Comparison And Analysis Of Radiofrequency Ablation And Surgical Resection In The Treatment Of Primary Small Hepatocellular Carcinoma

Objective:To provide a more rational and accurate method for primary small hepatocellular carcinoma(HCC)in clinical treatment through the comparison of B-ultrasound guiding percutaneous trans-hepatic radiofrequency ablation and surgical treatment in efficacy,complications and prognosis of single primary HCC with diameter≤3cm.Methods:The data of clinical patients with primary HCC treated in Shandong Provincial Hospital from January 2011 to January 2014 were retrospectively collected and analyzed.All patients were diagnosed as single small HCC,46 of them were treated by B-ultrasound guided percutaneous trans-hepatic radiofrequency ablation(RFA group),and 50 patients were treated by surgical resection(operation group).The recent efficacy and prognosis were evaluated by comparison of the two groups in the operation time,total blood loss,hospitalization time,liver function injury,complications,recurrence rate and survival rate.SPSS19.0 statistical software was used to analyze the data,and the count date and categorical data were compared by t test、X2 test and Fisher exact test.The difference was statistically significant with P<0.05.Result:(1)Tumor location ratio:The number of cases whose tumor located in the liver parenchyma is 38,8 cases whose tumor closed to liver capsule in RFA group;while 41 cases whose tumor closed to liver capsule,9 cases whose tumor located in the liver parenchyma in SR group.(2)Operation time,total blood loss and hospitalization time:The operation time of the patients was21.83±4.98 min in the RFA group,while it was 120.20±32.82 min in the SR group,there was significant difference between the two groups with P<0.05;The average total blood loss in the RFA group was 0 ml,while the average total blood loss in the SR group was 338.24±197.80ml,there was significant difference between the two groups with P<0.05;The hospital stay was 6.61±2.27 days in RFA group,while it was 12.50±4.25 days in SR group,the difference was significant with P<0.05.(3)Postoperative liver function level:In the second day after operation,the ALT was83.30±28.80 U/L and.AST was96.93±29.09 U/L in the RFA group,while the ALT was 385.500±297.13 U/L and the AST was 354.44±188.47 U/L in the SR group.In the fifth day,the ALT was 52.35±17.23U/L and AST was 53.25±16.35U/,While the ALT was 143.56±56.56 U/L and the AST was 154.75±67.40U/L in the SR group.There was a significant difference in the liver function between the two groups(P<0.05).(4)Complications:There were 4 cases of hyperthermia in the RFA group.There were 6 cases of hyperthermia,4 cases of bile leakage,6 cases of pleural and peritoneal effusions,3 cases of poor wound healing,2 cases of liver failure,and 4 case of intra-peritoneal hemorrhage in the operation group.No death cases appeared in the two groups.Total complications:4 cases in the RFA group,18 cases in the operation group.There was a significant difference in the complications between the two groups(P<0.05).(5)Recurrence rate and survival rate:The recurrence rate was 10.9%in the first year,30.4%in the second year and 43.5%in the third year in the RFA group;while it was 14.0%in the first year,34.0%in the second year and 46.0%in the third year in the operation group.There was no statistically significant in the difference.The overall survival rate was 100%in the first year,84.8%in the second year and 76.1%in the third year in the RFA group,while it was 96%in the first year,86%in the second year and 74%in the third year in the operation group.There was no significant difference.Conclusion:This study shows that B-ultrasound guided radiofrequency ablation for treatment of single HCC has advantages of small trauma,quick recovery,less damage to liver function,less complications and can achieve similar efficacy with the surgical treatment,while the recent recurrence rate and survival rate were no significant difference compared with operation.The effect and advantages of radiofrequency ablation for treatment of primary small HCC become increasingly obvious in the conditions of treatment indications,part of the open surgery can be replaced;and it can be widely used in clinical treatment.However,it still need comprehensive consideration,strict control of indications and individualized therapy in clinical diagnosis and treatment.