射频消融治疗中等体积肝癌患者的临床效果

Clinical effects of radio frequency ablation in the treatment of patients with moderate volume hepatocellular carcinoma

目的研究射频消融(RFA)治疗中等体积肝细胞癌(HCC)的临床效果。方法选择2011年1月~2012年12月成都医学院第一附属医院收治的HCC患者88例,依据治疗方法分为RFA组(n=44例)与对照组(n=44例)。RFA组于腹腔镜、超声引导下行RFA治疗,对照组行常规肝切除术治疗。观察两组术前及术后14 d甲胎蛋白(AFP)、E^-钙粘连蛋白(EC)、内皮抑素(E)、血管内皮生长因子(VEGF)水平、CD3^+、CD4^+、CD8^+、CD4^+/CD8^+、毒性淋巴细胞(CTL)、自然杀伤(NK)细胞等免疫细胞;观察术后并发症及1、3年生存情况。结果术后14 d,RFA组AFP、EC、E、VEGF水平均低于对照组,组间差异有统计学意义(P<0.05)。术后14 d,RFA组CD3^+、CD4^+、CD4^+/CD8^+、CTL、NK水平均高于对照组,CD8^+低于对照组,组间差异均有统计学意义(P<0.05);RFA组1、3年生存率(88.64%、72.73%)均高于对照组(70.45%、52.27%),差异均有统计学意义(P<0.05);RFA组术后并发症发生率(4.55%)低于对照组(27.27%),差异均有统计学意义(P<0.05)。结论 RFA治疗中等体积HCC可有效减少机体损伤,提高患者免疫能力,降低术后并发症发生率,改善患者预后,值得应用于临床。

Objective To study the clinical effects of radio frequency ablation （RFA） in the treatment of patients with moderate volume hepatoeellular carcinoma （HCC）. Methods 88 cases of patients with HCC who accepted treatment in the First Affiliated Hospital of Chengdu Medical College from January 2011 to December 2012 were selected and divided into RFA group （n = 44） and control group （n = 44） according to the random number table. RFA group was treated by RFA combined with peritoneoscope and uhrasonie guidance, and control group was treated by conventional hepate- ctomy. Before and 14 days after the operation, the levels of alpha fetoprotein （AFP）, E-cadherin （EC）, endostatin （E） and vascular endothelial growth factor （VEGF）, CD3＋, CD4＋, CD8＋, CD4＋/CD8＋, cytotoxic T lymphocytes （CTL） and NK cells of the two groups were observed; the postoperative complications, the one-year and three-year survival rates of the two groups were observed. Results 14 days after the operation, the levels of AFP, EC, E and VEGF of the RFA group were lower than those of the control group, the differences were statistically significant （P 〈 0.05）. 14 days after the operation, the levels of CD3^＋, CD4^＋, CD4^＋/CD8^＋, CTL and NK of RFA group were higher than those of control group, the level of CD8＋ was lower than that of the control group, the differences were statistically significant （P 〈 0.05）. The one-year and the three-year survival rates of the RFA group were 88.64% and 72.73% respectively, which were higher than those of the control group, whose one-year and three-year survival rates were 70.45% and 52.27% respectively, and the differences were statistically significant （P 〈 0.05）. The morbidity of postoperative complications of the RFA group （4.55%） was lower than that of the control group （27.27%）, and a statistical significanee was found （P 〈 0.05）. Conclusion RFA in the treatment of moderate volume HCC can effectively reduce the damage of organism, enhance the immuno competence of patients, lower the morbidity of postoperative complications and improve the prognosis of patients, so it is worthy of clinical application.