门静脉化疗预防肝癌切除术后复发的临床分析

Clinical Analysis of Portal Vein Chemotherapy in Preventing Recurrence of Hepatocellular Carcinoma after Radical Resection

目的探讨门静脉化疗在预防肝癌术后复发中的临床应用价值。方法将49例行根治性手术切除治疗的原发性肝癌患者作为研究对象,按照单盲、平行、随机数字分组法将49例患者分为观察组和对照组。对照组术后给予肝动脉化疗栓塞,观察组术后给予门静脉化疗。观察2组T细胞亚群变化、不良反应发生率、复发率及生存率。并分析门静脉化疗与预防肝癌术后复发的相关性。结果观察组术后CD3+、CD4+、CD8+及CD4+/CD8+明显高于对照组,差异有统计学意义(P<0.05)。观察组2年内复发率明显低于对照组,而3年生存率高于对照组,差异均有统计学意义(P<0.05)。多因素回归分析显示,门静脉化疗是预防肝癌术后复发的显著性影响因素(P<0.05)。结论门静脉化疗能有效改善患者外周血免疫指标,提高患者术后无瘤生存时间及生存率,门静脉化疗是有效预防术后复发的显著性影响因素。

Objective To explore the clinical efficacy of portal vein chemotherapy in preventing recurrence of hepatocellular carcinoma after radical resection. Methods According to the single blind,parallel,random digit grouping method,49 patients with hepatic carcinoma were randomly divided into the observation group and the control group. The control group was given the hepatic artery chemoembolization after radical resection,the observation group was treated with portal vein chemotherapy after radical resection,the changes of T cell subsets,incidence of adverse reaction,recurrence rate and the survival rate were observed.The correlation between portal vein chemotherapy and postoperative recurrence were analyzed. Results The observation group was significantly better than that of the control group in the CD3+、CD4+、CD8+and the CD4+/ CD8+ratio,the difference between the 2 groups was significant( P < 0. 05). The observation group was significantly lower than the control group in the 2-year recurrence rate,however,the observation group was significantly higher than the control group in the 3-year survival rate,the difference between the 2 groups was significant( P < 0. 05). Cox multivariate analysis showed that number of nodules,portal vein chemotherapy were impact factors of the recurrence after resection of hepatic carcinoma( P < 0. 05). Conclusion Portal vein chemotherapy can significantly improve the immuno-suppression and delay early recurrence,it has important clinical value in improving the survival rate.