超声引导下射频消融术与腹腔镜肝部分切除术治疗小肝癌的比较分析

目的 探讨超声引导下射频消融术与腹腔镜肝部分切除术治疗小肝癌的疗效对比。方法 回顾性分析2010年1月至2016年1月台州市立医院肝胆外科收治的小肝癌（直径≤3 cm）患者，根据治疗 方法分为超声引导下射频消融组（A组，47例）与腹腔镜肝部分切除组（B组，36例），比较两组的手术时 间、术中出血量、术后第1天疼痛评分、下床活动时间、进食时间、术后第2天AST和CRP水平，以及住 院时间、住院费用、术后并发症发生情况。结果 A组手术时间（29.1±12.3）min vs（127.5±29.6）min， P<0.001]、术中出血量（5.3±2.1）mL vs （138.3±37.5）mL，P<0.001]、术后第1天疼痛评分（0.9±0.3） vs （3.1±0.7），P=0.010]、下床活动时间（0.7±0.2） d vs （2.3±0.9） d， P=0.021]、进食时间（1.1±0.1） d vs （2.4± 0.6）d，P=0.045]、住院时间（7.3±2.4）d vs （12.3±3.7）d，P=0.012]和住院费用（23 872.8±2 159.5）元 vs（31 563.7±3 547.6）元，P=0.033]优于B组；且并发症中胆瘘（2.1% vs 13.8%，P=0.040）和肝功能不全发 生率（4.2% vs 19.4%，P=0.027）均低于B组。A组和B组术后1、3年总体生存率分别为90.0% vs 93.7%、 72.5% vs 81.3%，差异无统计学意义（P＞0.05）。 结论 在治疗直径≤3 cm的小肝癌时，超声引导下射频 消融术比腹腔镜肝部分切除术围手术期恢复更快；两者总体治疗效果相当，可根据具体情况选择性应用。

Comparison of ultrasound-guided radiofrequency ablation and laparoscopic partial hepatectomy in the treatment of small hepatocellular carcinoma

objective To compare the efficacy of ultrasound-guided radiofrequency ablation and laparoscopic partial hepatectomy in the treatment of small hepatocellular carcinoma. Methods From Jan. 2010 to Jan. 2016, patients with small hepatocellular carcinoma (diameter≤ 3 cm) in Taizhou Municipal Hospital were retrospectively analyzed. According to treatment methods, patients were divided into ultrasound-guided radiofrequency ablation group (group A, 47 cases) and laparoscopic partial hepatectomy group (group B, 36 cases). The operation time, intraoperative blood loss, pain score on the 1st day after operation, time to get out of bed, time to eat, AST and CRP levels on the 2nd day after operation, hospitalization time, hospitalization cost, postoperative complications were compared between the two groups. Results Group A was superior to group B in terms of operation time (29.1±12.3) min vs (127.5±29.6) min, P<0.001], intraoperative blood loss (5.3±2.1) mL vs(138.3±37.5) mL, P<0.001], pain score on the 1st day after operation (0.9±0.3) vs (3.1±0.7), P=0.010], time to get out of bed (0.7±0.2) d vs (2.3±0.9) d, P=0.021], time to eat (1.1±0.1) d vs (2.4±0.6) d, P=0.045], hospitalization time (7.3±2.4) d vs (12.3±3.7) d, P=0.012] and hospitalization cost (23 872.8±2 159.5) RMB vs(31 563.7±3 547.6) RMB, P=0.033]. The incidence of biliary fistula and hepatic insufficiency in group A was lower than those in group B (2.1% vs 13.8%, P=0.040; 4.2% vs 19.4%, P=0.027 respectively). Follow-up results showed that the overall 1-year and 3-year survival rates in group A and B were 90.0% vs 93.7%, 72.5% vs 81.3%, without significant difference (P>0.05). Conclusion Compared with laparoscopic partial hepatectomy, ultrasound-guided radiofrequency ablation is superior in perioperative recovery for treating small hepatocellular carcinoma (diameter ≤ 3 cm). The therapeutic effect is comparable between ultrasound-guided radiofrequency ablation and laparoscopic partial hepatectomy, which can be selectively applied according to specific situation.