特殊或高危部位原发性小肝癌超声引导下腹腔镜射频消融术治疗效果及术后免疫状况分析

doi:10.3760/cma.j.issn.2095-7041.2019.05.007

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摘要目的探讨超声引导下腹腔镜射频消融术(LRFA)治疗特殊或高危部位原发性小肝癌患者术后的免疫状况及临床疗效。方法回顾性分析2012年1月—2017年12月鄂东医疗集团市中心医院肝胆胰腺外科60例特殊或高危部位原发性小肝癌患者的临床资料,其中行超声引导下LRFA 32例(LRFA组),行腹腔镜肝切除术(LH)治疗28例(LH组)。LRFA组男25例、女7例,年龄38~84(61.13±12.30)岁;LH组男23例、女5例,年龄35~80(60.07±12.90)岁。比较两组患者术后根治率、免疫状况、术后并发症及无瘤生存率。结果两组患者均成功实施手术,无围手术期死亡病例。LRFA组和LH组的手术根治率分别为96.9%(31/32)和100.0%(28/28),差异无统计学意义(P＞0.05)。两组患者术后均随访3~72(46.8±18.5)个月。与LH组相比,LRFA组术后4周、8周CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺均较高,差异均有统计学意义(P值均＜0.05);LRFA组术后8周外周血CD3⁺、CD4⁺、CD8⁺、CD4⁺/CD8⁺与术前比较显著升高,Treg显著降低,差异均有统计学意义(P值均＜0.05)。两组患者术后并发症发生率差异无统计学意义(P＞0.05)。LRFA组无瘤生存时间明显长于LH组,两组患者术后1、2、3年无瘤生存率分别为93.7%、81.3%、56.3%和82.1%、71.5%、42.9%,差异均有统计学意义(P值均＜0.05)。结论 LRFA可精确定位、动态观察消融过程,拓宽了射频消融的适用范围,增强机体免疫功能,延长患者无瘤生存期。LRFA已成为特殊或高危部位原发性小肝癌微创治疗的主要手段。

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	彭沙沙
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关键词 ：肝肿瘤, 导管消融术,射频, 肝切除术, 腹腔镜外科手术

Abstract：Objective To explore the effects of ultrasound-guided laparoscopic radiofrequency ablation(LRFA) on the immunological function and clinical efficacy in patients with special or high-risk location small primary liver cancer.Methods The clinical data of 32 patients with small primary special or high-risk location heptocellular carcinoma undergoing ultrasound-guided laparoscopic radiofrequency ablation(LRFA group) from January 2012 to December 2017 in Department of Hepatobiliary and Pancreatic Surgery, the Central Hospital of Edong Healthcare Group, and 28 patients undergoing laparoscopic hepatectomy(LH group) during the same period were retrospectively analyzed. There were 25 males and 7 females in LRFA group, aged 38-84(61.13±12.30) years. In LH group, there were 23 males and 5 females, aged 35-80(60.07±12.90) years. Postoperative immune conditions, postoperative complications, radical surgery rates and disease-free survival rates between the two groups were compared.Results Operations in two groups were all successful without perioperative deaths. The radical operation rate of LRFA group and LH group was 96.9%(31/32) and 100.0%(28/28), respectively(P＞0.05).All patients were followed up for 3-72 (46.8±18.5) months. Compared with LH group, CD3⁺, CD4⁺, CD8⁺ and CD4⁺/CD8⁺ increased significantly at 4 and 8 weeks after operation in LRFA group (all P values＜0.05). Eight weeks after surgery, CD3⁺, CD4⁺, CD8⁺, CD4⁺/CD8⁺ of LRFA group were significantly increased (all P values＜0.05). Incidence of postoperative complications had no statistical difference between two groups(P＞0.05). The disease-free survival time of LRFA group was significantly longer than that of LH group. Postoperative disease-free survival rates of 1, 2 and 3 years for LRFA group were 93.7%, 81.3%, 56.3%. In LH group the rates were 82.1%, 71.5%, 42.9%, which had significant statistical differences with those in LRFA group(all P values＜0.05).Conclusions By ultrasound-guided laparoscopic radiofrequency ablation, we can not only locate accurately and observe the ablation zone in real-time, we can also broad the application scope of radiofrequency ablation, protect immunological function and improve disease-free survival rates. Ultrasound-guided laparoscopic radiofrequency ablation has become the main method of minimally invasive treatment for special or high-risk location small primary liver cancer.

Key words： Liver neoplasms Catheter ablation, radiofrequency Hepatectomy Laparoscopic surgical procedures

收稿日期: 2019-01-30

基金资助:国家自然科学基金(81360079);湖北省卫生健康科研基金资助(WJ2019H160)

通讯作者: 郭浚, Email: 1871690638@qq.com

引用本文:

彭沙沙, 郭浚, 夏国兵, 裴斐, 曾仲. 特殊或高危部位原发性小肝癌超声引导下腹腔镜射频消融术治疗效果及术后免疫状况分析[J]. 中华解剖与临床杂志, 2019, 24(5): 458-463.
Peng Shasha, Guo Jun, Xia Guobing, Pei Fei, Zeng Zhong. Clinical efficacy of ultrasound-guided laparoscopic radiofrequency ablation for special or high-risk location small primary liver cancer. Chinese Journal of Anatomy and Clinics, 2019, 24(5): 458-463.

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