肝切除联合微波消融对肝癌病人免疫功能及预后的影响  

Effects of hepatectomy combined with microwave ablation on immune function and prognosis of patients with hepatocellular carcinoma

作　　者：索质君 高金亭 刘利平[2] 张磊[3] 熊俊[3] SUO Zhijun;GAO Jinting;LIU Liping(Department of Hepatobiliary and Pancrea Surgery,Shenzhen Nanshan People＇ s Hospital,Shenzhen 518052,China)

机构地区：[1]深圳市南山区人民医院肝胆胰腺外科,518052 [2]暨南大学第二临床医学院肝胆外科 [3]华中科技大学附属协和医院肝胆外科

出　　处：《临床外科杂志》2018年第7期532-535,共4页Journal of Clinical Surgery

基　　金：国家自然青年科学基金资助项目(81402041);深圳市南山区技术研发和创意设计项目分项基金资助项目(南科研卫2013009号)

摘　　要：目的分析肝切除联合微波消融对肝细胞肝癌病人术后免疫功能及预后的影响。方法肝细胞肝癌病人50例,随机分成两组,实验组25例,行肝切除联合切面微波消融,对照组25例,行单纯肝切除。术前、术后1周及术后1个月检测病人淋巴细胞亚群变化,术后观察病人生存期及肿瘤复发率。结果两组术后1年和2年生存率比较差异无统计学意义(P>0.05)。两组术后1年无瘤生存率(DFS)比较,差异无统计学意义(P>0.05),实验组术后2年DFS(80%)高于对照组(56%)(P<0.05)。实验组术后CD3、CD4及B细胞显著升高,其术后1周百分比分别为(55.39±7.57)%、(33.27±4.95)%和(14.51±6.10)%;术后1个月百分比分别为(58.31±7.06)%、(35.59±4.95)%和(16.31±6.33)%,与对照组相比有差异统计学意义(P<0.05)。实验组组内比较,CD3、CD4及B细胞术后1周及1个月百分比持续升高,差异有统计学意义(P<0.05)。NK细胞术后1周呈升高趋势,百分比为(18.78±4.74)%;术后1个月逐渐恢复至术后1周状态,百分比为(17.65±4.49)%,两者间比较差异无统计学意义(P>0.05)。结论肝切除联合微波消融不仅能直接杀灭肿瘤细胞,而且能提高病人术后免疫功能,延长无瘤生存时间。Objective To investigate the immunologic changes and their prognostic significance after resection combined with microwave ablation of hepatocellular carcinoma（ HCC）. Methods 50 patients with hepatocellular carcinoma were randomly divided into two groups. 25 patients received resection combined with microwave ablation（ experimental group） and 25 patients received resection alone（ control group）. The percentage of peripheral blood T cells,B lymphocytes and NK cells were measured using flow cytometry before treatment,one week and one month after treatment. The survival time and recurrence rate were recorded. Results There were no differences in survival rates at 1 and 2 years between two groups（P〉0. 05）. There were also no differences in DFS at 1 year（P〈0. 05）. but DFS of experimental group（80%）was higher than control group（56%）（P〉0. 05）. The CD3 cells,CD4 cells and B cells in the experimental group were increased significantly after operations. The percentages of them at 1 week were（55. 39 ± 7. 57）% 、（33. 27 ± 4. 95）% 、（14. 51 ± 6. 10）%. The percentages of them at 1 month were（58. 31 ± 7. 06）% 、（35. 59 ± 4. 95）% 、（16. 31 ± 6. 33）%,respectively. There were significant differences with control group（ P〈0. 05 for all）. Compared in experimental group itself,the CD3 cells,CD4 cells and B cells kept increasing,and there were significant differences in 1 week and 1 month（ P〈0. 05 for all）. The NK cells were increased at 1 week and the percentage was（18. 78 ± 4. 74） %,but 1 month later the percentage was（17. 65 ± 4. 49） %（ P〉0. 05）. Conclusion Hepatectomy combined with microwave ablation was not only kill the tumor cells directly,but also improve the immune status in patients with HCC,it may also play an important role in prolonging recurrence time and decreasing recurrence rate.

关 键 词：肝癌 肝切除 微波消融 免疫治疗 

分 类 号：R735.7[医药卫生—肿瘤]