CT-RFA与L-RFA治疗膈顶部小肝癌的对比研究
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摘要
目的:探讨CT引导下射频消融(CT-FRA)与腹腔镜下射频消融(L-RFA)治疗膈顶部复发性小肝癌的安全性、有效性以及两者费用差异。方法:根据治疗方案,将116例局部复发性肝癌患者分为CT-FRA组和L-RFA组,比较两组术中并发症、总生存时间、局部控制率、术后并发症、住院时间、住院费用。结果:两组在5年生存率(36. 7%vs 44. 6%,P=0. 428 9)以及5年疾病控制率(73. 3%vs 67. 9%,P=0. 889 7)方面差异无统计学意义;但与L-RFA组相比,CT-FRA组的住院时间更短(2. 8 d vs 4. 1 d,P <0. 000 1)、住院费用更少(19 217. 6元vs 25 553. 6元,P <0. 000 1)。结论:对于膈顶部复发性小肝癌,CT-RFA和L-RFA都是有效的治疗手段,但CT-RFA相对简便且更经济。
Objective: Computed tomography-guided radiofrequency ablation( CT-RFA) and laparoscopic RFA( L-RFA) have been used to treat intrahepatic recurrent small hepatocellular carcinoma( HCC) abutting the diaphragmatic dome. However,the therapeutic safety,efficacy,and hospital expense have never been compared between the two techniques due to the scarcity of the cases. Methods: In this retrospective study,116 patients were divided into two groups with a total of 151 local recurrent HCC lesions abutting the diaphragm. We compared overall survival( OS),local tumor progression( LTP),postoperative complications,and hospital stay and expense between the two groups. Results: Our findings revealed no significant differences in 5-year OS( 36. 7% vs44. 6%,P = 0. 428 9) or 5-year LTP( 73. 3% vs 67. 9%,P = 0. 889 7) between CT-RFA and group L-RFA.The overall hospital stay( 2. 8 days vs 4. 1 days,P < 0. 000 1) and cost( $ 19 217. 6 vs $ 25 553. 6,P < 0. 000 1)were significantly lower in group CT-RFA in comparison with group L-RFA. Conclusion: CT-RFA is relatively easy and economic for recurrent small HCC abutting the diaphragm,and both CT-RFA and L-RFA are effective techniques.
Objective: Computed tomography-guided radiofrequency ablation( CT-RFA) and laparoscopic RFA( L-RFA) have been used to treat intrahepatic recurrent small hepatocellular carcinoma( HCC) abutting the diaphragmatic dome. However,the therapeutic safety,efficacy,and hospital expense have never been compared between the two techniques due to the scarcity of the cases. Methods: In this retrospective study,116 patients were divided into two groups with a total of 151 local recurrent HCC lesions abutting the diaphragm. We compared overall survival( OS),local tumor progression( LTP),postoperative complications,and hospital stay and expense between the two groups. Results: Our findings revealed no significant differences in 5-year OS( 36. 7% vs44. 6%,P = 0. 428 9) or 5-year LTP( 73. 3% vs 67. 9%,P = 0. 889 7) between CT-RFA and group L-RFA.The overall hospital stay( 2. 8 days vs 4. 1 days,P < 0. 000 1) and cost( $ 19 217. 6 vs $ 25 553. 6,P < 0. 000 1)were significantly lower in group CT-RFA in comparison with group L-RFA. Conclusion: CT-RFA is relatively easy and economic for recurrent small HCC abutting the diaphragm,and both CT-RFA and L-RFA are effective techniques.
引文
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[13] SARLI L,COSTI R,SANSEBASTIANO G,et al. Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy[J]. Br J Surg,2000,87(9):1161-1165.
[14]FITZGERALD S D,ANDRUS C H,BAUDENDISTEL L J,et al. Hypercarbia during carbon dioxide pneumoperitoneum[J]. Am J Surg,1992,163(1):186-190.
[2]BRUIX J,SHERMAN M. Management of hepatocellular carcinoma[J]. Hepatology,2005,42(5):1208-1236.
[3]SONG I,RHIM H,LIM H K,et al. Percutaneous radiofrequency ablation of hepatocellular carcinoma abutting the diaphragm and gastrointestinal tracts with the use of artificial ascites:safety and technical efficacy in 143 patients[J]. Eur Radiol,2009,19(11):2630-2640.
[4]KANG T W,RHIM H,LEE M W,et al. Radiofrequency ablation for hepatocellular carcinoma abutting the diaphragm:comparison of effects of thermal protection and therapeutic efficacy[J]. AJR Am J Roentgenol,2011,196(4):907-913.
[5]RHIM H,LIM H K. Radiofrequency ablation for hepatocellular carcinoma abutting the diaphragm:the value of artificial ascites[J]. Abdom Imaging,2009,34(3):371-380.
[6]THOMAS M B,ZHU A X. Hepatocellular carcinoma:the need for progress[J]. J Clin Oncol,2005,23(13):2892-2899.
[7]姜伟,张胜捷,李笑弓.射频消融治疗肾细胞癌的研究进展[J].东南大学学报(医学版),2016,35(5):785-788.
[8]孙飞虎,何仕诚,杜瑞杰,等.脊柱转移性肿瘤的介入微创治疗现状[J].东南大学学报(医学版),2018,37(1):174-178.
[9]RAUT C P,IZZO F,MARRA P,et al. Significant long-term survival after radiofrequency ablation of unresectable hepatocellular carcinoma in patients with cirrhosis[J]. Ann Surg Oncol,2005,12(8):616-628.
[10]LIVRAGHI T,MELONI F,di STASI M,et al. Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis:is resection still the treatment of choice?[J]. Hepatology,2008,47(1):82-89.
[11] LIVRAGHI T,SOLBIATI L,MELONI M F,et al. Treatment of focal liver tumors with percutaneous radio-frequency ablation:complications encountered in a multicenter study 1[J].Radiology,2003,226(2):441-451.
[12]MULIER S,MULIER P,NI Y,et al. Complications of radiofrequency coagulation of liver tumours[J]. Br J Surg,2002,89(10):1206-1222.
[13] SARLI L,COSTI R,SANSEBASTIANO G,et al. Prospective randomized trial of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy[J]. Br J Surg,2000,87(9):1161-1165.
[14]FITZGERALD S D,ANDRUS C H,BAUDENDISTEL L J,et al. Hypercarbia during carbon dioxide pneumoperitoneum[J]. Am J Surg,1992,163(1):186-190.