经皮射频消融术与腹腔镜肝切除术治疗原发性小肝癌的疗效及预后比较
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摘要
目的:比较经皮射频消融术与腹腔镜肝切除术治疗原发性小肝癌的疗效及预后。方法:回顾性分析2012年1月—2014年12月间收治的140例原发性小肝癌患者资料,其中80例行射频消融术(消融组),60例行腹腔镜肝切除术(腔镜组)。比较两组患者术后血清肝功能指标与肿瘤标志物水平的变化、并发症发生率、根治率、复发率及生存率。结果:术前两组的基线资料、肝功能指标及肿瘤标志物水平均无统计学差异(均P>0.05)。术后消融组肝功能指标先升后降,腔镜组则呈持续降低,消融组术后短期内丙氨酸氨基转移酶、天门冬氨酸氨基转移酶水平均明显高于腔镜组(均P<0.05);两组术后肿瘤标志物水平均逐渐降低,两组间差异无统计学意义(均P>0.05)。消融组术后并发症发生率明显低于腔镜组(3.75%vs. 20.00%,P=0.002)。两组根治率、复发率以及1、2、3年总生存率和无瘤生存率均无统计学差异(均P>0.05)。结论:两种手术方式对原发性小肝癌的疗效及预后无统计学差异,射频消融术后并发症较少,但对短期肝功能存在一定损害。
Objective: To compare the efficacy and prognosis of percutaneous radiofrequency ablation and laparoscopic hepatectomy in treatment of small hepatocellular carcinoma(HCC). Methods: The clinical data of 140 patients with small HCC treated from January 2012 to December 2014 were retrospectively analyzed. Of the patients, 80 cases underwent percutaneous radiofrequency ablation(ablation group) and 60 cases underwent laparoscopic hepatectomy(laparoscopic group). The changes in postoperative serum liver function parameters and tumor markers and incidence of postoperative complications, as well as the radical cure rate, and the recurrence and survival rates were compared between the two groups of patients.Results: There were no significant differences in baseline data and levels of liver function parameters and tumor markers between the two groups of patients before operation(all P>0.05). After operation, the liver function parameters in ablation group first rose and then fell, and declined continuously in laparoscopic group, and in the ablation group, the levels of alanine aminotransferase and aspartate aminotransferase were significantly higher than those in laparoscopic group for a short period of time after the operation(all P<0.05); the levels of tumor markers were gradually reduced in both groups, which showed no significant differences between the two groups(all P>0.05). The incidence of postoperative complications in ablation group was significantly lower than that in laparoscopic group(3.75% vs. 20.00%, P=0.002). There were no significant differences concerning the radical cure rate and the recurrence rate, and the 1-, 2-and 3-year survival rates between the two groups(all P>0.05). Conclusion: There is no evident difference in efficacy and prognosis between the two treatment methods in treatment of small HCC. Radiofrequency ablation is associated with fewer complications, but with short-term injury to liver function.
Objective: To compare the efficacy and prognosis of percutaneous radiofrequency ablation and laparoscopic hepatectomy in treatment of small hepatocellular carcinoma(HCC). Methods: The clinical data of 140 patients with small HCC treated from January 2012 to December 2014 were retrospectively analyzed. Of the patients, 80 cases underwent percutaneous radiofrequency ablation(ablation group) and 60 cases underwent laparoscopic hepatectomy(laparoscopic group). The changes in postoperative serum liver function parameters and tumor markers and incidence of postoperative complications, as well as the radical cure rate, and the recurrence and survival rates were compared between the two groups of patients.Results: There were no significant differences in baseline data and levels of liver function parameters and tumor markers between the two groups of patients before operation(all P>0.05). After operation, the liver function parameters in ablation group first rose and then fell, and declined continuously in laparoscopic group, and in the ablation group, the levels of alanine aminotransferase and aspartate aminotransferase were significantly higher than those in laparoscopic group for a short period of time after the operation(all P<0.05); the levels of tumor markers were gradually reduced in both groups, which showed no significant differences between the two groups(all P>0.05). The incidence of postoperative complications in ablation group was significantly lower than that in laparoscopic group(3.75% vs. 20.00%, P=0.002). There were no significant differences concerning the radical cure rate and the recurrence rate, and the 1-, 2-and 3-year survival rates between the two groups(all P>0.05). Conclusion: There is no evident difference in efficacy and prognosis between the two treatment methods in treatment of small HCC. Radiofrequency ablation is associated with fewer complications, but with short-term injury to liver function.
