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腹腔镜肝切除术与射频消融术对原发性肝癌患者肝功能和免疫功能及3年无瘤生存率的影响
古曦,杨俭,杨小玲,覃莉,王叶
0
(四川大学华西医院肝脏外科)
摘要:
【摘要】目的 探究腹腔镜肝切除(LH)与射频消融术(RFA)治疗对原发性肝癌(HCC)患者肝功能、免疫功能及3年无瘤生存率的影响。方法 回顾性分析2014年3月~2016年1月我院122例HCC患者临床资料,其中行LH术治疗68例(LH组),行RFA术治疗54例(RFA组)。记录两组手术相关指标(手术时间、术中出血量、输血率、术后住院时间)及围术期并发症发生情况,比较两组术前及术后1周肝功能[谷丙转氨酶(ALT)、谷草转氨酶(AST)]、免疫功能[T淋巴细胞亚群(CD3+、CD4+、CD8+)]差异,并采用KaplanMeier法绘制3年无瘤生存曲线,使用Logrank法比较两组3年无瘤率。结果LH组手术时间、术中出血量、输血率及术后住院时间均高于RFA组(P<005)。两组围术期并发症发生率比较差异无统计学意义(P>005)。术后1周时,两组肝功能指标(ALT、AST)、CD8+均较术前升高(P<005),且LH组高于RFA组(P<005);两组部分免疫功能指标(CD3+、CD4+)较术前降低(P<005),且LH组低于RFA组(P<005)。术后3年时,LH组无瘤生存42例(6176%),RFA组无瘤生存19例(3519%),且LH组3年无瘤生存率明显高于RFA组(P<005)。结论 RFA术与LH术治疗HCC各有优劣,RFA术在微创方面更具优势,但无瘤生存情况不及LH术,临床应根据实际情况,为HCC患者制定个性化的治疗方案。
关键词:  原发性肝癌  射频消融术  腹腔镜  肝切除  无瘤生存
DOI:
基金项目:
Effects of laparoscopic hepatectomy and radiofrequency ablation on liver function, immune function and 3 year disease free survival rate in patients with primary hepatocellular carcinoma
GU Xi,YANG Jian,YANG Xiaoling,QIN Li,WANG Ye
(Department of Liver Surgery, West China Hospital, Sichuan University)
Abstract:
【Abstract】Objective To investigate the effects of laparoscopic hepatectomy (LH) and radiofrequency ablation (RFA) on liver function, immune function and 3year diseasefree survival rate in patients with primary hepatocellular carcinoma (HCC). Methods The clinical data of 122 patients with HCC in our hospital were retrospectively analyzed. Among them, 68 patients underwent LH (LH group) and 54 patients underwent RFA (RFA group). The surgical related indexes (operative time, intraoperative blood loss, blood transfusion rate, postoperative hospital stay) and occurrence of perioperative complications were recorded in the two groups. Liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST)] and immune function [T lymphocyte subsets (CD3+, CD4+, CD8+)] were compared between the two groups before operation and at 1 week after operation. The 3year tumorfree survival curve was drawn by KaplanMeier method, and Logrank method was used to compare the diseasefree rate in the two groups. 〖WTHZ〗Results〖WTBZ〗 The operative time, intraoperative blood loss, blood transfusion rate and postoperative hospital stay in LH group were higher than those in RFA group (P<005). There was no significant difference in the incidence rate of perioperative complications between the two groups (P>005). At 1 week after operation, the liver function indexes (ALT, AST) and CD8+ were higher than those before operation (P<005), and the indexes in LH group were higher than those in RFA group (P<005). The partial immune function indexes (CD3+, CD4+) in the two groups were lower than those before operation (P<005), and the indexes in LH group were lower than those in RFA group (P<005). At 3 years after operation, there were 42 patients (6176%) of diseasefree survival in LH group and 19 patients (3519%) of diseasefree survival in RFA group, and the 3year diseasefree survival rate in LH group was significantly higher than that in RFA group (P<005). Conclusion RFA and LH have advantages and disadvantages in the treatment of HCC. RFA has advantages in minimally invasive surgery, but the diseasefree survival is inferior to LH. Clinically, it is necessary to develop the personalized treatment regimen for HCC patients according to the actual situation.
Key words:  Primary hepatocellular carcinoma  Radiofrequency ablation  Laparoscopy  Hepatectomy  Disease free survival

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