underwent radiofrequency catheter ablation and femoral artery embolization and hepatic arterial chemoembolization. The 3-year tumor-free survival rate (66.7%, 16/24) in the reoperation group was higher than that in the ablation and embolization group (47.8%, 11/23) (P <0.05) Less than ablation embolization (34.8%, 8/23) (P <0.05). There was no significant difference in the 3-year survival rates and recurrence rates of tumors with diameter less than 3 cm after operation or ablation and embolization (P> 0.05). However, the 3-year survival rate of surgical treatment for 3 ~ 5 cm tumor was higher than that of ablation and embolization, and the recurrence rate was lower than that of ablation and embolization (all P <0.05). Conclusion Clinicians should provide patients with recurrent small hepatocellular carcinoma (<3 mm) with treatment plans based on their specific circumstances and take patient wishes into account. The tumor is 3 ~ 5 mm surgery is appropriate.