引文
[1]She WH,Chan AC,Cheung TT,et al.Short-and long-term impact of reoperation for complications after major hepatectomy for hepatocellular carcinoma[J].Surgery,2016,160(5):1236-1243.
[2]牛广林.手术切除与经皮射频消融治疗小肝癌的临床对比研究[J].中国医药指南,2013,11(31):466-467.Niu GL.Clinical comparison between surgical resection and percutaneous radiofrequency ablation in treatment of small liver cancers[J].Guide of China Medicine,2013,11(31):466-467.
[3]Rossi S,Di Stasi M,Buscarini E,et al.Percutaneous RF interstitial thermal ablation in the treatment of hepatic cancer[J].AJR Am JRoentgenol,1996,167(3):759-768.doi:10.2214/ajr.167.3.8751696
[4]中国抗癌协会肝癌专业委员会,中华医学会肝病学分会肝癌学组,中国抗癌协会病理专业委员会,等.原发性肝癌规范化病理诊断指南(2015年版)[J].中华肝胆外科杂志,2015,21(3):145-151.doi:10.3760/cma.j.issn.1007-8118.2015.03.001.Chinese Society of Liver Cancer,Liver Cancer Group,Society of Hepatology,Chinese Medical Association,Chinese Society of Pathology,et al.Evidence-based practice guidelines for the standardized pathological diagnosis of primary liver cancer(2015edition)[J].Chinese Journal of Hepatobiliary Surgery,2015,21(3):145-151.doi:10.3760/cma.j.issn.1007-8118.2015.03.001.
[5]刘江伟,黄建钊,孙倩,等.射频消融术和手术治疗原发性肝癌对照分析[J].中国医学计算机成像杂志,2016,22(5):444-450.doi:10.3969/j.issn.1006-5741.2016.05.011.Liu JW,Huang JZ,Sun Q,et al.Clinical Analysis of the Radiofrequency Ablation for Primary Hepatic Carcinoma[J].Chinese Computed Medical Imaging,2016,22(5):444-450.doi:10.3969/j.issn.1006-5741.2016.05.011.
[6]Johnson PJ,Berhane S,Kagebayashi C,et al.Assessment of liver function in patients with hepatocellular carcinoma:a new evidencebased approach-the ALBI grade[J]J Clin Oncol,2015,33(6):550-558.doi:10.1200/JCO.2014.57.9151.
[7]Schulz PO,Ferreira FG,Nascimento Mde F,et al.Association of nonalcoholic fatty liver disease and liver cancer[J].World JGastroenterol,2015,21(3):913-918.doi:10.3748/wjg.v21.i3.913.
[8]徐治军,许戈良,马金良,等.超声引导下经皮射频消融与腹腔镜肝切除术治疗原发性小肝癌的对比研究[J].中国普通外科杂志,2017,26(1):18-24.doi:10.3978/j.issn.1005-6947.2017.01.004.Xu ZJ,Xu GL,Ma JL,et al.Ultrasound guided percutaneous radiofrequency ablation versus laparoscopic hepatectomy for small primary liver cancer[J].Chinese Journal of General Surgery,2017,26(1):18-24.doi:10.3978/j.issn.1005-6947.2017.01.004.
[9]王细文,王巍威,赵宏智,等.经皮射频消融术与腹腔镜肝癌切除术治疗小肝癌的临床疗效观察[J].西部医学,2017,29(2):183-186.doi:10.3969/j.issn.1672-3511.2017.02.008.Wang X W,Wang WW,Zhao H Z,et al.Comparison of percutaneous radiofrequency ablation and laparoscopic liver resection in treatment of small hepatocellular carcinoma[J].Medical Journal of West China,2017,29(2):183-186.doi:10.3969/j.issn.1672-3511.2017.02.008.
