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目的探讨“套餐式”微创手术治疗原发性肝癌的疗效及对血清T淋巴细胞亚群(CD3~+、CD4~+、CD8~+、CD4~+/CD8~+比值)、NK细胞(CD56~+)、金属蛋白酶-9(MMP-9)和血管内皮生长因子(VEGF)的影响。方法选取原发性肝癌患者85例,根据患者治疗意愿分为3组:A组35例行单纯肝动脉化疗栓塞(TACE)治疗,B组30例行TACE~+氩氦刀冷冻治疗,C组20例行TACE~+氩氦刀冷冻~+125I放射性粒子植入治疗;观察3组治疗前后血清T淋巴细胞亚群、CD56~+、MMP-9和VEGF水平变化情况,统计3组术后近期肿块缩小率及随访12,16个月复发率和生存率。结果治疗2周后,3组血清CD3~+、CD4~+、CD4~+/CD8~+比值、NK细胞水平均明显升高(P均<0.05),CD8~+和MMP-9、VEGF水平均明显降低(P均<0.05);治疗5周和7周后,B组和C组各指标改善情况均明显优于治疗2周后和A组(P均<0.05);术后7周,C组各指标改善情况均明显优于术后5周及B组(P均<0.05)。术后12周,B组和C组肿块缩小率明显高于A组(P<0.05),C组明显高于B组(P<0.05)。随访12,16个月,B组和C组复发率均明显低于A组,生存率均明显高于A组,且C组复发率明显低于B组,生存率明显高于B组,差异均有统计学意义(P均<0.05)。结论 “套餐式”微创治疗原发性肝癌效果更好,可明显改善机体免疫功能,抑制肿瘤血管的新生,降低复发率和病死率,值得临床推广应用。
Objective To investigate the effect of “package-type” minimally invasive surgery on primary hepatocellular carcinoma (HCC) and its effect on serum T-lymphocyte subsets (CD3 +, CD4 +, CD8 +, CD4 + / CD8 + (CD56 +), metalloproteinase-9 (MMP-9) and vascular endothelial growth factor (VEGF). Methods Totally 85 patients with primary hepatocellular carcinoma (HCC) were enrolled in this study. They were divided into 3 groups according to their willingness to treat: 35 patients in group A underwent simple hepatic artery chemoembolization (TACE), 30 patients in group B received TACE ~ + argon-helium cryoablation, and group C 20 cases of TACE ~ + Argon cryoablation ~ + 125I radioactive seed implantation treatment; observed before and after treatment in three groups of T lymphocyte subsets, CD56 ~ +, MMP-9 and VEGF levels changes, statistics of three groups after surgery Mass reduction and follow-up 12,16 months recurrence rate and survival rate. Results After 2 weeks of treatment, the levels of CD3 +, CD4 +, CD4 + / CD8 + and NK cells in 3 groups were significantly increased (all P <0.05), while the levels of CD8 +, MMP- 9 and VEGF (P <0.05). After 5 weeks and 7 weeks of treatment, the improvement of each index in group B and group C was significantly better than that in group A and group A (P <0.05). After 7 weeks, The indexes in group C were better than those in group B and 5 weeks after operation (P <0.05). At 12 weeks after operation, the mass shrinkage in group B and group C was significantly higher than that in group A (P <0.05), and that in group C was significantly higher than that in group B (P <0.05). At 12 and 16 months of follow-up, the recurrence rates of group B and C were significantly lower than those of group A, the survival rates were significantly higher than those of group A, and the recurrence rates of group C were significantly lower than those of group B. The survival rates were significantly higher than those of group B All were statistically significant (P <0.05). Conclusion “Package-type” minimally invasive treatment of primary liver cancer better, can significantly improve the body’s immune function, inhibition of tumor angiogenesis and reduce the recurrence rate and mortality, it is worthy of clinical application.