CAJ | 학술논문

目的评价分析腹腔镜下射频消融(radiofrequency ablation,RFA)治疗原发性肝癌的安全及疗效性.方法回顾性研究分析2008年5月至2010年7月中日友好医院应用腹腔镜下RFA治疗原发性肝癌78例,全部病例均在腹腔镜超声引导下至少一个病灶穿刺活检确诊为肝细胞肝癌.其中男41例,女37例,年龄31～87岁(中位年龄57岁).统计分析肿瘤坏死情况、肿瘤局部复发对总生存率的影响.结果 78例患者中位随访16个月.肿瘤直径、是否邻近大血管、周围是否有卫星灶及是否联合经导管肝动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)是影响肿瘤复发的主要因素.直径＜3 cm的肿瘤完全消融率90.5％(38/42),明显比＞3 ～5 cm的肿瘤消融率71.4％ (20/28)高,二者比较差异有统计学意义(x2 =4.291,P=0.038).肿瘤未邻近大血管组的肿瘤消融率91.9％ (61/67),高于肿瘤邻近大血管组的消融率63.6％ (7/11),二者相比差异有统计学意义(x2 =6.351,P=0.012).RFA组和联合TACE组的肿瘤消融率分别为75.0％和88.9％,两者相比,差异无统计学意义(x2=1.567,P=0.211).RFA治疗后平均总生存期(48.7±2.4)个月,术后1、2、3、4、5年的总生存率分别为86.1％、76.9％、60.3％、51.8％、33.1％.结论 RFA是肝脏恶性肿瘤安全、有效的治疗手段,而腹腔镜下RFA,能够更好的判断肿瘤大小、数目以及肿瘤与周围血管的关系,使穿刺更加准确,从而获得更好的远期疗效.
목적 평개분석복강경하사빈소융(radiofrequency ablation,RFA)치료원발성간암적안전급료효성.방법 회고성연구분석2008년5월지2010년7월중일우호의원응용복강경하RFA치료원발성간암78례,전부병례균재복강경초성인도하지소일개병조천자활검학진위간세포간암.기중남41례,녀37례,년령31～87세(중위년령57세).통계분석종류배사정황、종류국부복발대총생존솔적영향.결과 78례환자중위수방16개월.종류직경、시부린근대혈관、주위시부유위성조급시부연합경도관간동맥화료전새(transcatheter arterial chemoembolization,TACE)시영향종류복발적주요인소.직경＜3 cm적종류완전소융솔90.5％(38/42),명현비＞3 ～5 cm적종류소융솔71.4％ (20/28)고,이자비교차이유통계학의의(x2 =4.291,P=0.038).종류미린근대혈관조적종류소융솔91.9％ (61/67),고우종류린근대혈관조적소융솔63.6％ (7/11),이자상비차이유통계학의의(x2 =6.351,P=0.012).RFA조화연합TACE조적종류소융솔분별위75.0％화88.9％,량자상비,차이무통계학의의(x2=1.567,P=0.211).RFA치료후평균총생존기(48.7±2.4)개월,술후1、2、3、4、5년적총생존솔분별위86.1％、76.9％、60.3％、51.8％、33.1％.결론 RFA시간장악성종류안전、유효적치료수단,이복강경하RFA,능구경호적판단종류대소、수목이급종류여주위혈관적관계,사천자경가준학,종이획득경호적원기료효.
Objective To investigate the efficacy and safety of laparoscopic radiofrequency ablation (RFA) therapy for hepatocellular carcinoma.Methods Clinical data of 78 hepatocellular carcinoma patients undergoing laparoscopic radiofrequency in Beijing China-Japan Friendship Hospital from May.2008 to July.2010 were reviewed retrospectively.Age ranged from 31 to 87 years,41 were male and 37 were female.Intraoperative ultrasound-guided needle biopsy was performed and diagnosis of hepatocellular carcinoma was established in all cases before RFA was carried out.Data analysis was performed using software SPSS or OriginPro7.Necrosis,local recurrence of the tumor and the cumulative survival rate were analyzed by Kaplan-Meier test and x2 test.Results The median follow-up time was 16 months after RFA treatment.Tumor size,proximity to intrahepatic vessels and combination with TACE were factors that influence local recurrence.The complete ablation (CA) rate was remarkably higher in tumors ＜ 3 cm than in tumors ＞ 3 -5 cm (90.5％ vs 71.4％,x2 =4.291,P =0.038 ).Tumors adjacent to major vessels had a significantly lower CA rate as compared with those not adjacent to them (63.6％ vs 91.9％,x2 =6.351,P =0.012).The CA rate were 88.9％ in the TACE ± RFA group and 75.0％ in the RFA group ( x2 =1.567,P =0.211 ).The mean overall survival were 48.7 ± 2.4 months,the cumulative survival rate was 86.1％ at 1 year、76.9％ at 2 years、60.3％ at 3 years、51.8％ at4 years and 33.1％ at 5 years.Conclusions Laparoscopic RFA is safe,mini-invasive and effective for unresectable hepatic carcinoma with a favorable long term survival.