| 董姝英,薛 炜,李登科,朱如杭,孙文兵.腹腔镜肝切除术与经皮射频消融术治疗原发性小肝癌的效果对比研究及其预后的影响因素分析[J].,2022,(10):1980-1985 |
| 腹腔镜肝切除术与经皮射频消融术治疗原发性小肝癌的效果对比研究及其预后的影响因素分析 |
| Comparative Study of Effect of Laparoscopic Hepatectomy and Percutaneous Radiofrequency Ablation in the Treatment of Small Primary Liver Cancer and Analysis of Influencing Factors of Prognosis |
| 投稿时间：2022-01-23 修订日期：2022-02-20 |
| DOI：10.13241/j.cnki.pmb.2022.10.038 |
| 中文关键词: 经皮射频消融术 腹腔镜肝切除术 原发性小肝癌 效果 预后 |
| 英文关键词: Percutaneous radiofrequency ablation Laparoscopic hepatectomy Small primary liver cancer Effect Prognosis |
| 基金项目:国家自然科学基金项目（81803038） |
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| 中文摘要: |
| 摘要 目的：对比腹腔镜肝切除术、经皮射频消融术（RFA）治疗原发性小肝癌的效果，并分析预后的影响因素。方法：本研究收集我科2016年8月~2018年8月期间收治的160例原发性小肝癌患者的病例资料，根据治疗方式将患者分为A组（腹腔镜肝切除术，80例）和B组（RFA，80例）。对比两组围术期指标、肝功能指标、并发症发生率及预后情况。对所有患者进行为期3年的随访，记录患者生存情况，经单因素及多因素Logistic回归分析预后的影响因素。结果：B组的术中出血量、住院总费用少于A组，平均手术时间、住院时间短于A组（P<0.05）。两组术后3 d丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）以及总胆红素（TBIL）水平升高，甲胎蛋白（AFP）水平下降，组内不同时间点对比差异有统计学意义（P<0.05）。两组术后并发症发生率组间对比，无统计学差异（P>0.05）。两组死亡率组间对比无统计学差异（P>0.05）。根据患者的预后情况将160例患者分为死亡组（n=32）和存活组（n=128）。研究证明AFP≥20 ng/mL、肿瘤多发、微血管癌栓、白蛋白＜35 g/L、凝血酶原时间≥13 s、Child-Pugh分级为B级是原发性小肝癌患者预后的危险因素（P<0.05）。结论：原发性小肝癌采用RFA或腹腔镜肝切除术治疗，均可获得较好的临床效果，且安全可靠，RFA在术中出血量、住院总费用、手术时间、住院时间方面略占优势。此外，凝血酶原时间、肿瘤数目、白蛋白、微血管癌栓、Child-Pugh分级、AFP是原发性小肝癌患者预后的影响因素。 |
| 英文摘要: |
| ABSTRACT Objective: To compare the effect of laparoscopic hepatectomy and percutaneous radiofrequency ablation (RFA) in the treatment of small primary liver cancer, and to analyze the influencing factors of prognosis. Methods: This study collected the case data of 160 patients with small primary liver cancer who were treated in our department from August 2016 to August 2018. According to the treatment methods, the patients were divided into group A (laparoscopic hepatectomy, 80 cases) and group B (RFA, 80 cases). The perioperative indexes, liver function indexes, incidence of complications and prognosis were compared. All patients were followed up for 3 years, the survival of patients was recorded, and the influencing factors of prognosis were analyzed by univariate and multivariate Logistic regression. Results: The amount of intraoperative bleeding and total hospitalization cost in group B were less than those in group A. The average operation and hospitalization time in group B were shorter than those in group A (P<0.05). At the 3 d after operation, the levels of alanine aminotransferase (ALT), total bilirubin (TBIL) and aspartate aminotransferase (AST) increased and the level of alpha fetoprotein (AFP) decreased in the two groups, there were significant differences at different time points in the group (P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P>0.05). There was no significant difference in mortality between the two groups (P>0.05). According to the prognosis of patients, 160 patients were divided into death group (n=32) and survival group (n=128). The results showed AFP≥20 ng/mL, the number of tumors was multiple, microvascular invasion, albumin<35 g/L, prothrombin time≥13 s and Child-Pugh grade B were the risk factors for the prognosis of patients with small primary liver cancer (P<0.05). Conclusion: RFA or laparoscopic hepatectomy for small primary liver cancer can obtain good clinical effect, which is safe and reliable. RFA has a slight advantage in amount of intraoperative bleeding, total hospitalization cost, operation time and hospitalization time. In addition, prothrombin time, tumor number, albumin, microvascular invasion, Child-Pugh grade and AFP are the prognostic factors of patients with small primary liver cancer. |
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