目的:比较经皮原位射频消融与手术切除治疗肝脏肿瘤的疗效。方法:1999年11月至2004年6月，中山大学肿瘤防治中心共收治434例肝功能Child A级的小肝癌（单个肿瘤、直径≤5.0cm）病人。其中手术切除183例，射频消融治疗251例。结果:手术切除组1、3、5年存活率分别为91.18％、70.18％、55.51％，射频消融组存活率分别为91.92％、74.41％、58.22％，两组之间差异无统计学意义（P=0.6253）；分层分析显示, 对于直径≤3.0cm肿瘤，手术切除组1、3、5年存活率分别为95.87%、73.69%、62.45%，射频消融组1、3、5年存活率分别为95.46%、80.15％、72.79％，两组之间差异无统计学意义（P=0.5641）；对于直径3.1～5.0cm肿瘤，手术切除组1、3、5年存活率分别为88.07％、67.63％、51.18％，射频消融组1、3、5年存活率分别为80.16%、60.63％、32.34％，两组之间差异无统计学意义（P=0.1256）；多因素分析显示肿瘤大小和总胆红素（serum bilirubin）是影响存活率的独立危险因素。结论:对于肝功能较好的单个肿瘤的小肝癌病人，射频消融与手术切除效果相近，可达到根治性效果，可代替部分开腹手术切除。

Objective:To compare the effectiveness of percutaneous radiofrequency ablation (PRFA) and surgical resection as an initial treatment for patients with small hepatocellular carcinoma (HCC). Methods:Between November 1999 and June 2004,434 patients with a solitary HCC (diameter less than 5cm) and wellpreserved liver function (Childpugh class A ) received PRFA or surgical resection (SR) in Sun Yatsen University Cancer Center.Among them,183 patients received SR and 251 patients received PRFA. Results:The overall 1year,3year and 5year survival rates for SR group were 91.18%,70.18%,55.51% respectively,and for PRFA group were 91.92%,7441%,58.22% respectively.In patients with tumor diameter ≤3cm,the overall 1year,3-year and 5-year survival rates for SR group were 9587%,7369%,6245% respectively,and for PRFA group were 95.46%,80.15%,72.79% respectively.In patients with tumor diameter from 3.0m to 5.0cm, the overall 1year,3-year and 5-year survival rates for SR group were 88.07％,67.63％,51.18％ respectively,and for PRFA group were 80.16%,60.63％,32.34％ respectively.Survival of patients treated with PRFA were dependent on tumor size and serum bilirubin. Conclusion:PRFA is as effective as surgical resection in the group of solitary and small HCC.PRFA can be used instead of surgical resection in proper situations.