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目的比较射频消融(RFA)与微波消融(MWA)分别联合肝动脉化疗栓塞(TACE)治疗原发性肝癌的临床疗效及安全性。方法回顾性研究2008年1月至2012年12月符合纳入标准的97例采用RFA联合TACE(RFA+TACE组)以及MWA联合TACE(MWA+TACE组)治疗原发性肝癌患者的临床资料,其中RFA+TACE组42例,MWA+TACE组55例。比较两组患者的肿瘤消融率、总体生存时间、术后并发症发生率、住院时间及住院费用。结果总体比较及TNM分期后分层比较,两组间肿瘤完全消融率差异均无统计学意义(P均>0.05)。RFA+TACE组的中位生存期为27.1个月,生存时间为(32.2±16.6)个月,MWA+TACE组的中位生存期为24.6个月,生存时间为(28.8±13.7)个月,两组1、2、3、4和5年生存率比较差异无统计学意义(P均>0.05)。按照肿瘤TNM分期(Ⅰ期、Ⅱ期、Ⅲ期)及肝功能Child-pugh分级(A级、B级)后分层比较,两组间生存时间差异均无统计学意义(P均>0.05);组内比较TNM分期越晚、肝功能越差则生存率越低,差异有统计学意义(P<0.05)。COX回归分析显示年龄越大、肿瘤分期越晚、肝功能越差,患者的预后越差。两组并发症发生率、住院时间比较差异无统计学意义(P均>0.05)。MWA+TACE组患者的住院费用显著低于RFA+TACE组(P<0.01)。结论两种方法对于原发性肝癌的治疗都是一种安全高效的方式。MWA+TACE的患者住院费用较少,其在临床治疗中具有一定的优势。
Objective To compare the clinical efficacy and safety of radiofrequency ablation (RFA) and microwave ablation (MWA) combined with transcatheter arterial chemoembolization (TACE) in the treatment of primary liver cancer. Methods The clinical data of 97 patients with primary liver cancer treated with RFA combined with TACE (RFA+TACE group) and MWA combined with TACE (MWA+TACE group) were reviewed retrospectively from January 2008 to December 2012. There were 42 patients in the RFA+TACE group and 55 patients in the MWA+TACE group. The tumor ablation rate, overall survival time, incidence of postoperative complications, length of stay, and hospitalization costs were compared between the two groups. There was no significant difference in total ablation rate between the two groups (P>0.05). In the RFA+TACE group, the median survival time was 27.1 months, the survival time was (32.2±16.6) months, the median survival time in the MWA+TACE group was 24.6 months, and the survival time was (28.8±13.7) months. There was no significant difference in survival rates between the two groups at 1, 2, 3, 4 and 5 years (P>0.05). According to the tumor TNM staging (I, II, III) and liver function Child-pugh classification (Grade A, B) after the stratification, the difference in survival time between the two groups were not statistically significant (P all> 0.05) The later the TNM staging, the worse the liver function was, the lower the survival rate was. The difference was statistically significant (P<0.05). COX regression analysis showed that the older the age, the later the tumor stage, and the worse the liver function, the worse the patient’s prognosis. There was no significant difference in the incidence of complications and length of stay between the two groups (P>0.05). The cost of hospitalization in the MWA+TACE group was significantly lower than that in the RFA+TACE group (P<0.01). Conclusion Both methods are safe and effective methods for the treatment of primary liver cancer. Patients with MWA+TACE have less hospital expenses and have certain advantages in clinical treatment.