腹腔镜下射频消融和经皮射频消融治疗原发性肝癌的效果观察  

Observations on the effect of laparoscopic radiofrequency ablation and percutaneous radiofrequency ablation in the treatment of primary hepatocellular carcinoma

作　　者：陈磊[1] 唐彤[2] 张代忠[1] 柳凤玲 杨中秋 严欢 CHEN Lei;TANG Tong;ZHANG Daizhong;LIU Fengling;YANG Zhongqiu;YAN Huan(Department of General Surgery,Dazhou Central Hospital,Dazhou,Sichuan 635000,China;不详)

机构地区：[1]四川省达州市中心医院普通外科,635000 [2]四川省达州市中心医院肝胆胰外科,635000

出　　处：《临床外科杂志》2024年第11期1179-1183,共5页Journal of Clinical Surgery

基　　金：2020年四川省医学(青年创新)科研课题项目(S2024A)。

摘　　要：目的探究腹腔镜下射频消融(LRFA)、经皮射频消融(PRFA)对原发性肝癌病人抗肿瘤免疫、并发症发生率及复发率的影响。方法2020年1月~2022年8月收治原发性肝癌病人81例,根据治疗方法分为两组,观察组42例,行LRFA治疗;对照组39例,行PRFA治疗。比较两组瘤体完全消融率、术后并发症发生率、复发率及手术前后肿瘤坏死因子(TNF)-α、糖类抗原(CA)199、白细胞介素(IL)-6、高尔基体蛋白(GP)73、C反应蛋白(CRP)、甲胎蛋白(AFP)及外周血T淋巴细胞亚群水平。结果观察组瘤体完全消融率95.24%,与对照组(92.31%)比较,差异无统计学意义(P>0.05)。术后1天,观察组与对照组IL-6分别为(124.63±45.41)pg/ml和(168.28±51.26)pg/ml,CRP分别为(19.14±5.03)ng/L和(28.26±7.47)ng/L,TNF-α分别为(94.32±18.49)pg/ml和(108.41±20.11)pg/ml;术后3天,观察组与对照组IL-6分别为(92.37±24.11)pg/ml和(105.83±27.45)pg/ml,CRP分别为(14.87±4.37)ng/L和(17.25±5.06)ng/L,TNF-α分别为(75.41±12.10)pg/ml和(82.64±16.83)pg/ml,均较术前升高(P<0.05),两组比较,差异有统计学意义(P<0.05)。术后7天,观察组与对照组CD3+分别为(66.27±7.82)%和(65.14±7.63)%、AFP分别为(156.23±30.27)μg/ml和(160.84±32.33)μg/ml,GP73分别为(65.21±10.26)μg/L和(67.44±11.03)μg/L,CA199分别为(44.89±11.41)U/L和(45.12±13.07)U/L,CD4分别为(32.02±6.03)%和(31.53±6.11)%,CD4+/CD8+分别为(1.31±0.39)和(1.29±0.37);术后14天,观察组与对照组CD3+分别为(71.25±6.83)%和(70.89±6.76)%、AFP分别为(48.52±18.31)μg/ml和(50.11±19.12)μg/ml,GP73分别为(48.25±8.46)μg/L和(49.12±10.12)μg/L,CA199分别为(19.27±5.16)U/L和(20.07±5.39)U/L,CD4分别为(38.25±7.45)%和(37.61±7.92)%,CD4+/CD8+分别为(1.49±0.42)和(1.47±0.45),均较术前升高(P<0.05),但两组比较差异无统计学意义(P>0.05)。观察组术后并发症发生率(42.86%)及12个月复发率(2.38%)均较对照组低(66.67%、17.95%),差异有统计学意义(P<0.05)。观察组术后12个月Objective To investigate the effects of laparoscopic radiofrequency ablation(LRFA)and percutaneous radiofrequency ablation(PRFA)on anti-tumor immunity,complication rate and recurrence rate in patients with primary liver cancer.Methods A total of 81 patients with primary liver cancer treated in Dazhou Central Hospital from January 2020 to August 2022 were selected and divided into observation group(LRFA,n=42)and control group(PRFA,n=39)according to the treatment plan.Compare the total ablation rate,postoperative complication rate,recurrence rate of the two groups,as well as tumor necrosis factor-α(TNF-α),carbohydrate antigen 199(CA199),interleukin-6(IL-6),Golgi protein 73(GP73),C-reactive protein(CRP),alpha-fetoprotein(AFP)and peripheral blood T lymphocyte subpopulation levels before and after surgery.Results There was no significant difference between the observation group(95.24%)and the control group(92.31%)(P>0.05).At 1 d postoperatively,IL-6 was(124.63±45.41)pg/ml and(168.28±51.26)pg/ml,CRP was(19.14±5.03)ng/L and(28.26±7.47)ng/L,and TNF-αwas(94.32±18.49)pg/ml and(108.41±20.11)pg/ml;at 3 d postoperatively,IL-6 was(92.37±24.11)pg/ml and(105.83±27.45)pg/ml in the observation group and the control group,respectively,CRP was(14.87±4.37)ng/L and(17.25±5.06)ng/L,and TNF-αwas(75.41±12.10)pg/ml and(82.64±16.83)pg/ml,which were all higher than that of preoperative period(P<0.05).At 7 d postoperatively,CD3+in the observation group and control group were(66.27±7.82)%and(65.14±7.63)%,AFP was(156.23±30.27)μg/ml and(160.84±32.33)μg/ml,GP73 was(65.21±10.26)μg/L and(67.44±11.03)μg/L,CA199 was(44.89±11.41)U/L and(45.12±13.07)U/L,CD4 was(32.02±6.03)%and(31.53±6.11)%,and CD4+/CD8+was(1.31±0.39)and(1.29±0.37)respectively;at 14 d postoperatively,CD3+was(71.25±6.83)%and(70.89±6.76)%,AFP was(48.52±18.31)μg/ml and(50.11±19.12)μg/ml,GP73 was(48.25±8.46)μg/L and(49.12±10.12)μg/L,CA199 was(19.27±5.16)U/L and(20.07±5.39)U/L,and CD4 was(38.25±7.7)U/L and(20.07±5.39)U/L,respectively,in the obse

关 键 词：腹腔镜下射频消融 经皮射频消融 原发性肝癌 抗肿瘤免疫 并发症 

分 类 号：R735.7[医药卫生—肿瘤]