论文部分内容阅读
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 of laparoscopic radiofrequency ablation (LRFA) in the treatment of hepatocellular carcinoma and evaluate its curative effect. Methods The clinical data of 78 patients with hepatocellular carcinoma (HCC) admitted from February 2009 to February 2011 were retrospectively analyzed. The patients who met the inclusion criteria were divided into three groups: LRFA group (32 cases), percutaneous radiofrequency ablation (PRFA group), 21 cases and surgical resection group (25 cases). The changes of liver function and AFP in each group before and after operation were evaluated. Visual acuity score (VAS) was used to evaluate the degree of postoperative pain relief and score of postoperative KPS functional status. The incidence of postoperative complications and intrahepatic recurrence Rate, tumor-free survival, overall survival, and survival analysis. Results (1) At 3 months after operation, the indexes of ALT, AST, GGT, ALP and AFP in 3 groups were significantly lower than those before operation (P <0.05); ALB decreased significantly at 1 week and gradually recovered to January after operation Normal (P <0.05). There was no significant difference in TBIL between the three groups. (2) Grade 3 pain in LRFA group and PRFA group was significantly lower than that in surgical resection group. VAS pain evaluation results in 3 groups were statistically significant (P <0.05). (3) The incidence of complications in LRFA group was lower than that in other two groups (P = 0.012,0.007). The incidence of wound infection in surgical resection group was significantly different from LRFA group (χ2 = 7.015, P = 0.008) . (4) Before 6 months, the KPS scores in the surgical resection group were lower than those in the LRFA group and the PRFA group, and then the scores of the three groups were similar at each time point. (5) There was no significant difference in intrahepatic recurrence, tumor-free survival and overall survival at 6, 12, 18 and 24 months after operation in all three groups. The survival curves in LRFA group were higher than those in PRFA group and resection group . (6) The average operation time, hospitalization time and cost in surgical resection group were significantly higher than those in LRFA group (P <0.05). There was no significant difference between LRFA group and PRFA group. Conclusion LRFA has the advantages of laparoscopy and radiofrequency ablation. The postoperative recovery of liver function and AFP is comparable with PRFA and surgical treatment. The method is helpful to postoperative patients with pain relief, fewer complications, low intrahepatic recurrence rate, tumor-free survival rate and high overall survival rate. It is a safe minimally invasive and effective treatment of liver cancer and is worthy of widespread clinical promotion.