Clinical Research Of Radiofrequency Ablation And Microwave Ablation For Primary Liver Carcinoma

Objective:To study the clinical characteristics of primary hepatocellular carcinoma and investigate the clinical results of Radiofrequency ablation (RFA) and Microwave ablation (MWA) for the treatment of hepatocellular carcinoma.Methods:85 patients are treated from Jan.2006 to Dec.2009 in the Department of Hepatobliary Surgery, the Affiliated Yuhuang-ding Hospital of Yantai, Medical College, Qingdao University.standards:the patient who is primary hepatoceullar carcinoma with severe liver cirrhosis is not suitable for surgery, but liver function is Child-pugh A grade or Child-pugh B grade; the patient is higher risk to surgery who have an older age, poorer health or suffering from severe diabetes, heart disease and other systemic diseases; the diameter of primary hepatic tumor's single nodule≤5cm, or the diameter of two nodules<5cm, particularly≤3cm; The patient have no severe ascites, hepatic encephalopathy, gastric-esophagus variceal bleeding history, portal vein tumor thrombus and distant metastasis and those who refuse surgery for various reasons.43 cases of primary hepatic carcinoma were treated by RFA,42 cases of primary hepatic carcinoma were treated by MWA. A total of 107 Nodules were ablation lesions, including 22 double nodules. the datas are all showed with "mean±SD", Calculated by SPSS 17.0 software, measurement data is calculated by t test, count data is calculated byx2 test, the risk factors of tumoral recurrence are analyzed by Cox regression model, free-tumor survival are analyzed by Kaplan-meier and Log-rank test, P<0.05 is viewed as significant difference criterion, those are used to analyze clinical data and follow-up results.Results:The general case feature:1.There are 85 cases of liver hepatic patients, 63 case are males,22 case are females, the ratio of the prevalence of the primary hepatic carcinoma in male and female is 3:1.2. The minimum age was 33, the maximum age was 78, the average age was 57.3±8.3, mainly concentrates in the 50- 60 years old.3.The symptoms mainly were symptomless (60.0%), fatigue and weight loss (54.1%), the dominated signs mainly were liver palms and spider (58.8%) and sensitive to percussion on the liver (31.8%).4. Many patient were complied with hypertension (83.5%); diabetes mellitus (61.2%).5.All of the patients were infected by hepatictis B virus, the ratio of the hepatictis B surface antigen (HBsAg) is 98.8%, the one of the hepatictis B e antiboy (HBeAb) is 74.1%, the one of the hepatitis B virus core antigen (HBcAb) is 100%. Postoperative complications and follow-up:1.the incidence of fever, pain in RFA and MWA group have no statistically significance.2. The complete ablation rate of RFA and MWA group were 95.2% and 90.7%, MWA group is higher than RFA group, but there was no statistically significance.3. The intrahepatic recurrence rates of RFA and MWA group in 1,2 and 3-year was 14.0%, 53.5%,76.7% and 16.7%,57.1%,83.3%.using four table X2 test, the results shows there was no statistically significance between the two groups.4. The postoperative recurrence rate were not associated with the treatment methods, age, sex, the level of a-fetoprotein, liver function, whether combined with cirrhosis, tumor size, number of nodules by Cox regression analysis method.5. The RFA and MWA group tumor-free survival rates were 86.0%,50.4%,25.2% vs 85.5%,50.0%,23.7%, the average tumor-free survival time was 25.53 months vs 25.50 months (X2=0.22,P=0.64).6. When the tumor diameter<3cm,the 1,2,3-free survival rates in RFA and MWA group were 91.3%,59.1%,29.6% vs 90.5%,51.9%,26.0%, the average tumor-free survival time was 28.80 months vs 25.73 months (X2=1.52,P=0.22).7. When the tumor diameter in 3-5cm, the 1,2,3-free survival rates in RFA and MWA group were 80.0%, 40.0%,20.0% vs 80.4%,48.4%,18.2%, the average survival time of tumor-free was 21.75 months vs 24.92 months (X2=0.25,P= 0.62).Conclusion:1. The majority of small hepatocellular carcinoma were lack of typical clinical signs and symptoms, the patients who is 40 years old, male, especially with chronic hepatitis B virus (HBV) should regularly monitor a-fetoprotein and ultrasonography every 6 months, the one who is HBeAg positive should be treatmented and monitor the occurrence of HCC at the same time.2. Complete ablation rate, complications and days of staying in hospital in RFA and MWA group have no statistically significance, and the intrahepatic recurrence after treatment of small hepatic carcinoma had no statistically significance in 1,2,3-year.3.The postoperative recurrence rate of FRA and MWA group were not associated with the treatment methods, age, sex, the levels of a-fetoprotein, liver function, whether combined with cirrhosis, tumor size, number of nodules.4.tumor-free survival rates had no significant differences between the RFA and MWA group, but the tumor fulled of vessels could be considered by microwave therapy.