[10]Kim Y,Ejaz A,Tayal A,et al.Temporal trends in population based death rates associated with chronic liver disease and liver cancer in the United States over the last 30 years[J].Cancer,2014,120(19):3058-3065.doi:10.1002/cncr.28843.
[11]Yip CW,Cheung PF,Leung IC,et al.Granulin-epithelin precursor interacts with heparan sulfate on liver cancer cells[J].Carcinogenesis,2014,35(11):2485-2494.doi:10.1093/carcin/bgu164.
[12]曾鹏,周乐杜,王栋,等.射频消融治疗小肝癌疗效及预后因素分析[J].中国普通外科杂志,2014,23(7):904-909.doi:10.7659/j.issn.1005-6947.2014.07.008.Zeng P,Zhou LD,Wang D,et al.Radiofrequency ablation for small hepatocellular carcinoma:efficacy and prognostic factors[J].Chinese Journal of General Surgery,2014,23(7):904-909.doi:10.7659/j.issn.1005-6947.2014.07.008.
[13]Imai K,Yamashita YI,Yusa T,et al.Microvascular Invasion in Small-sized Hepatocellular Carcinoma:Significance for Outcomes Following Hepatectomy and Radiofrequency Ablation[J].Anticancer Res,2018,38(2):1053-1060.doi:10.21873/anticanres.12322.
[14]王艳红.肝癌的综合治疗之我见[J].中华临床医师杂志:电子版,2015,9(19):3488-3493.doi:10.3877/cma.j.issn.1674-0785.2015.19.002.Wang YH.Comprehensive treatment of liver cancer[J].Chinese Journal of Clinicians:Electronic Edition,2015,9(19):3488-3493.doi:10.3877/cma.j.issn.1674-0785.2015.19.002.
[15]Tsukamoto M,Yamashita YI,Imai K,et al.Long-term Favorable Outcomes of Radiofrequency Ablation for Hepatocellular Carcinoma as an Initial Treatment:A Single-center Experience Over a 10-Year Period[J].Anticancer Res,2018,38(2):1047-1052.doi:10.21873/anticanres.12321.
[16]张发鹏,袁荣发,张引,等.腹腔镜下射频消融治疗小肝癌的临床疗效分析[J].中国普通外科杂志,2018,27(1):35-41.doi:10.3978/j.issn.1005-6947.2018.01.006.Zhang FP,Yuan RF,Zhang Y,et al.Clinical efficacy of laparoscopic radiofrequency ablation in treatment of small primary hepatocellular carcinoma[J].Chinese Journal of General Surgery,2018,27(1):35-41.doi:10.3978/j.issn.1005-6947.2018.01.006.
[17]李柱,乔安意,王翀,等.超声引导下射频消融术治疗肝癌疗效及预后影响因素分析[J].中国医学物理学杂志,2017,34(10):1058-1063.doi:10.3969/j.issn.1005-202X.2017.10.018.Li Z,Qiao AY,Wang C,et al.Therapeutic effect of ultrasoundguided radiofrequency ablation on hepatocellular carcinoma and the factors affecting prognosis[J].Chinese Journal of Medical Physics,2017,34(10):1058-1063.doi:10.3969/j.issn.1005-202X.2017.10.018.
[18]Rong Z,Lu Q,Yan J.Totally laparoscopic radiofrequency-assisted liver partition with portal vein ligation for hepatocellular carcinoma in cirrhotic liver[J].Medicine(Baltimore),2017,96(51):e9432.doi:10.1097/MD.0000000000009432.
