手术治疗与介入治疗对晚期复发性肝癌患者预后、纤维化指标及下肢静脉血栓形成的影响

Effect of surgical and interventional therapy on prognosis,fibrosis index,and lower extremity venous thrombosis in patients with advanced recurrent liver cancer

目的探讨手术治疗与介入治疗对晚期复发性肝癌患者预后、纤维化指标及下肢静脉血栓形成的影响。方法收集2018年10月至2020年10月荆州市第二人民医院收治的120例肝癌患者的临床资料,将2018年10月至2019年9月复发后再次进行手术治疗的肝癌患者作为对照组(n=64),将2019年10月至2020年10月进行介入治疗的肝癌患者作为观察组(n=56)。比较两组患者治疗前后的凝血功能指标[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)]、纤维化指标[层粘连蛋白(LN)、透明质酸(HA)、Ⅲ型前胶原肽(PⅢP)、Ⅳ型胶原(ⅣC)]水平,以及治疗后下肢静脉血栓、并发症的发生情况。比较不同年龄肝癌患者下肢静脉血栓的发生情况、两组患者治疗后1年生存率。结果治疗后,观察组患者的APTT、PT均长于对照组患者,FIB水平高于对照组患者,LN、HA、PⅢP、ⅣC水平均低于对照组患者,下肢静脉血栓、并发症的发生率均低于对照组患者,差异均有统计学意义(P﹤0.05)。青年组和中老年组患者下肢静脉血栓的发生率比较,差异无统计学意义(P﹥0.05)。结论与手术治疗相比,介入治疗更能改善复发性肝癌患者的预后,减少对患者凝血功能、肝纤维化的影响,降低下肢静脉血栓的发生率。

Objective To explore the effect of surgery and interventional therapy on the prognosis,fibrosis index,and lower extremity venous thrombosis in patients with advanced recurrent liver cancer.Method The clinical data of 120 patients with liver cancer admitted to the Second Hospital of Jingzhou from October 2018 to October 2020 were collected.The patients with liver cancer who underwent surgical treatment again after recurrence from October 2018 to September 2019 were taken as the control group(n=64),and the patients with liver cancer who underwent interventional treatment from October 2019 to October 2020 were taken as the observation group(n=56).The coagulation function indexes[prothrombin time(PT),activated partial thromboplastin time(APTT)and fibrinogen(FIB)],fibrosis indexes[laminin(LN),hyaluronic acid(HA),procollagen-III-peptide(PIIIP)and collagen type IV(IVC)]levels of the two groups of patients before and after the treatment were compared.The occurrence of lower extremity venous thrombosis and complications after the treatment were also compared between the two groups.The occurrence of lower extremity venous thrombosis in patients with liver cancer of different ages and the one-year survival rate of the two groups after treatment were compared.Result After the treatment,the APTT and PT of the observation group were longer,the level of FIB was higher,the levels of LN,HA,HPC-III,and IV-C were lower,the incidence rate of lower extremity venous thrombosis and complications were significantly lower than those of the control group,and the differences were statistically significant(P<0.05).There was no significant difference in the incidence rate of lower extremity venous thrombosis between the young group and the middle-to-old group(P>0.05).Conclusion Interventional therapy could improve the prognosis of patients with recurrent liver cancer compared with surgery,reduce the impact on patients’coagulation function and the tendency of liver fibrosis,and would also reduce the incidence of lower extremity venous thrombosis.