手術(shù)切除與開腹射頻消融治療大肝癌的療效分析

徐博，施紅旗（溫州醫(yī)科大學(xué)附屬第一醫(yī)院　肝膽外科，浙江　溫州　325000）

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手術(shù)切除與開腹射頻消融治療大肝癌的療效分析

徐博，施紅旗
（溫州醫(yī)科大學(xué)附屬第一醫(yī)院肝膽外科，浙江溫州325000）

[摘 要]目的 比較手術(shù)切除與開腹射頻消融治療大肝癌的療效。方法 收集2012年1月至2015年9月我院原發(fā)性大肝癌患者58例，其中行開腹肝癌切除術(shù)35例，開腹射頻消融術(shù)23例。比較兩組患者術(shù)前及術(shù)后的相關(guān)臨床指標(biāo)及術(shù)后生存率。結(jié)果 術(shù)前，開腹切除組肝功能分級(jí)（P=0.021）、凝血酶原時(shí)間（P=0.034）、總膽紅素（P=0.016）和肝硬化程度（P=0.033）明顯好于開腹射頻消融組。而術(shù)中輸血量（P=0.025）、術(shù)后第2天ALT（P=0.008）及AST（P=0.017）指標(biāo)，開腹切除組顯著差于開腹射頻消融組。兩組術(shù)后嚴(yán)重并發(fā)癥發(fā)生率及術(shù)后生存率無明顯差別（P=0.652）。結(jié)論 對(duì)于肝功能稍差的大肝癌患者，開腹射頻消融術(shù)有利于減小手術(shù)風(fēng)險(xiǎn)，控制術(shù)后并發(fā)癥，醫(yī)師可根據(jù)患者綜合情況進(jìn)行術(shù)式選擇。

[關(guān)鍵詞]肝癌；肝切除；開腹射頻消融

Hepatectomy versus open radiofrequency ablation procedures for large liver cancer:analysis of the curative effect

XU Bo,SHI Hong-qi.Department of Hepatobiliary Surgery,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325000,China

Abstract objectiveTo compare the efficacy of hepatectomy and open radiofrequency ablation(RFA)procedure for large liver cancer.MethodsThe clinical data of 58 patients(23 patients underwent hepatectomy and 35 patients underwent open radiofrequency ablation procedure)with large liver cancer from Jan.2012 to Sep.2015 were collected and retrospectively analyzed.Survival curves were calculated and compared by the Logrank test.ResultsThe comparison results showed that,before the surgery,the hepatectomy group had better liver function classification(P=0.021); shorter prothrombin time(P=0.034),lower total bilirubin level(P=0.008),and lower degree of cirrhosis(P=0.033).But the amount of blood fransfusion was larger(P=0.025),the ALT and AST levels at day 2 post-operative were higer(P=0.008,P=0.017)in hepatectomy group.There was no significant difference between two groups in post-operative complications and overall survival rate(P=0.652).ConclusionFor large liver cancer patients with poor liver function,open radiofrequency ablation procedure can reduce surgical risk and post-operative complication rate.Operation choice should be carried out according to general condition of patients.

Key words liver cancer; hepatectomy; open radiofrequency ablation

隨著肝癌治療技術(shù)的迅速發(fā)展，其治療方式推陳出新。肝部分切除和射頻消融（radiofrequency ablation，RFA）治療都是針對(duì)局部的治療，但是可接受手術(shù)切除的肝癌患者不到30%，其中絕大部分都是大肝癌患者。因此，除了手術(shù)切除之外的開腹射頻消融術(shù)成為治療大肝癌的一種重要手段，但其療效還有待進(jìn)一步驗(yàn)證。我們通過比較我院58例手術(shù)切除與開腹射頻消融治療的大肝癌患者，初步評(píng)價(jià)其療效，現(xiàn)報(bào)道如下。

1 資料和方法

1.1一般資料

收集我院肝膽外科2012年1月至2015年9月原發(fā)性大肝癌患者58例，男45例，女13例。……