腹腔镜肝癌切除术与经腹腔镜射频消融术对肝细胞癌患者免疫功能、疼痛相关指标及肝功能的影响
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摘要
目的:探讨腹腔镜肝癌切除术与腹腔镜射频消融术对肝细胞癌患者免疫功能、疼痛相关指标及肝功能的影响。方法:将96例肝细胞癌患者随机分为对照组和观察组,每组48例,对照组行腹腔镜肝细胞癌切除术,观察组行腹腔镜射频消融术治疗,比较两组免疫功能、疼痛指标及肝功能水平。结果:治疗前两组CD3~+、CD4~+、CD8~+、CD4~+/CD8~+、COR、NE、CRP、ALT及AST水平差异相当,差异无统计学意义(P>0.05);治疗后,观察组CD3~+、CD4~+及CD4~+/CD8~+水平均显著高于对照组(P<0.05),观察组CD8~+、COR、NE、CRP、ALT及AST水平均显著低于对照组,差异有统计学意义(P<0.05)。结论:与腹腔镜肝癌切除术相比,经腹腔镜射频消融术治疗肝细胞癌可以更有效改善患者免疫功能及肝功能,减轻疼痛,具有一定临床价值。
Objective:To investigate the effects of laparoscopic hepatectomy and laparoscopic radiofrequency ablation on immune function,pain related indexes and liver function in patients with hepatocellular carcinoma.Methods:Ninety-six patients with hepatocellular carcinoma were randomly divided into two groups:control group and observation group.The patients in the control group were treated with laparoscopic hepatectomy,and the patients in the observation group were treated with laparoscopic radiofrequency ablation.The immune function,pain index and liver function were compared between the two groups.Results:There was no significant difference in the levels of CD3~+,CD4~+,CD8~+,CD4~+/CD8~+,COR,NE,CRP,ALT and AST in two groups before treatment(P>0.05).After treatment,the levels of CD3~+,CD4~+and CD4~+/CD8~+in the observation group were significantly higher than those in the control group(P<0.05).The levels of CD8~+,COR,NE,CRP,ALT and AST in the observation group were significantly lower than those in the control group(P<0.05).Conclusion:Compared with laparoscopic hepatectomy,laparoscopic radiofrequency ablation for hepatocellular carcinoma can improve the immune function and liver function,reduce pain,and has certain clinical value.
Objective:To investigate the effects of laparoscopic hepatectomy and laparoscopic radiofrequency ablation on immune function,pain related indexes and liver function in patients with hepatocellular carcinoma.Methods:Ninety-six patients with hepatocellular carcinoma were randomly divided into two groups:control group and observation group.The patients in the control group were treated with laparoscopic hepatectomy,and the patients in the observation group were treated with laparoscopic radiofrequency ablation.The immune function,pain index and liver function were compared between the two groups.Results:There was no significant difference in the levels of CD3~+,CD4~+,CD8~+,CD4~+/CD8~+,COR,NE,CRP,ALT and AST in two groups before treatment(P>0.05).After treatment,the levels of CD3~+,CD4~+and CD4~+/CD8~+in the observation group were significantly higher than those in the control group(P<0.05).The levels of CD8~+,COR,NE,CRP,ALT and AST in the observation group were significantly lower than those in the control group(P<0.05).Conclusion:Compared with laparoscopic hepatectomy,laparoscopic radiofrequency ablation for hepatocellular carcinoma can improve the immune function and liver function,reduce pain,and has certain clinical value.
引文
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3 褚志强.原发性肝癌手术治疗的生存率分析及影响因素研究[D].石河子大学,2013.
4 Lee MW,Raman SS,Asvadi NH,et al.Radiofrequency ablation of hepatocellular carcinoma as bridge therapy to liver transplantation:A 10‐year intention‐to‐treat analysis[J].Hepatology,2017,65(6):1979-1990.
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7 王莉琳.2010年美国肝病年会(AASLD)肝细胞癌诊疗指南[J].北京医学,2011,33(3):236-251.
8 中华人民共和国卫生和计划生育委员会医政医管局.原发性肝癌诊疗规范(2017年版)[J].传染病信息,2017,16(3):705-720.
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13 Choi JE,You JH,Kim DK,et al.Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy:a systematic review and meta-analysis[J].European urology,2015,67(5):891-901.
14 陈少华,程莉.老年原发性肝癌手术切除后复发癌有效治疗方式选择[J].实用老年医学,2015,29(7):568-570.
15 Cheung TT,Dai WC,Tsang SHY,et al.Pure laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma in 110patients with liver cirrhosis:apropensity analysis at a single center[J].Annals of surgery,2016,264(4):612-620.
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17 Yazici P,Akyuz M,Yigitbas H,et al.A comparison of perioperative outcomes in elderly patients with malignant liver tumors undergoing laparoscopic liver resection versus radiofrequency ablation[J].Surgical endoscopy,2017,31(3):1269-1274.
18 朱松.肝动脉介入联合脾动脉栓塞对老年肝癌伴脾亢病人免疫细胞的影响[J].实用老年医学,2017,31(12):1141-1144.
19 Wolf MJ,Adili A,Piotrowitz K,et al.Metabolic activation of intrahepatic CD8+T cells and NKT cells causes nonalcoholic steatohepatitis and liver cancer via cross-talk with hepatocytes[J].Cancer cell,2014,26(4):549-564.
