冷循环射频与手术治疗肝癌的临床研究

【摘要】 目的 比较冷循环射频与手术肝癌的疗效、并发症情况、住院花费、住院天数及生活质量。 肝癌患者159例，分为两组：肿瘤直径≤5.0cm、单发肿瘤44例，手术治疗29例，冷循环射频治疗15例；肿瘤直径＞5.0cm患者115例，手术治疗54例，冷循环射频治疗61例。冷循环射频治疗采用Col-tip RFTM系统，于超声引导下将集束射频治疗针穿刺进入肿瘤进行治疗。分组比较两种治疗的肝功能、AFP改变、并发症情况、住院天数及花费、生活质量评分等。描述影像学变化。结果 冷循环射频治疗对患者肝脏功能的破坏小于手术治疗。冷循环射频治疗和手术治疗对患者AFP水平的没有明显差异。冷循环射频治疗并发症发生率，住院天数及花费低于手术治疗，术后生存质量高于手术治疗。肿瘤直径≤5.0cm、单发肿瘤，冷循环射频和手术1年生存率及中位生存时间没有差异。结论 相对于手术，冷循环射频治疗也是一种安全，有效的肝癌治疗方法。

【关键词】 射频 手术 肝癌 生活质量

Clinical study of the application of radio frequency ablation and operation on treatment of liver cancer

【Abstract】 Objective To probe into the treatment effect，complications rate，life quality and hospitalization expenses of applying radio frequency ablation (RFA) to treat liver cancer and compare to of the operation.Methods 159 liver cancer patients were included in this study.y were pided into two groups according to the diameters of their tumors and whether their tumors were solo.Among 44 cases in the group of solo tumor with tumor diameters equal and less than 5.0cm，29 cases received operations and 15 received radio frequency treatments，among 115 cases of the group with tumour diameters more than 5.0cm，54 cases received operations and 61 received radio frequency treatments.The operations were hepatolobectomy.Radio frequency treatment were conducted either percutaneously or intraoperatively under the guidance of ultrasound.The bundled needles were punctured into the tumors and performed radio frequency treatments，with treatment frequency of 480kHz，treatment time 12min.Collected data of liver function（ALT，ALB，TB），AFP，complications，hospitalization days and expenses of patients receiving operations and radio frequency treatments respectively，observed changes in radiology.Differences between the above-mentioned data of patients received operations and radio frequency treatments within two groups were compared.Results The damaging effect of liver function of radio frequency treatment was less severe than operations.There was no significant difference between the AFP changes of patients received radio frequency treatment and those received operations.Concerning complications，hospitalization days and expenses，situations of patients received radio frequency treatments were than those received operations.In the group of solo tumor with tumor diameters less than 5.0cm，there was no significant difference in short term living rate and quality of living between patients received radio frequency treatments and those received operations.Conclusion Compare to operations，RFA treatment is also a kind of effective and safe way to deal with liver cancer.

【Key words】 radio frequency ablation operations liver cancer life quality

，手术根治性切除仍然被认为是治疗肝癌最有效的手段。然而，由于肝癌发病隐匿，大部分病人确诊时已属中晚期，仅有10%～20%的患者有机会接受手术根治性治疗。对于占绝大多数的无法行手术根治性切除的肝癌患者来说，寻求非手术姑息性的治疗手段有着重要的意义。超声引导下射频消融术（radio-frequency ablation，RFA）作为最新的导向治疗方法之一，在肝癌治疗领域受到了关注。本研究对两组分别接受手术和冷循环射频（以下简称“射频” ）治疗的肝癌患者进行比较，现报道如下。

1 资料与方法

1.1 一般资料 从2003年2月～2004年11月，四川大学华西普外科收治的肝癌患者159例，根据肿瘤直径大小以及是否单发病灶将患者分为两组：肿瘤直径≤5.0cm、单发肿瘤组44例，接受手术治疗29例，接受射频治疗15例；直径＞5.0cm组115例，接受手术治疗54例，接受射频治疗61例。患者一般资料见表1。诊断依据为：B型超声、CT及肝癌标志物——甲胎蛋白（AFP）水平，手术组术后病理诊断结果，冷循环射频组肝穿刺活检结果。

表1 患者一般资料情况

注：*包括肝腺癌，胆管腺癌及结肠转移性腺癌；**包括肉瘤样癌、乳头状癌及神经内分泌癌以及缺乏病理活检结果的射频治疗病例

1.2 方法

1.2.1 手术治疗方法 接受手术治疗的患者两组共83例。经术前检查，一般情况良好，肝功能Child-Pugh A级(82例)或B级(1例)。术前保肝治疗后，择期于全麻下行根治性或姑息性肝脏肿瘤切除，术式包括：肝左叶切除，肝右叶切除，肝中央叶切除，肝左外叶切除，肝右后叶切除等。

1.2.2 射频治疗方法 接受射频治疗的患者两组共44例。采用由美国RADIONICS生产的冷循环超能射频肿瘤治疗系统（Cool-tip RF System），集束针功率0～200W，频率480kHz，冷循环，射频脉冲发送方式。对患者进行射频治疗。主要根据患者肝脏肿瘤的生长部位，患者一般情况以及有无增加开腹手术危险性的其他疾病来确定采用开腹或者经皮射频治疗。

经皮射频患者采用局部浸润麻醉，患者取平卧位，麻醉成功后，常规消毒铺巾，在患者大腿后侧粘贴耦合电极，超声引导下以BARD肝穿刺活检针穿刺取标本后，沿着超声确定的进针入路将集束针插至治疗靶区。依次开启冷循环泵及射频治疗仪，循环泵流量＞80ml/min，每次治疗时间12min。治疗时肿瘤靶区温度升至65℃以上，从而达到毁损肿瘤细胞的目的。治疗毕调节输出功率使集束针温度达到90℃～99℃，持续5～10s，以使针道炭化，起到止血以及防止癌细胞随针道转移或种植的目的。可根据每例患者肿瘤的大小、数目以及治疗过程中患者对治疗的耐受情况采用多部位，多次（≤3次）RFA治疗。

开腹RFA患者采用全麻，麻醉后常规开腹，暴露肝脏，术中超声确定治疗靶区位置，选择进针入路，其余操作同经皮RFA。治疗完毕后清点手术器械，常规关腹。

1.3 疗效观察 以治疗后患者的临床表现，术后并发症情况，术前以及术后肝功能改变，AFP改变，术后B超或CT检查结果，生活质量评分，住院天数，住院治疗花费作为主要评价指标。

癌症患者生活质量评估量表Quick-FLIC［1］进行随访，获得患者术后生活质量自评分数，对患者生活质量进行评估。

1.4 统计学方法 统计使用SPSS11.5(SPSS Inc.Chicago，IL)统计软件。对于基本符合正态分布的数据采用t检验或配对t检验；对于不符合正态分布的数据采用秩和检验；率的比较采用卡方检验。

2 结果

2.1 一般情况 (1)肿瘤直径≤5.0cm，单发病灶：手术组患者术后主要表现为疼痛（29/29例）。4例患者术后出现腹腔内出血；3例患者术后出现大量腹水；1例患者出现短暂的心衰；1例患者出现麻醉反应；1例患者术后出现严重肝功能衰竭，大量胸腹腔积液，呼吸衰竭，酸碱平衡紊乱，抢救无效于术后3天死亡。RFA治疗组患者术后主要表现为肝区不适感（10/15例）。4例患者无任何自觉不适；1例患者诉腹胀；全部15例患者均未出现严重并发症。(2)肿瘤直径＞5.0cm：<