超声引导下聚桂醇与无水乙醇注射硬化治疗肝囊肿患者疗效比较研究

Comparison of lauromacrogol and anhydrous ethanol sclerotherapy under ultrasound guidance in the treatment of patients with hepatic cysts

目的比较在超声引导下聚桂醇与无水乙醇硬化治疗肝囊肿(HC)患者的疗效。方法2019年10月~2022年10月我院收治的HC患者107例,被随机分为观察组54例和对照组53例,分别在超声引导下穿刺囊腔内注射聚桂醇或无水乙醇治疗,于治疗后6个月复查超声。采用荧光免疫分析法检测血清高尔基体蛋白73(GP73)、蛋白二硫化物异构酶A3(PDIA3)和壳多糖酶3样蛋白1(CHI3L1)水平,采用ELISA法检测血清髓过氧化物酶(MPO)和皮质醇(Cor)水平,采用化学发光法检测血清淀粉样蛋白A(SAA)水平,采用视觉模拟评分法(VAS)评价疼痛程度。结果观察组治疗总有效率为98.1%,显著高于对照组的88.7%(P<0.05),在随访时,观察组囊肿复发率为3.7%,显著低于对照组的16.9%(P<0.05);在术后1w,观察组血清GP73、PDIA3和CHI3L1水平分别为(23.1±3.8)pg/L、(69.2±5.6)ng/mL和(44.9±4.9)ng/L,显著低于对照组【分别为(37.3±4.3)pg/L、(94.8±5.4)ng/mL和(67.7±4.6)ng/L,P<0.05】;观察组血清MPO、Cor和SAA水平分别为(121.5±18.3)U/L、(259.7±24.1)ng/L和(14.5±2.5)mg/L,显著低于对照组【分别为(158.1±20.1)U/L、(298.6±26.3)ng/L和(20.2±3.1)mg/L,P<0.05】;在术后1 d和3 d,观察组VAS评分分别为(3.1±0.6)分和(2.2±0.3)分,均显著低于对照组【分别为(4.5±0.5)分和(3.2±0.4)分,P<0.05】;术后,对照组出现腹痛和醉酒貌等不良反应发生率为20.8%,显著高于观察组的3.7%(P<0.05)。结论在超声引导下穿刺向囊腔内注射聚桂醇硬化治疗HC患者可能比注射无水乙醇有更好的临床疗效,且不良反应发生率低,可能与激起机体应激反应轻有关。

Objective The aim of this study was to explore the efficacy of lauromacrogol and anhydrous ethanol sclerotherapy under ultrasound guidance in the treatment of patients with hepatic cysts(HC).Methods 107 patients with HC were enrolled in our hospital between October 2019 and October 2022,and were divided randomly into observation(n=54)and control group(n=53),receiving lauromacrogol or absolute ethanol sclerotherapy under ultrasound(US)guidance.After 6 months of treatment,the ultrasonography was performed,and the clinical efficacy was evaluated.Serum Golgi protein 73(GP73),protein disulfide isomerase A3(PDIA3)and chitosanase 3-like protein 1(CHI3L1)levels were detected by fluoroimmunoassay.Serum myeloperoxidase(MPO)and cortisol(Cor)levels were measured by ELISA,and serum amyloid A(SAA)level was detected by chemiluminescence.The visual analogue scale(VAS)score was evaluated.Results The total effectiveness rate in the observation group was 98.1%,significantly higher than 88.7%in the control group(P<0.05),and at the end of six-month of follow-up,the recurrence of HC was 3.7%,much lower than 16.9%(P<0.05)in the control;one week after operation,serum GP73,PDIA3 and CHI3L1 levels in the observation group were(23.1±3.8)pg/L,(69.2±5.6)ng/mL and(44.9±4.9)ng/L,all significantly lower than[(37.3±4.3)pg/L,(94.8±5.4)ng/mL and(67.7±4.6)ng/L,respectively,P<0.05]in the control;serum MPO,Cor and SAA levels were(121.5±18.3)U/L,(259.7±24.1)ng/L and(14.5±2.5)mg/L,all significantly lower[(158.1±20.1)U/L,(298.6±26.3)ng/L and(20.2±3.1)mg/L,respectively,P<0.05]in the control;at day one and three after sclerotherapy,the VAS score in the observation group were(3.1±0.6)and(2.2±0.3),both much less than[(4.5±0.5)and(3.2±0.4),P<0.05]in the control;the incidence of untoward effect,such as abdominal pain and drunkenness-like symptoms in the observation group was 3.7%,much lower than 20.8%(P<0.05)in the control group.Conclusion The sclerotherapy with lauromacrogol injection in the treatment of patients with HC has a relatively better clinical efficacy as compared to the ethanol injection,which might be related to a low body stress reaction and low incidence of side effects.