[19]周勇旭,陆朝阳,潘博,等.射频消融术治疗肝癌的研究新进展[J].现代生物医学进展,2015,15(5):991-994.doi:10.13241/j.cnki.pmb.2015.05.050.Zhou YX,Lu CY,Pan B,et al.The Progress of Radiofrequency Ablation for the Treatment of Liver Cancer[J].Progress in Modern Biomedicine,2015,15(5):991-994.doi:10.13241/j.cnki.pmb.2015.05.050.
[20]王冠秀,白春辉,石伟欣,等.以生存率及复发率探讨切除手术与射频消融治疗小肝癌的长远效果差异[J].现代中西医结合杂志,2015,24(3):290-292.doi:10.3969/j.issn.1008-8849.2015.03.025.Wang GX,Bai CH,Shi WX,et al.Comparison of the short-and long-term efficacy of surgical resection of radiofrequency ablation for small liver cancer by survival and recurrence rates[J].Modern Journal of Integrated Traditional Chinese and Western Medicine,2015,24(3):290-292.doi:10.3969/j.issn.1008-8849.2015.03.025.
[21]Zhang L,Xie XY,Chen Y,et al.Hepatitis B surface antigen predicts recurrence after radiofrequency ablation in patients with low hepatitis B virus loads[J].Medicine(Baltimore),2017,96(52):e9377.doi:10.1097/MD.0000000000009377.
[22]Lai C,Jin RA,Liang X,et al.Comparison of laparoscopic hepatectomy,percutaneous radiofrequency ablation and open hepatectomy in the treatment of small hepatocellular carcinoma[J].J Zhejiang Univ Sci B,2016,17(3):236-246.doi:10.1631/jzus.B1500322.
[23]肖金成,郭雷鸣,康鑫鑫,等.射频消融术与立体定向放射治疗原发性小肝癌的临床效果比较[J].肿瘤防治研究,2017,44(12):831-835.doi:10.3971/j.issn.1000-8578.2017.17.0613.Xiao JC,Guo LM,Kang XX,et al.Comparison of Efficiency and Safety Between Radiofrequency Ablation and Stereotactic Body Radiotherapy on Primary Small Hepatocellular Carcinoma[J].Cancer Research on Prevention and Treatment,2017,44(12):831-835.doi:10.3971/j.issn.1000-8578.2017.17.0613.
[24]Bertrand J,Caillol F,Borentain P,et al.Percutaneous hepatic radiofrequency for hepatocellular carcinoma:results and outcome of 46 patients[J].Hepat Med,2015,7:21-27.doi:10.2147/HMER.S67940.
[2]牛广林.手术切除与经皮射频消融治疗小肝癌的临床对比研究[J].中国医药指南,2013,11(31):466-467.Niu GL.Clinical comparison between surgical resection and percutaneous radiofrequency ablation in treatment of small liver cancers[J].Guide of China Medicine,2013,11(31):466-467.
[3]Rossi S,Di Stasi M,Buscarini E,et al.Percutaneous RF interstitial thermal ablation in the treatment of hepatic cancer[J].AJR Am JRoentgenol,1996,167(3):759-768.doi:10.2214/ajr.167.3.8751696
[4]中国抗癌协会肝癌专业委员会,中华医学会肝病学分会肝癌学组,中国抗癌协会病理专业委员会,等.原发性肝癌规范化病理诊断指南(2015年版)[J].中华肝胆外科杂志,2015,21(3):145-151.doi:10.3760/cma.j.issn.1007-8118.2015.03.001.Chinese Society of Liver Cancer,Liver Cancer Group,Society of Hepatology,Chinese Medical Association,Chinese Society of Pathology,et al.Evidence-based practice guidelines for the standardized pathological diagnosis of primary liver cancer(2015edition)[J].Chinese Journal of Hepatobiliary Surgery,2015,21(3):145-151.doi:10.3760/cma.j.issn.1007-8118.2015.03.001.
[5]刘江伟,黄建钊,孙倩,等.射频消融术和手术治疗原发性肝癌对照分析[J].中国医学计算机成像杂志,2016,22(5):444-450.doi:10.3969/j.issn.1006-5741.2016.05.011.Liu JW,Huang JZ,Sun Q,et al.Clinical Analysis of the Radiofrequency Ablation for Primary Hepatic Carcinoma[J].Chinese Computed Medical Imaging,2016,22(5):444-450.doi:10.3969/j.issn.1006-5741.2016.05.011.
