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目的:评估比较目前三种主流技术对小肝癌的治疗作用及对患者预后的影响。创新点:首次同时比较两种手术技术和一种微创射频技术对小肝癌患者的治疗效果,并且将小肝癌患者通过年龄分层,获得最优的治疗选择,以期指导临床上更个性化及精准化的治疗方案。方法:选取2005年至2010年间94例符合单个肿瘤直径小于5 cm或不超过3个肿瘤且每个肿瘤直径小于3 cm的小肝癌患者,分至3个治疗组,分别为腹腔镜肝切除组(28例)、经皮射频消融组(33例)和开放肝切除组(33例)。经过3年的跟踪随访,统计比较3组患者的疾病预后及相关指标。结论:本研究中统计结果显示,经皮射频消融组的无瘤生存率和总生存率明显比两个手术组低(图2和3)。腹腔镜手术组和开放手术组的生存及预后情况无明显差异,而腹腔镜手术组的创伤和术后并发症率要低于开放手术组(表2)。本研究根据中心经验将全部患者以60岁进行年龄划分(图5和6)。对于60岁以下的小肝癌患者来说,手术的效果明显优于射频消融术,故应优先选择微创的腹腔镜肝切除术;60岁以上的小肝癌患者经射频治疗获得的生存结果与手术无显著差异,同时射频治疗具有创伤轻微、可重复、并发症少等优势,故可以酌情选择手术或射频治疗。
OBJECTIVE: To evaluate the effects of the three current mainstream technologies on the treatment of small hepatocellular carcinoma (HCC) and their prognosis. Innovation: For the first time at the same time compare the two surgical techniques and a minimally invasive radiofrequency technology for the treatment of patients with small liver cancer, and small staging of patients with liver cancer by stratified access to optimal treatment options, with a view to guiding the clinical more personalized and Accurate treatment options. Methods: From 1994 to 2010, 94 patients with small hepatocellular carcinoma whose single tumor diameter was less than 5 cm or less than 3 cm and each tumor diameter was less than 3 cm were selected and divided into three treatment groups, namely laparoscopic liver resection group (28 cases), percutaneous radiofrequency ablation group (33 cases) and open hepatectomy group (33 cases). After 3 years follow-up, the prognosis and related indexes of the 3 groups were statistically compared. CONCLUSIONS: The statistical results in this study showed that the tumor-free survival and overall survival were significantly lower in the percutaneous radiofrequency ablation group than in the two surgical groups (Figures 2 and 3). The survival and prognosis of laparoscopic surgery group and open surgery group had no significant difference, while the laparoscopic surgery group trauma and postoperative complications rate was lower than the open surgery group (Table 2). Based on the central experience, this study divided all patients by age of 60 years (Figures 5 and 6). For patients under 60 years of age with small liver cancer, the effect of surgery was significantly better than radiofrequency ablation, it should be the preferred choice of minimally invasive laparoscopic liver resection; patients over the age of 60 with small liver cancer after radiofrequency survival and surgery No significant difference, while radiofrequency treatment with minor trauma, repeatable, less complications and other advantages, it can choose surgery or radiofrequency treatment.