肝射频消融术相对肝切除术对围手术期炎症反应的影响  

Effect of liver radiofrequency ablation versus hepatectomy on perioperative inflammatory reaction

作　　者：田雪[1] 韩侨宇[1] 安海燕[1] 冯艺[1] TIAN Xue;HAN Qiaoyu;AN Haiyan;FENG Yi(Department of Anesthesiology,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院麻醉科,北京100044

出　　处：《海军军医大学学报》2024年第6期776-780,共5页Academic Journal of Naval Medical University

基　　金：北京市科技计划项目(Z131100006813037);天普研究基金(UF201324).

摘　　要：目的评估择期肝切除术与肝射频消融术患者围手术期血浆IL-6、IL-10、CRP的水平,探讨2种手术方式围手术期炎症反应程度及其与短期预后的关系。方法纳入37例肝占位患者为研究对象,其中择期肝切除术19例、肝射频消融术18例。采用ELISA法检测患者术前、术毕及术后不同时间点血浆IL-6、IL-10、CRP水平,通过非参数检验判断治疗前后的动态变化,并比较2种手术方式围手术期炎症因子水平及预后指标。结果治疗前后肝切除术患者围手术期血浆IL-6、IL-10、CRP水平及肝射频消融术患者IL-6、CRP水平均存在动态变化(均P<0.05)。肝切除术后24 h及48 h的IL-6,术毕IL-10,术后24、48、72 h CRP水平均显著高于术前(均P<0.05);肝射频消融术术毕IL-6水平显著高于术前(P<0.05),IL-10、CRP水平在手术前后的差异均无统计学意义(均P>0.05)。与肝切除术患者比较,射频消融术术后48 h CRP水平降低,术后住院时间缩短(均P<0.05)。结论肝射频消融术后全身炎症反应程度相对较小,可能有利于患者加速康复。Objective To assess the levels of interleukin(IL)-6,IL-10,and C reactive protein(CRP)in plasma perioperatively in patients undergoing elective hepatectomy and liver radiofrequency ablation,and to explore the extent of perioperative inflammatory responses and their relationship with short-term prognosis.Methods Totally 37 patients with hepatic lesions were enrolled,including 19 patients undergoing elective hepatectomy and 18 undergoing liver radiofrequency ablation.The plasma levels of IL-6,IL-10 and CRP were detected by enzyme-linked immunosorbent assay preoperatively,immediately after surgery,and at various time points postoperatively.The dynamic changes before and after treatment were determined by non-parametric tests.The levels of perioperative inflammatory factors and prognostic indexes were compared between the 2 surgical methods.Results Significant dynamic changes were observed in the perioperative plasma levels of IL-6,IL-10,and CRP in patients undergoing hepatectomy,as well as in the levels of IL-6 and CRP in patients undergoing liver radiofrequency ablation(all P<0.05).The levels of IL-6 at 24 and 48 h after hepatectomy,IL-10 immediately after surgery,and CRP at 24,48,and 72 h postoperatively were significantly higher than those before surgery(all P<0.05).After liver radiofrequency ablation,the level of IL-6 immediately after surgery was significantly higher than that before surgery(P<0.05),while the levels of IL-10 or CRP before or after surgery were not significantly different(all P>0.05).Compared with patients undergoing hepatectomy,the CRP level at 48 h after radiofrequency ablation was significantly lower,and the postoperative hospital stay was significantly shorter(both P<0.05).Conclusion Postoperative systemic inflammatory response is relatively lower after liver radiofrequency ablation,which may accelerate rehabilitation.

关 键 词：肝切除术 肝射频消融术 白细胞介素6 白细胞介素10 C反应蛋白 围手术期 

分 类 号：R657.3[医药卫生—外科学]