摘要
目的:探讨腹腔镜肝切除联合微波消融治疗老年肝细胞癌的疗效和安全性。方法:回顾性分析125例老年肝细胞癌患者,根据手术方法不同分为对照组73例和观察组52例。对照组行腹腔镜肝切除术,观察组在腹腔镜肝切除术中进行微波消融。比较两组患者手术情况、淋巴细胞亚群以及术后生存复发情况。结果:观察组患者术中出血量、引流管拔除时间以及住院时间均低于对照组(t分别为6.370,7.260,7.136,均P<0.05)。两组患者CD8随时间降低(F时间=43.716,P<0.05),观察组CD8降低幅度大于对照组(F时间×组间=5.179,P<0.05),观察组CD8整体水平低于对照组(F组间=3.792,P<0.05)。两组患者CD3、CD4以及CD4/CD8随时间升高(F时间=85.692,62.534,37.589,均P<0.05),观察组CD3、CD4以及CD4/CD8升高幅度大于对照组(F时间×组间=5.213,6.513,6.721,均P<0.05),观察组CD3、CD4以及CD4/CD8整体水平高于对照组(F组间=6.571,4.538,5.363,均P<0.05)。观察组2年生存率高于对照组(41例,78.8%与45例,61.6%,χ^2=4.186,P=0.041)。观察组1年和2年无复发生存率高于对照组(1年:44例,84.6%与50例,68.5%,χ^2=4.233,P=0.040;2年:37例,71.1%与39例,53.4%,χ^2=4.005,P=0.045)。结论:腹腔镜肝切除术联合微波消融能够改善机体及肿瘤局部的免疫微环境,减少复发,具有较好的临床疗效。
Objective To investigate the efficacy and safety of laparoscopic hepatectomy combined with microwave ablation in the treatment of hepatocellular carcinoma(HCC)in elderly patients.Methods A total of 125 elderly patients with HCC were divided into the control group(n=73)and the observation group(n=52)according to the surgical method.The control group received laparoscopic hepatectomy and the observation group underwent microwave ablation during laparoscopic hepatectomy.The operation procedures,lymphocyte subsets and postoperative recurrence were compared between the two groups.Results The bleeding volume,drainage tube removal time and hospitalization length were lower in the observation group than in the control group(t=6.370,7.260 and 7.136,respectively,P<0.05).CD8 levels decreased with time in both groups(Ftime=43.716,P<0.05),and the decrease of CD8 in the observation group was greater than in the control group(Ftime×group=5.179,P<0.05).The overall level of CD8 was lower in the observation group than in the control group(Fgroup=3.792,P<0.05).The levels of CD3,CD4 and CD4/CD8 increased with time in both groups(Ftime=85.692,62.534 and 37.589,all P<0.05),and the increases of CD3,CD4 and CD4/CD8 in the observation group were greater than in the control group(Ftime×group=5.213,6.513 and 6.721,all P<0.05).The overall levels of CD3,CD4 and CD4/CD8 were higher in the observation group than in the control group(Fgroup=6.571,4.538 and 5.363,all P<0.05).The 2-year survival rate was higher in the observation group than in the control group(41 cases or 78.8%vs.45 cases or 61.6%,χ^2=4.186,P=0.041).The 1-year and 2-year relapse-free survival rates were higher in the observation group than in the control group(1-year:44 cases or 84.6%vs.50 cases or 68.5%,χ^2=4.233,P=0.041;2-year:37 cases or 71.1%vs.39 cases or 53.4%,χ^2=4.005,P=0.045).Conclusions Laparoscopic hepatectomy combined with microwave ablation can improve the systemic immunity and the immunity of the microenvironment at the site of the tumor,reduce recurrence,and
作者
王宇翾
王凤飚
回建峰
雷道雄
郑俊杰
Wang Yuxuan;Wang Fengbiao;Hui Jianfeng;Lei Daoxiong;Zheng Junjie(Department of Hepatobiliary and Gastrointestinal Surgery,the Fourth Central Hospital of Tianjin,Tianjin 300140,China)
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2020年第4期439-442,共4页
Chinese Journal of Geriatrics
关键词
癌
肝细胞
腹腔镜
微波
Carcinoma hepatocellular
Laparoscopy
Microwave
