腹腔镜下微波消融术干预晚期肝癌血管形成的临床研究

Clinical study of the intervention of laparoscopic microwave ablation in angiogenesis of advanced liver cancer

目的:探讨腹腔镜微波消融术对晚期肝癌患者癌组织血管形成的影响,为完善其治疗机制提供依据。方法:回顾分析2011年4月至2013年2月为46例晚期肝癌患者行腹腔镜下微波消融术的临床资料,观察其临床疗效与并发症。于手术前后抽取静脉血,检测甲胎蛋白(alpha fetal protein,AFP)、血管内皮生长因子(vascular endothelial growth factor,VEGF)及血小板源性生长因子(platelet derived growth factor,PDGF)的血清水平。结果:术后1个月,总有效率为71.7%,常见并发症为疼痛(39.1%)、低热(37.0%)、胃肠道反应(30.4%)、腹腔内积液或感染(23.9%)、胸膜炎(10.9%)、心率异常(10.9%)及血压异常(6.52%),停止微波消融或经对症治疗均可缓解。治疗后,肿块最大直径平均水平明显减小(P<0.05),血清AFP、VEGF、PDGF水平明显降低(P<0.05),25例瘤内外血流信号完全消失,17例瘤内血流信号消失,4例发现新生灶。结论:腹腔镜下微波消融术可灭活肝癌病灶内部血管,并减少VEGF与PDGF的分泌,抑制新生血管生成,可能为其抑制晚期肝癌细胞增殖的重要机制之一。

Objective： To explore the influence of laparoscopic microwave ablation on angiogenesis of advanced liver cancer,so as to provide evidence to complete its therapeutic mechanism. Methods： The clinical data of 46 patients with advanced liver cancer from Apr. 2011 to Feb. 2013 were retrospectively analyzed,and all the patients were treated with laparoscopic microwave ablation. The clinical effect and complications were recorded,and the venous blood before and after treatment were extracted to detect serum alpha fetal protein（ AFP）,vascular endothelial growth factor（ VEGF） and platelet derived growth factor（ PDGF）. Results： In 1 month after treatment,the total effective rate was 71. 7%,and the common complications were pain（ 39. 1%）,low-grade fever（ 37. 0%）,gastrointestinal reaction（ 30. 4%）,abdominal cavity effusion or infection（ 23. 9%）,pleuritis（ 10. 9%）,abnormal heart rate（ 10. 9%） and dysarteriotony（ 6. 25%）,all the complications remitted after cease of microwave ablation or expectant treatment. After treatment,the tumor diameter decreased significantly（ P 〈 0. 05）,and the serum levels of AFP,VEGF and PDGF were lower than those before treatment（ P〈 0. 05）. Furthermore,25 patients’ blood flow signals inside and outside tumor completely disappeared,17 patients’ blood flow signals inside tumor disappeared,and 4 patients were found new focus. Conclusions： Laparoscopic microwave ablation could inactivate the blood vessels within liver lesions,reduce the secretion of VEGF and PDGF,and inhibit angiogenesis,which may be one of its important mechanisms to inhibit the cell proliferation of advanced liver cancer.