腹腔镜超声辅助射频消融术治疗原发性肝癌的临床疗效研究

目的 探讨腹腔镜超声(Lap US)辅助射频消融术(RFA)治疗原发性肝癌(PLC)的临床疗效.方法选择138例PLC患者,根据医生介绍、患者自愿的原则分为Lap US组(n=70)和对照组(n=68).Lap US组患者接受Lap US辅助RFA治疗,对照组患者接受肝切除术治疗.观察并比较术前及术后2周两组患者的血管内皮生长因子(VEGF)、内皮细胞抑制素(E)、E-钙黏蛋白(EC)、甲胎蛋白(AFP)水平,细胞因子诱导的杀伤(CIK)细胞、自然杀伤(NK)细胞及T、Th、Ts等T淋巴细胞水平,转化生长因子-β(TGF-β)、可溶性白细胞介素-2受体(sIL-2R)等肿瘤细胞分泌因子水平.比较两组患者的术后并发症发生率及1年和3年生存率.结果术前两组患者的VEGF、E、EC、AFP水平比较,差异均无统计学意义(P﹥0.05);术后2周Lap US组患者的VEGF、E、EC、AFP水平均明显低于对照组(P﹤0.01).术前两组患者的CIK、NK、T、Th、Ts细胞计数比较,差异均无统计学意义(P﹥0.05);术后2周Lap US组患者的CIK、NK、T、Th细胞计数均明显多于对照组(P﹤0.01),Ts细胞计数明显少于对照组(P﹤0.01).术前两组患者的TGF-β、sIL-2R水平比较,差异均无统计学意义(P﹥0.05);术后2周Lap US组患者的TGF-β、sIL-2R水平均明显低于对照组(P﹤0.01).Lap US组患者术后并发症发生率为4.29％(3/70),明显低于对照组的23.53％(16/68),差异有统计学意义(P﹤0.01).Lap US组患者的1年和3年生存率(87.1％、71.4％)均高于对照组(69.1％、54.4％),差异均有统计学意义(P﹤0.05).结论Lap US辅助RFA治疗PLC疗效显著,可有效改善各项临床指标,值得临床推广应用.

Clinical efficacy of laparoscopic ultrasound assisted radiofrequency ablation in the treatment of primary liver cancer

Objective To evaluate the efficacy of laparoscopic ultrasound (Lap US) assisted radiofrequency ablation (RFA) in the treatment of primary live cancer (PLC). Method One hundred and thirty-eight patients with PLC were en-rolled and divided into Lap US group (n=70) or control group (n=68), following the patients'wills after doctor's intro-duction according to the principle of voluntary. Patients in Lap US group underwent Lap US assisted RFA, while the pa-tients in control group underwent liver resection. The levels of vascular endothelial growth factor (VEGF), endostatin (E), E-cadherin (EC), alpha fetoprotein (AFP);the amount of CIK cells, NK cells and T lymphocyte such as T, Th, Ts;and the levels of factors secreted by tumor cells such as transforming growth factor beta (TGF-β) and soluble interleukin-2 recep-tor (sIL-2R) of patients were observed before the treatments and at 2 weeks after treatment in both of the groups and were compared. The postoperative complications and the 1, 3-year survivals of two groups were compared. Result Before treatments, there was no significant difference between two groups on the levels of VEGF, E, EC and AFP (P>0.05). Two weeks after the treatment, the levels of VEGF, E, EC, and AFP in Lap US group were all significantly lower than those in control group (P<0.01). Before treatments, there was no significant difference between two groups on the amount of CIK cells, NK cells, T, Th and Ts cells (P>0.05). Two weeks after the treatment, the amount of CIK cells, NK cells, T and Th cells in Lap US group were significantly larger than those in control group (P<0.01), while the amount of Ts cells in Lap US group was significantly smaller than that in control group (P<0.01). Before treatments, there was no significant differ-ence between two groups on the levels of TGF-βand sIL-2R (P>0.05). Two weeks after the treatment, the levels of TGF-βand sIL-2R in Lap US group were significantly lower than those in control group (P<0.01). The postoperative complica-tion rate of Lap US group (4.29％, 3/70) was significantly lower than that of control group (23.53％, 16/68) (P<0.01). The 1- and 3-year survival rates of Lap US group (87.1％, 71.4％) were respectively higher than those of control group (69.1％, 54.4％), and the differences were statistically significant (P<0.05). Conclusion Lap US assisted RFA is effective in the treatment of PLC, which can effectively improve the clinical indicators and is worthy of clinical application.