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目的探讨射频消融对肝细胞癌(HCC)手术切除后复发病例再治疗的效果,比较不同复发时间的疗效差别。方法以行超声引导经皮射频消融(RFA)治疗的手术切除后复发性肝细胞癌(RHCC)患者(RHCC组)和同期行RFA治疗的首发HCC患者(首发HCC组)为研究对象。(1)RHCC组42例患者,男34例,女8例,平均年龄(58±10)岁;复发灶大小1.5~6.6cm,平均(3.8±1.4)cm。RFA治疗前5例伴肝外转移。肝功能A级21例,B级19例,C级2例。手术切除距肝内初次复发时间为1~96个月,平均22.8个月。术后1年内肿瘤复发者20例40灶(RHCC近期组),术后1年以上复发者22例37灶(RHCC远期组)。(2)首发HCC组148例患者,男117例,女31例,平均年龄59岁。肿瘤大小1.2~7.0cm,平均(4.0±1.4)cm。RFA治疗后1个月采用增强CT检查评价消融成功率;比较RHCC近期组、RHCC远期组和首发HCC组的治疗效果、复发转移情况及生存期。结果首发HCC组RFA成功率为87.2%(129例),局部复发率为16.2%(24例),另位复发率为37.8%(56例),平均生存期为(39.0±2.1)个月;RHCC近期组、远期组RFA成功率分别为85.0%和95.5%(P>0.05),局部复发率分别为15.0%和13.6%(P>0.05),另位复发率为60.0%和18·2%(P=0.005),平均生存期为(15.4±2.3)个月和(39.5±4.5)个月(P<0.005)。与首发HCC组相比,RHCC远期组消融成功率与局部复发率均无显著性差异(P>0.05),RHCC近期组生存期低于首发HCC组(P<0.05)。RHCC远期组1例患者治疗后出血,经射频止血、输血等保守治疗缓解。结论RFA治疗RHCC的预后及疗效与复发的时间相关;对于术后远期复发者,行RFA治疗可获得同首发HCC相似的生存期,而手术后近期复发者疗效相对较差。
Objective To investigate the effect of radiofrequency ablation on re-treatment of recurrent hepatocellular carcinoma (HCC) patients after resection, and to compare the curative effect of different recurrence time. Methods The patients with RHCC (RHCC group) and RFA-treated primary HCC group (primary HCC group) underwent ultrasound-guided percutaneous radiofrequency ablation (RFA) as the study object. (1) In the RHCC group, 42 patients were male and 34 females, with a mean age of (58 ± 10) years. The size of the recurrence was 1.5 ~ 6.6 cm (mean, 3.8 ± 1.4) cm. 5 cases before RFA with extrahepatic metastasis. A grade in 21 cases of liver function, B grade in 19 cases, C grade in 2 cases. Surgical resection from the liver within the first relapse time of 1 to 96 months, an average of 22.8 months. Tumor recurrence within 1 year after surgery in 20 cases of 40 foci (RHCC recent group), more than 1 year after the recurrence of 22 cases of 37 foci (RHCC long-term group). (2) 148 patients with primary HCC, 117 males and 31 females, with an average age of 59 years. Tumor size 1.2 ~ 7.0cm, with an average (4.0 ± 1.4) cm. The success rate of ablation was evaluated by enhanced CT at 1 month after RFA treatment. The therapeutic effect, recurrence, metastasis and survival were compared between the RHCC group, the long-term RHCC group and the primary HCC group. Results The success rate of RFA in the primary HCC group was 87.2% (129 cases), the local recurrence rate was 16.2% (24 cases) and the other was 37.8% (56 cases). The mean survival time was (39.0 ± 2.1) months. The success rates of RFA in the immediate and long-term group were 85.0% and 95.5% (P> 0.05), and the local recurrence rates were 15.0% and 13.6% (P> 0.05) % (P = 0.005). The average survival time was (15.4 ± 2.3) months and (39.5 ± 4.5) months (P <0.005). Compared with the primary HCC group, there was no significant difference in the success rate between the long-term RHCC group and the local recurrence rate (P> 0.05). The survival rate of the short-term RHCC group was lower than that of the primary HCC group (P <0.05). One patient in RHCC group had hemorrhage after treatment, which was relieved by conservative treatment such as radio-frequency hemostasis and blood transfusion. Conclusions The prognosis and curative effect of RFA in treating RHCC are related to the time of relapse. For long-term postoperative recurrence, the survival time of RFA is similar to that of initial HCC, but the relapse after operation is relatively poor.