CAJ | 학술논문

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。
목적：탐토경복강경사빈소융술（LRFA）치료간세포암적림상응용병평개료효。방법회고성분석2009년2월지2011년2월간수치적78례간세포암（HCC）환자적림상자료。장부합납입표준적병례분위LRFA조32례，경피사빈소융술（PRFA조）21례화수술절제조25례。검측각조술전화술후간공능화AFP적변화，응용시각모의평분법（VAS）평개환자술후동통완해정도，진행술후KPS공능상태평분，관찰술후병발증발생솔화간내복발솔、무류생존솔、총생존솔，병진행생존분석。결과(1)술후3월시，3조적ALT、AST、GGT、ALP、AFP각지표명현저우술전（P＜0.05）；ALB술후1주하강명현，지술후1월축점회복정상（P＜0.05）；3조적TBIL지표차이무통계학의의。(2) LRFA조화PRFA조술후3급동통명현저우수술절제조；3조VAS동통평개결과차이유통계학의의（P＜0.05）。(3) LRFA조적병발증발생솔저우기타량조（P=0.012，0.007），수술절제조적상구감염발생솔여LRFA조비교，차이유통계학의의（χ2=7.015，P=0.008）。(4)술후6월전，수술절제조적KPS평분저우LRFA조화PRFA조，이후각시간점3조평분상근。(5)3조술후6、12、18、24개월적간내복발솔、무류생존솔화총생존솔차이무통계학의의，LRFA조적생존곡선균고우PRFA조화수술절제조。(6)수술절제조평균수술시간、주원시간화비용명현고우LRFA조（P＜0.05），LRFA조여PRFA조차이무통계학의의。결론 LRFA치료HCC겸구복강경화사빈소융적우점，술후간공능화AFP적회복정도여PRFA、수술치료방법상당。해방법유조우환자술후동통완해，병발증소，간내복발솔저，무류생존솔、총생존솔고，시일충안전미창、료효학절적간암치료방법，치득림상엄범추엄。
Objective To investigate the clinical application and effect of laparoscopic radiofrequency ablation (LRFA) in treating hepatocellular carcinoma. Methods The clinical data of 78 patients with HCC treated in the Second Affiliated Hospital to Guangzhou Medical University were collected and retrospectively analyzed from February 2009 to February 2011. The patients were divided into 3 groups, LRFA group (n=32), PRFA group (n=21), and surgery group (n=25). The changes of liver function and AFP in every group were detected before and after the surgery. Visual analogue scale (VAS) was used to assess the degree of pain release and KPS was used to evaluate the whole function after the operation. Moreover, the complications and the related survival rates of the three groups were observed and analyzed after operations.Results (1) ALT, AST, GGT, ALP, and AFP of the three groups all decreased apparently three months after the surgery (P<0.05). ALB descended one week after surgery, then rose gradually to normal in one month (P<0.05). TBIL had no statistical difference in each group. (2) The pain degree of group LRFA and PRFA was obviously lower than the surgery group, and had statistical differences (P<0.05). (3) The rate of complications of the LRFA group was lower than the other two groups(P=0.012,0.007). The wound infection between open surgery group and LRFA group showed statistical differences(χ2=7.015,P=0.008). (4) 6 months after the surgery, KPS score in the surgery group was lower, but in the following time, the three groups got similar scores. (5)The intrahepatic recurrence rate, tumor-free survival rate, and overall survival rate of the three groups had no statistical differences 6-, 12-, 18-, and 24-month after the operation. Survival curve of group LRFA was relatively higher. (6) The average surgery time, length of hospital stay, and hospital costs of the operation group were all much higher in the three groups (P<0.05), while the other two groups had no statistical differences. Conclusions LRFA takes advantage of both laparoscope and radiofrequency ablation, and the postoperative liver function and AFP are as good as PRFA and traditional surgery. LRFA can help reducing postoperative pains, complications, and intrahepatic recurrence rate. The tumor-free survival rate and overall survival rate are increased as well. Therefore, LRFA is safe, minimally invasive and has reliable effects for the treatment of HCC.