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目的研究微波消融治疗原发性小肝癌(≤5cm)对外周血播散癌细胞及细胞免疫功能影响。方法微波消融治疗19例小肝癌病人,手术切除治疗21例。于术前、术后30min、1d及7d采外周静脉血,巢式RT-PCR检测AFPmRNA,监测CD3、CD4、CD8及CD4/CD8。结果巢式RT-CR检测外周血AFPmRNA,两组40例病人术前阳性率为40%(16/40);微波组和手术组均有3例病人治疗前AFPmRNA阴性,术后30min转为阳性,两组之间比较无差异;微波组术后7d内外周血细胞免疫功能无明显变化,手术组降低。随访1~16个月,4例肝内复发或远处转移病人治疗前后AFPmRNA均阳性。结论与手术切除相比,微波消融治疗原发性小肝癌也可同样程度地造成癌细胞脱落入血,对外周血细胞免疫功能(7d内)无明显影响,有其自身特点;治疗前后外周血AFPmRNA均呈阳性表达(7d内)者,复发/转移的可能性增大。
Objective To investigate the effect of microwave ablation on primary small hepatocellular carcinoma (≤5cm) on peripheral blood-smear cancer cells and cellular immune function. Methods Microwave ablation of 19 cases of small liver cancer patients, surgical resection in 21 cases. Peripheral venous blood was collected preoperatively, 30 min, 1 d and 7 d after operation. AFP mRNA was detected by nested RT-PCR and CD3, CD4, CD8 and CD4 / CD8 were detected. Results AFP mRNA was detected by nested RT-PCR in 40 patients (40%, 40/40) in both groups. AFP mRNA was negative in 3 patients before and after treatment in the microwave group and the operation group, and was positive at 30 min There was no difference between the two groups. In the microwave group, the immune function of the peripheral blood did not change significantly within 7 days after operation, and the operation group decreased. All cases were followed up for 1 ~ 16 months. Four patients with intrahepatic recurrence or distant metastasis had positive AFP mRNA before and after treatment. Conclusion Compared with the surgical resection, microwave ablation of primary small hepatocellular carcinoma can also cause cancerous cells shed into the blood to the same extent, which has no obvious effect on the peripheral blood cell immune function (within 7 days) and has its own characteristics. Before and after treatment, AFP mRNA The positive expression (within 7d), the possibility of recurrence / metastasis increased.