20 张燕如,徐栋,邢培华.肝癌患者应用超声引导下腹腔镜射频消融治疗对其免疫功能的影响分析[J].浙江创伤外科,2016,21(5):961-962.
21 Su YQ,Zheng ZL,Li J,et al.Effects of parecoxib sodium intervention before induction on inflammatory stress response and endocrine steady state after laparoscopic surgery[J].Journal of Hainan Medical University,2017,23(12):55-58.
22 Bulut O,Aslak KK,Levic K,et al.A randomized pilot study on single-port versus conventional laparoscopic rectal surgery:effects on postoperative pain and the stress response to surgery[J].Techniques in coloproctology,2015,19(1):11-22.
2 Maharajan K,Hey HWD,Tham I,et al.Solitary vertebral metastasis of primary clear cell carcinoma of the liver:a case report and review of literature[J].Journal of Spine Surgery,2017,3(2):287-293.
3 褚志强.原发性肝癌手术治疗的生存率分析及影响因素研究[D].石河子大学,2013.
4 Lee MW,Raman SS,Asvadi NH,et al.Radiofrequency ablation of hepatocellular carcinoma as bridge therapy to liver transplantation:A 10‐year intention‐to‐treat analysis[J].Hepatology,2017,65(6):1979-1990.
5 Liu PH,Hsu CY,Hsia CY,et al.Surgical resection versus radiofrequency ablation for single hepatocellular carcinoma≤2cm in a propensity score model[J].Annals of surgery,2016,263(3):538-545.
6 Casaccia M,Santori G,Bottino G,et al.Laparoscopic resection vs laparoscopic radiofrequency ablation for the treatment of small hepatocellular carcinomas:A single-center analysis[J].World journal of gastroenterology,2017,23(4):653-660.
7 王莉琳.2010年美国肝病年会(AASLD)肝细胞癌诊疗指南[J].北京医学,2011,33(3):236-251.
8 中华人民共和国卫生和计划生育委员会医政医管局.原发性肝癌诊疗规范(2017年版)[J].传染病信息,2017,16(3):705-720.
9 Lepage C,Capocaccia R,Hackl M,et al.Survival in patients with primary liver cancer,gallbladder and extrahepatic biliary tract cancer and pancreatic cancer in Europe 1999-2007:results of EUROCARE-5[J].European Journal of Cancer,2015,51(15):2169-2178.
10 Valery PC,Laversanne M,Clark PJ,et al.Projections of primary liver cancer to 2030in 30countries worldwide[J].Hepatology,2018,67(2):600-611.
11 Ciria R,Cherqui D,Geller DA,et al.Comparative short-term benefits of laparoscopic liver resection:9000cases and climbing[J].Annals of surgery,2016,263(4):761-777.
12 Wolfe BM,Gardiner B,Frey CF.Laparoscopic cholecystectomy:a remarkable development[J].Jama,2015,314(13):1406-1406.
13 Choi JE,You JH,Kim DK,et al.Comparison of perioperative outcomes between robotic and laparoscopic partial nephrectomy:a systematic review and meta-analysis[J].European urology,2015,67(5):891-901.
14 陈少华,程莉.老年原发性肝癌手术切除后复发癌有效治疗方式选择[J].实用老年医学,2015,29(7):568-570.
15 Cheung TT,Dai WC,Tsang SHY,et al.Pure laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma in 110patients with liver cirrhosis:apropensity analysis at a single center[J].Annals of surgery,2016,264(4):612-620.
16 Lin CC,Cheng YT,Lin SM.The effectiveness of multiple electrode radiofrequency ablation in patients with hepatocellular carcinoma with lesions more than 3cm in size and barcelona clinic liver cancer stage A to B2[J].Liver cancer,2016,5(1):8-20.
17 Yazici P,Akyuz M,Yigitbas H,et al.A comparison of perioperative outcomes in elderly patients with malignant liver tumors undergoing laparoscopic liver resection versus radiofrequency ablation[J].Surgical endoscopy,2017,31(3):1269-1274.
18 朱松.肝动脉介入联合脾动脉栓塞对老年肝癌伴脾亢病人免疫细胞的影响[J].实用老年医学,2017,31(12):1141-1144.
19 Wolf MJ,Adili A,Piotrowitz K,et al.Metabolic activation of intrahepatic CD8+T cells and NKT cells causes nonalcoholic steatohepatitis and liver cancer via cross-talk with hepatocytes[J].Cancer cell,2014,26(4):549-564.
20 张燕如,徐栋,邢培华.肝癌患者应用超声引导下腹腔镜射频消融治疗对其免疫功能的影响分析[J].浙江创伤外科,2016,21(5):961-962.
21 Su YQ,Zheng ZL,Li J,et al.Effects of parecoxib sodium intervention before induction on inflammatory stress response and endocrine steady state after laparoscopic surgery[J].Journal of Hainan Medical University,2017,23(12):55-58.
22 Bulut O,Aslak KK,Levic K,et al.A randomized pilot study on single-port versus conventional laparoscopic rectal surgery:effects on postoperative pain and the stress response to surgery[J].Techniques in coloproctology,2015,19(1):11-22.