[6]Johnson PJ,Berhane S,Kagebayashi C,et al.Assessment of liver function in patients with hepatocellular carcinoma:a new evidencebased approach-the ALBI grade[J]J Clin Oncol,2015,33(6):550-558.doi:10.1200/JCO.2014.57.9151.
[7]Schulz PO,Ferreira FG,Nascimento Mde F,et al.Association of nonalcoholic fatty liver disease and liver cancer[J].World JGastroenterol,2015,21(3):913-918.doi:10.3748/wjg.v21.i3.913.
[8]徐治军,许戈良,马金良,等.超声引导下经皮射频消融与腹腔镜肝切除术治疗原发性小肝癌的对比研究[J].中国普通外科杂志,2017,26(1):18-24.doi:10.3978/j.issn.1005-6947.2017.01.004.Xu ZJ,Xu GL,Ma JL,et al.Ultrasound guided percutaneous radiofrequency ablation versus laparoscopic hepatectomy for small primary liver cancer[J].Chinese Journal of General Surgery,2017,26(1):18-24.doi:10.3978/j.issn.1005-6947.2017.01.004.
[9]王细文,王巍威,赵宏智,等.经皮射频消融术与腹腔镜肝癌切除术治疗小肝癌的临床疗效观察[J].西部医学,2017,29(2):183-186.doi:10.3969/j.issn.1672-3511.2017.02.008.Wang X W,Wang WW,Zhao H Z,et al.Comparison of percutaneous radiofrequency ablation and laparoscopic liver resection in treatment of small hepatocellular carcinoma[J].Medical Journal of West China,2017,29(2):183-186.doi:10.3969/j.issn.1672-3511.2017.02.008.
[10]Kim Y,Ejaz A,Tayal A,et al.Temporal trends in population based death rates associated with chronic liver disease and liver cancer in the United States over the last 30 years[J].Cancer,2014,120(19):3058-3065.doi:10.1002/cncr.28843.
[11]Yip CW,Cheung PF,Leung IC,et al.Granulin-epithelin precursor interacts with heparan sulfate on liver cancer cells[J].Carcinogenesis,2014,35(11):2485-2494.doi:10.1093/carcin/bgu164.
[12]曾鹏,周乐杜,王栋,等.射频消融治疗小肝癌疗效及预后因素分析[J].中国普通外科杂志,2014,23(7):904-909.doi:10.7659/j.issn.1005-6947.2014.07.008.Zeng P,Zhou LD,Wang D,et al.Radiofrequency ablation for small hepatocellular carcinoma:efficacy and prognostic factors[J].Chinese Journal of General Surgery,2014,23(7):904-909.doi:10.7659/j.issn.1005-6947.2014.07.008.
[13]Imai K,Yamashita YI,Yusa T,et al.Microvascular Invasion in Small-sized Hepatocellular Carcinoma:Significance for Outcomes Following Hepatectomy and Radiofrequency Ablation[J].Anticancer Res,2018,38(2):1053-1060.doi:10.21873/anticanres.12322.
[14]王艳红.肝癌的综合治疗之我见[J].中华临床医师杂志:电子版,2015,9(19):3488-3493.doi:10.3877/cma.j.issn.1674-0785.2015.19.002.Wang YH.Comprehensive treatment of liver cancer[J].Chinese Journal of Clinicians:Electronic Edition,2015,9(19):3488-3493.doi:10.3877/cma.j.issn.1674-0785.2015.19.002.
[15]Tsukamoto M,Yamashita YI,Imai K,et al.Long-term Favorable Outcomes of Radiofrequency Ablation for Hepatocellular Carcinoma as an Initial Treatment:A Single-center Experience Over a 10-Year Period[J].Anticancer Res,2018,38(2):1047-1052.doi:10.21873/anticanres.12321.
