Comparison Of Microwave Ablation And Surgical Resection For Small Hepatocellular Carcinoma

Objective：Compare the efficacy of surgical resection with microwaveablation in the treatment of small hepatocellular carcinoma, this paper discussesclinical application of two kinds of treatment.Methods：Retrospective analysis of the small hepatocellular carcinomapatients in our department from March2004to March2009, whose firsttreatment was surgical resection or microwave ablation therapy.The totalnumber of cases is59, includes38cases of tumor resection,21cases ofmicrowave ablation.59cases of patients with clinical diagnosis of primary livercancer underwent ultrasound, CT/MRI,AFP, liver function, coagulationfunction testing,and liver puncture or surgical pathology in the preoperative orpostoperative.48cases were male and11females, age29-73years, median age53.7years; AFP positive71.1%(42/59); HBsAg-positive72.9%(43/59),HCV-Ab-positive10.2%(6/59), one cases of HBsAg, and HCV-Ab positive.Of Surgery for the treatment group,combined hepatic resection in5cases, liversegment resection in7patients, partial liver resection in26cases. Ofmicrowave ablation group, Percutaneous microwave ablation in15cases,laparotomy in6cases. Access to inpatient cases, return visit, telephone andletters，records in patients with serum alanine aminotransferase (ALT) changes,recurrence, survival time, and postoperative complications.Results：1Recurrence rate:Resection of small hepatocellular carcinoma operation treatment groupsafter1,3years recurrence rates were7.9%(3/38) and21.1%(8/38), small hepatic microwave ablation treatment group1,3year recurrence rates were14.3%(3/21) and47.6%(10/21), small hepatocellular carcinoma operationexcision treatment group and microwave ablation treatment group1yearrecurrence rate showed no significant difference, between3year recurrencerates have significant difference (P <0.05).2Survival rate:Surgical resection for small hepatocellular carcinoma treatment groupafter1,3year recurrence rates were7.9%(3/38) and21.1%(8/38) respectively,microwave ablation of small hepatocellular carcinoma treatment group after1,3-year, recurrence rate of14.3%(3/21) and47.6%(10/21) respectively.1-yearrecurrence rate of small HCC surgical resection group, and microwave ablationgroup was no significant difference, but between the two groups, the3-yearrecurrence rate was statistically different (P <0.05).3Operation time and intraoperative hemorrhage：All the members of the surgery resection group had bleeding, blood loss isin average of323.68±57.05ml。Microwave ablation group hadn’t bleedingor little blood loss, which was less than the surgical resection group. Theoperation time of surgery resection group was about125.66±35.08minutes inaverage, the mean operative time of the open microwave ablation treatmentgroup was92.5±20.43minutes, the mean operative time of percutaneousmicrowave ablation treatment group was34.0±5.41minutes. There arestatistically significant between the three groups.4The changes of liver function after surgery:The liver function is changed in surgery resection group and microwavegroup. The indexes of liver function is significant changed, such as ALT、AST、CHE、ALB. There are statistically significant between the surgeryresection group and microwave group in the four indexes in3days of postoperative（P<0.05）, there are statistically significant between these twogroups in ALT and CHE in7days of postoperative（P>0.05）.5Complications and postoperative hospital stay:Five cases in the surgical resection treatment group came out compli-cations, including wound healing poorer, pleural effusion, subphrenic effusion.Percutaneous microwave ablation,7cases came out complications, includingpain, fever; Percutaneous microwave ablation after six cases of varying degreesof pain and fever, of which three cases had mild abdominal distention. The twogroups did not occur with treatment-related deaths, and all the complicationsdisappeared after conservative treatment. Surgical resection treatment group,postoperative hospital stay was13.5±4.8days, microwave ablation group,postoperative hospital stay was5.1±2.4days,between the two groups, therewas significant difference.Conclusion： To small hepatocellular carcinoma, microwave ablationgroup could achieve similar long-term survival results compared with surgicalresection treatment group. compared with microwave ablation, surgicalresection had advantage in median survival and the recurrence rate, so wesuggest surgical resection, but microwave ablation had advantage in operatedsimply, higher hyperthermia efficiency, completely situ-inactivated， littletrauma，little impact on liver function, low severe complication rate, goodrepeatability, can be applied to older, poor general state et al,who is notsuitable for surgery or refuse surgery.