摘要
目的:观察射频消融(RFA)治疗同时性结直肠癌肝转移患者前后外周血免疫指标的变化,评价RFA治疗对机体免疫功能影响及其疗效、预后。方法:选取同时性结直肠癌肝转移患者56例,根据治疗方式和时间不同,分为同期手术切除组和分期RFA组。采用流式细胞术检测患者治疗前后外周血中T淋巴细胞亚群的比例变化,并记录临床病理特点、随访资料。比较两组患者免疫变化、术后并发症发生率、1年后局部复发率及新生转移率、中位生存期、3年存活率。结果:1)免疫功能变化。两组术前CD3+、CD4+、CD8+T细胞数及CD4+/CD8+比例差异无统计学意义(P>0.05);两组术后1周CD3+无明显变化(P>0.05),CD4+及CD4+/CD8+比例均下降,CD8+T细胞数均上升,提示两组均降低了患者机体免疫力,但分期RFA组较同期手术组CD4+及CD4+/CD8+比例下降幅度小,CD8+T细胞数增高幅度小,提示分期RFA组对患者机体免疫力影响较同期切除组小,差异有统计学意义(P<0.05);分期RFA组择期行RFA术后1周(即首次术后1个月)CD3+无明显变化(P>0.05),CD4+T细胞数及CD4+/CD8+比例均上升,CD8+T细胞数目下降,增强了该组患者免疫力及抗肿瘤免疫应答反应,分期RFA组术后CD4+T细胞数目及CD4+/CD8+比值均显著高于同期手术切除组,CD8+T细胞数显著低于同期手术切除组(P<0.05)。2)术后并发症发生率同期手术切除组高于分期RFA组,差异有统计学意义(60.9%vs 18.2%,P<0.05)。3)1年后局部复发率同期手术切除组低于分期RFA组(7.14%vs 14.89%),新生转移率同期手术切除组高于分期RFA组(17.39%vs 9.09%),差异有统计学意义(P<0.05)。结论:同时性结直肠肝转移瘤患者分期行RFA治疗临床效果满意,降低了术后并发症发生率,对患者免疫功能影响小,一定程度上保护和改善了患者免疫功能,延长了患者生命。
Objecttve：Radio frequency ablation （RFA） changes in treatment of simultaneous liver metastases of colorectal cancer patients before and after peripheral blood immune index,evaluate the effect of RFA treatment on the immune function of organism,and its curative effect,prognosis.Methods：Select 56 cases of liver metastases of colorectal cancer patients.According to the treatment methods and different time,divided into synchronous operation resection group and staging of RFA group.By the changes of peripheral blood T lymphocyte subsets in patients with the percentage of cells with flow cytometry,and record the clinical pathological characteristics,follow-up data.Comparison of two groups of patients with immune changes,postoperative complication rate,rate,median survival time,survival rate of 3 years local recurrence rate and a new metastasis after 1 years.Results：1） the change of immune function. preoperative CD3＋ T,CD4＋ T,CD8＋ T cell count,no statistically significant differences in the proportion of CD4＋/CD8＋ （P＞0.05）;Postoperative one week CD3＋ no significant changes,CD4＋ and CD4＋/CD8＋ ratio decreased,CD8＋ T cells were increased,suggesting that both groups reduced the patient immunity,but the staging of RFA group than in the same period of the surgery group,CD4＋ and CD4＋/CD8＋ ratio decline small,CD8＋ T cell count increased a modest,suggesting that the immune system of the patient affect the staging of RFA group than the same period the body resection group is small,the difference was statistically significant （P＜0.05）;Staging RFA group undergoing elective RFA after 1 week （after one month） CD3＋ no significant changes,CD4＋T cells and CD4＋/CD8＋ ratio were increased,CD8＋decreased T cell number and enhance the patients immunity and resistance tumor immune response,staging RFA group was the number of CD4＋T cells and CD4＋/CD8＋ ratio were significantly higher than the surgery group,CD8＋ T cells was significantly lower than the same period resection
出处
《中国现代普通外科进展》
CAS
2015年第8期609-613,共5页
Chinese Journal of Current Advances in General Surgery
关键词
结直肠肿瘤
肝肿瘤
同时性肿瘤转移
分期射频消融
免疫功能
预后
Colorectal neoplasms
Liver neoplasms
Simultaneous tumor metastasis
Radiofrequency ablation
Immune function
Prognosis