[16]张发鹏,袁荣发,张引,等.腹腔镜下射频消融治疗小肝癌的临床疗效分析[J].中国普通外科杂志,2018,27(1):35-41.doi:10.3978/j.issn.1005-6947.2018.01.006.Zhang FP,Yuan RF,Zhang Y,et al.Clinical efficacy of laparoscopic radiofrequency ablation in treatment of small primary hepatocellular carcinoma[J].Chinese Journal of General Surgery,2018,27(1):35-41.doi:10.3978/j.issn.1005-6947.2018.01.006.
[17]李柱,乔安意,王翀,等.超声引导下射频消融术治疗肝癌疗效及预后影响因素分析[J].中国医学物理学杂志,2017,34(10):1058-1063.doi:10.3969/j.issn.1005-202X.2017.10.018.Li Z,Qiao AY,Wang C,et al.Therapeutic effect of ultrasoundguided radiofrequency ablation on hepatocellular carcinoma and the factors affecting prognosis[J].Chinese Journal of Medical Physics,2017,34(10):1058-1063.doi:10.3969/j.issn.1005-202X.2017.10.018.
[18]Rong Z,Lu Q,Yan J.Totally laparoscopic radiofrequency-assisted liver partition with portal vein ligation for hepatocellular carcinoma in cirrhotic liver[J].Medicine(Baltimore),2017,96(51):e9432.doi:10.1097/MD.0000000000009432.
[19]周勇旭,陆朝阳,潘博,等.射频消融术治疗肝癌的研究新进展[J].现代生物医学进展,2015,15(5):991-994.doi:10.13241/j.cnki.pmb.2015.05.050.Zhou YX,Lu CY,Pan B,et al.The Progress of Radiofrequency Ablation for the Treatment of Liver Cancer[J].Progress in Modern Biomedicine,2015,15(5):991-994.doi:10.13241/j.cnki.pmb.2015.05.050.
[20]王冠秀,白春辉,石伟欣,等.以生存率及复发率探讨切除手术与射频消融治疗小肝癌的长远效果差异[J].现代中西医结合杂志,2015,24(3):290-292.doi:10.3969/j.issn.1008-8849.2015.03.025.Wang GX,Bai CH,Shi WX,et al.Comparison of the short-and long-term efficacy of surgical resection of radiofrequency ablation for small liver cancer by survival and recurrence rates[J].Modern Journal of Integrated Traditional Chinese and Western Medicine,2015,24(3):290-292.doi:10.3969/j.issn.1008-8849.2015.03.025.
[21]Zhang L,Xie XY,Chen Y,et al.Hepatitis B surface antigen predicts recurrence after radiofrequency ablation in patients with low hepatitis B virus loads[J].Medicine(Baltimore),2017,96(52):e9377.doi:10.1097/MD.0000000000009377.
[22]Lai C,Jin RA,Liang X,et al.Comparison of laparoscopic hepatectomy,percutaneous radiofrequency ablation and open hepatectomy in the treatment of small hepatocellular carcinoma[J].J Zhejiang Univ Sci B,2016,17(3):236-246.doi:10.1631/jzus.B1500322.
[23]肖金成,郭雷鸣,康鑫鑫,等.射频消融术与立体定向放射治疗原发性小肝癌的临床效果比较[J].肿瘤防治研究,2017,44(12):831-835.doi:10.3971/j.issn.1000-8578.2017.17.0613.Xiao JC,Guo LM,Kang XX,et al.Comparison of Efficiency and Safety Between Radiofrequency Ablation and Stereotactic Body Radiotherapy on Primary Small Hepatocellular Carcinoma[J].Cancer Research on Prevention and Treatment,2017,44(12):831-835.doi:10.3971/j.issn.1000-8578.2017.17.0613.
[24]Bertrand J,Caillol F,Borentain P,et al.Percutaneous hepatic radiofrequency for hepatocellular carcinoma:results and outcome of 46 patients[J].Hepat Med,2015,7:21-27.doi:10.2147/HMER.S67940.