發(fā)布時(shí)間：2018-08-04 16:04

【摘要】：研究背景和目的:肝移植、手術(shù)切除和經(jīng)皮射頻消融是早期肝細(xì)胞癌(巴塞羅那分級(jí)標(biāo)準(zhǔn))的根治性治療方式,手術(shù)切除和經(jīng)皮射頻消融在臨床工作中應(yīng)用最為廣泛。但是,對(duì)中等大小(直徑3-5cm)肝細(xì)胞癌手術(shù)切除術(shù)和經(jīng)皮射頻消融治療療效一直存在爭議。本研究通過回顧性隊(duì)列分析比較手術(shù)切除和經(jīng)皮射頻消融治療對(duì)單發(fā)、初治的中等大小肝細(xì)胞癌療效。材料與方法:回顧性收集2007年01月至2011年12月在上海東方肝膽外科醫(yī)院治療的初發(fā)、單個(gè)中等大小肝細(xì)胞癌患者基本資料(符合納入標(biāo)準(zhǔn))。共收集了388例患者病例資料,其中手術(shù)切除組共196例,經(jīng)皮射頻消融組共192例,兩組在腫瘤大小和其他肝臟病變情況相似。應(yīng)用Kaplan-Meier生存分析方法分析兩組總體生存率(Overall survival,OS)無瘤生存率(Disease free survival,DFS)。兩組間生存率差異的顯著性應(yīng)用Log-rank檢測。Cox風(fēng)險(xiǎn)模型進(jìn)行單因素和多因素危分析。全面評(píng)估其遠(yuǎn)期結(jié)局及預(yù)后相關(guān)危險(xiǎn)因素。結(jié)果:共388例患者臨床基本資料被納入本研究中。手術(shù)組196例(男性:女性=172:24,平均年齡52.9±10.5(22.0-80.0)歲),經(jīng)皮射頻消融組192例(男性:女性=167:25,平均年齡57.9±10.9(34.0-79.0)歲)。手術(shù)組有1例患者因肝功能衰竭圍手術(shù)期死亡。手術(shù)組術(shù)后43(21.9%)例發(fā)生并發(fā)癥,Clavein3級(jí)、5級(jí)并發(fā)癥各9例、1例;射頻消融組術(shù)后27(14.1%)(P=0.048)例出現(xiàn)并發(fā)癥,無Clavein3級(jí)和5級(jí)并發(fā)癥。手術(shù)組術(shù)后平均住院時(shí)間8.8±3.2(4-21)天,射頻經(jīng)皮射頻消融組平均住院時(shí)間2.4±0.9(1-8)天(P0.001)。手術(shù)組相對(duì)經(jīng)皮射頻消融組具有更高的總體累積生存率(1、3和5年OS分別為93.8%、61.9%和41.0%VS 92.2%、55.1%和30.8%)(P=0.01)和無瘤生存率(1、3和5年DFS分別為73.2%、30.4%和16.9%VS65.6%、26.0%和8.7%)(P=0.005)。衛(wèi)星灶、微血管侵犯、局部腫瘤進(jìn)展、Child分級(jí)和γ-GT是影響預(yù)后的危險(xiǎn)因素。射頻消融治療本身和腫瘤大于4cm是局部腫瘤進(jìn)展的危險(xiǎn)因素。腫瘤大于4cm和白蛋白小于35g/L是經(jīng)皮射頻消融組局部腫瘤進(jìn)展的危險(xiǎn)因素。腫瘤靠近大血管或膽囊是手術(shù)組局部腫瘤進(jìn)展的危險(xiǎn)因素。結(jié)論:手術(shù)切除比經(jīng)皮射頻消融更能為單發(fā)、初治的中等大小肝細(xì)胞癌患者帶來更高的累積生存率和無瘤生存率。經(jīng)皮射頻消融組具有更少的住院時(shí)間和術(shù)后并發(fā)癥。衛(wèi)星灶、微血管侵犯、局部腫瘤進(jìn)展、Child分級(jí)和γ-GT是影響預(yù)后的危險(xiǎn)因素。射頻消融治療本身和腫瘤大于4cm是局部腫瘤進(jìn)展的危險(xiǎn)因素。
[Abstract]:Background and objective: liver transplantation, surgical resection and percutaneous radiofrequency ablation are the radical treatments for early hepatocellular carcinoma (Barcelona grading standard). Surgical resection and percutaneous radiofrequency ablation are most widely used in clinical work. However, the efficacy of surgical resection and percutaneous radiofrequency ablation for moderate size (3-5cm) hepatocellular carcinoma has been controversial. A retrospective cohort analysis was conducted to compare the efficacy of surgical resection and percutaneous radiofrequency ablation in the treatment of single, newly treated medium sized hepatocellular carcinoma (HCC). Materials and methods: from January 2007 to December 2011, the basic data of patients with single medium size hepatocellular carcinoma (HCC) were collected retrospectively from January 2007 to December 2011 in Shanghai Oriental Hepatobiliary surgery Hospital. A total of 388 cases were collected, including 196 cases in the surgical resection group and 192 cases in the percutaneous radiofrequency ablation group. The size of the tumor and other liver lesions in the two groups were similar. The Overall survival rate (Disease free survival rate) was analyzed by Kaplan-Meier survival analysis. The difference of survival rate between the two groups was analyzed by univariate and multivariate risk analysis using Log-rank. Cox risk model. Comprehensive evaluation of its long-term outcome and prognostic risk factors. Results: a total of 388 patients were included in this study. 196 patients (male: female: 172: 24, mean age 52.9 鹵10.5 (22.0-80.0) and 192 patients (male: female: 167: 25, mean age 57.9 鹵10.9 (34.0-79.0) years) were treated with percutaneous radiofrequency ablation. In the operation group, one patient died of liver failure during perioperative period. In the operation group, complications were found in 43 cases (21.9%) and in the radiofrequency ablation group (9 cases, 1 case, respectively), while in the radiofrequency ablation group (27 cases, 14.1%) (0.048%), there were no complications in grade Clavein3 and grade 5. The average hospitalization time was 8.8 鹵3.2 (4-21) days in the operation group and 2.4 鹵0.9 (1-8) days in the radiofrequency catheter ablation group (P0.001). The overall cumulative survival rate was higher in the operation group than that in the percutaneous radiofrequency ablation group (93.81.9% and 55.1% and 30.8%, respectively) (P < 0.01) and the tumor-free survival rate (DFS = 73.4% and 16.9VS65.65.6m, 26.0% and 8.7%, respectively) in the operation group and 41.0%VS 92.2%, 55.1% and 30.8%, respectively. Satellite foci, microvascular invasion, local tumor progression, Child grade and 緯-GT were risk factors for prognosis. Radiofrequency ablation itself and tumor larger than 4cm are risk factors for local tumor progression. Tumor larger than 4cm and albumin less than 35g/L are risk factors of local tumor progression in percutaneous radiofrequency ablation. Tumor proximity to large vessels or gallbladder is a risk factor for tumor progression in the surgical group. Conclusion: surgical resection is more effective than percutaneous radiofrequency ablation in the treatment of medium sized hepatocellular carcinoma (HCC) with higher cumulative and tumor-free survival rates. The percutaneous radiofrequency ablation group had less hospital stay and postoperative complications. Satellite foci, microvascular invasion, local tumor progression, Child grade and 緯-GT were risk factors for prognosis. Radiofrequency ablation itself and tumor larger than 4cm are risk factors for local tumor progression.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R735.7

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