Ultrasound-guided Percutaneous Microwave Ablation For The Treatment Of Hepatocellular Carcinoma

Objective: To study the efficacy and safety of ultrasound-guided percutaneous microwave ablation(MWA)in the treatment of hepatocellular carcinoma(diameter ? 5cm).Methods: We retrospectively analyzed 273 cases of hepatocellular carcinoma(?5cm)surgical treatment in the Eastern Hospital of the Fourth Hospital of Hebei Medical University from November 2012 to June 2017.Among them,52 cases underwent microwave ablation therapy,221 cases underwent liver resection(LR).Basic patient-related information was obtained through medical records,outpatient records and telephone follow-up.The follow-up deadline was September 1,2017.All statistical data were analyzed using SPSS 17.0 software.Count data using ?2 test to detect the consistency of baseline data among patients in each group.The Kaplan-Meier method is used to depict the survival curve.COX regression analysis was used to study the correlation factors such as gender,age,number of tumors,tumor size,preoperative albumin,alpha fetoprotein,total bilirubin,prothrombin time,Child classification of liver function,and survival rate.The Log-rank test was used to compare the difference in the efficacy of microwave ablation and surgical resection between hepatocellular carcinoma patients with tumor diameter ?5cm,P<0.05 was considered has statistical significane.Results:1.52 cases(69 lesions)were treated with microwave ablation.The complete ablation rate was 98.55%(68/69)after the first treatment.One case without complete ablation achieved complete ablation by secondary ablation.During the follow-up period,9 patients had local tumor progression(LTP)and5 had intra-hepatic distant recurrence(IDR).There were 3 serious complications after the operation,including infection,liver abscess,andintestinal perforation.They were treated with anti-infective therapy,abscess drainage,and bowel resection.The overall survival(OS)of the 52 patients treated with MWA after 1 and 3 years was 93.5% and 76.6%,respectively.The median survival period is 29 months.The incidence of complications after microwave ablation was 5.8%(3/52).2.The 1-year and 3-year overall survival rate of 221 patients after surgical resection were 90.8% and 74.5%,and the median survival time was 20 months.The incidence of complications after hepatectomy was 10.9%(24/221).3.Log-rank test results showed that there was no significant difference in the long-term survival rate between surgical resection and microwave ablation of hepatocellular carcinoma patients with diameter ?5cm(P=0.099);COX univariate analysis showed that the number of tumors(P=0.034)was a risk factor for the prognosis of patients undergoing microwave ablation.Conclusions:1.Ultrasound-guided percutaneous microwave ablation of hepatocellular carcinoma with diameter ? 5cm is safe and effective.Compared with surgical resection,a similar long-term survival rate can be obtained with a lower incidence of complications;2.Patients with hepatocellular carcinoma with high bilirubin,low albumin level,and poor coagulation function,microwave ablation treatment can achieve similar survival rates as surgical resection.3.For patients with hepatocellular carcinoma undergoing microwave ablation treatment,the number of tumors is a risk factor that affects its prognosis.