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目的比较手术切除和经皮热消融治疗早期肝癌的临床结果。方法2002年4月至2005年12月,中山大学附属第一医院收治105例早期肝癌(114个结节)患者,单个结节直径≤5 cm或结节数目≤3个、直径≤3 cm,用单盲法(信封法)随机分为两组。分别采用开腹手术切除(54例)和超声引导经皮微波或射频消融治疗(51例)。结果手术组和消融组比较,首次治疗肿瘤完全清除率为100%(54/54)vs 94.1%(48/51),局部复发率均为0。首次远处复发平均时间4.9个月vs 9.6个月(P=0.130),复发率16.7%vs 27.5%(P=0.182)。1年、2年和3年无瘤生存率分别为82.4%、82.4%和82.4%vs 78.5%、61.5%和51.3%(P=0.128),同期总生存率分别为91.3%、86.4%和86.4%vs 93.5%、87.1%和87.1%(P=0.808)。治疗所需平均时间145 m in vs 27 m in(P<0.005),需输血的例数7 vs 0(P=0.013)。治疗相关并发症率11.1%vs 7.8%(P=0.742),平均住院时间19.2 d vs 5.2 d(P<0.005)。治疗后第7天WHO Perform ance Status grades评分0~1级者,16例vs32例(P=0.001),第30天时为33例vs 44例(P=0.004)。结论对早期肝癌经皮热消融治疗可获得与手术切除相近的局部疗效和3年生存率。消融治疗具有微创、简便和经济的优点,可以考虑作为早期肝癌的首选治疗手段之一。
Objective To compare the clinical results of surgical resection and percutaneous thermal ablation of early hepatocellular carcinoma. Methods From April 2002 to December 2005, 105 patients with early hepatocellular carcinoma (114 nodules) were treated in the First Affiliated Hospital of Sun Yat-sen University. The diameter of individual nodules ≤5 cm or nodules ≤3, the diameter ≤3 cm, A single-blind method (envelope method) were randomly divided into two groups. Laparotomy (54 cases) and ultrasound-guided percutaneous microwave radiofrequency ablation (51 cases) were performed respectively. Results Compared with the ablation group, the complete clearance rate of the first treatment group was 100% (54/54) vs 94.1% (48/51), and the local recurrence rate was 0. The mean first recurrence distance was 4.9 months vs 9.6 months (P = 0.130), with a recurrence rate of 16.7% vs 27.5% (P = 0.182). The 1 year, 2 year and 3 year disease free survival rates were 82.4%, 82.4% and 82.4% vs 78.5%, 61.5% and 51.3% respectively (P = 0.128), with overall survival rates of 91.3%, 86.4% and 86.4 % vs 93.5%, 87.1% and 87.1% (P = 0.808). The mean duration of treatment was 145 m in vs 27 m in (P <0.005), and the number of transfusions required was 7 vs 0 (P = 0.013). The treatment-related complication rates were 11.1% vs 7.8% (P = 0.742), mean length of stay was 19.2 days vs 5.2 days (P <0.005). On the 7th day after treatment, the WHO Perform ance Status grades were graded 0 to 1, 16 vs 32 (P = 0.001), and 33 patients vs 44 patients on the 30th day (P = 0.004). Conclusions The local curative effect and 3-year survival rate similar to surgical resection are obtained for percutaneous thermal ablation of early hepatocellular carcinoma. Ablation treatment with minimally invasive, simple and economical advantages, can be considered as one of the preferred treatment of early liver cancer.