Fan Jianhua, He Sha, Zheng Yi
Department of Ultrasound, Hubei Maternal and Child Health Hospital, Wuhan 430070, China.
J BUON. 2019 Nov-Dec;24(6):2411-2417.
To explore the clinical efficacy of ultrasound-guided radiofrequency ablation (RFA) in liver cancer adjacent to the gallbladder and to analyze its prognosis.
80 patients with liver cancer adjacent to the gallbladder, who were admitted to our hospital from January 2015 to April 2018, were enrolled and divided into the Observation group (n=40) and the Control group (n=40). All of the patients underwent cholecystectomy and lymph node dissection combined with postoperative chemotherapy. RFA was performed in the Observation group, while radical cholecystectomy and radical hepatectomy were conducted simultaneously in the Control group. Follow up was by telephone, and tumor-associated factor levels, liver function and cellular and humoral immune function-related indicators at 1 month after intervention, tumor size before and after treatment and cases of normal alpha-fetoprotein (AFP) level and tumor disappearance after treatment were compared between the two groups. The complications rates during treatment (increase in transaminases, elevation of bilirubin, intratumoral hemorrhage, bile duct injury and gastrointestinal perforation), clinical efficacy and 1-year survival in the two groups were statistically analyzed.
At 1 month after intervention, the Observation group had substantially lower levels of tumor-associated factors AFP, carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) (p<0.05), obviously lower levels of liver function indicators aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBIL), indirect bilirubin (IBIL) and direct bilirubin (DBIL) (p<0.05), but distinctly higher levels of immunoglobulin G (IgG), IgA and IgM, cluster of differentiation 4+ (CD4+), CD8+ and CD4+/CD8+ (p<0.05) than the Control group. Before and after treatment, the tumor size in the Observation group was smaller than in the Control group (p<0.05). The Observation group exhibited notably more cases of normal APF level and tumor disappearance after treatment (p<0.05), markedly lower incidence rates of increase in transaminases, elevation of bilirubin, intratumoral hemorrhage, bile duct injury and gastrointestinal perforation during treatment (p<0.05) than the Control group. Additionally, the rate of stable disease (SD) was notably higher and the 1-year survival rate was higher in the Observation group than in the Control group (p<0.05).
RFA for liver cancer adjacent to the gallbladder can effectively lower the levels of tumor markers, improve liver function and enhance immunity, with a few operative complications and high efficacy, so it has a positive impact in prolonging the survival of patients.
探讨超声引导下射频消融术（RFA）治疗胆囊旁肝癌的临床疗效并分析其预后。
选取2015年1月至2018年4月我院收治的80例胆囊旁肝癌患者，分为观察组（n = 40）和对照组（n = 40）。所有患者均行胆囊切除术及淋巴结清扫术并术后化疗。观察组行RFA，对照组同时行根治性胆囊切除术和根治性肝切除术。通过电话随访，比较两组干预后1个月肿瘤相关因子水平、肝功能及细胞和体液免疫功能相关指标、治疗前后肿瘤大小以及治疗后甲胎蛋白（AFP）水平正常和肿瘤消失的病例数。对两组治疗期间并发症发生率（转氨酶升高、胆红素升高、瘤内出血、胆管损伤和胃肠道穿孔）、临床疗效及1年生存率进行统计学分析。
干预后1个月，观察组肿瘤相关因子AFP、糖类抗原19-9（CA19-9）和癌胚抗原（CEA）水平显著低于对照组（p<0.05），肝功能指标天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、总胆红素（TBIL）、间接胆红素（IBIL）和直接胆红素（DBIL）水平明显低于对照组（p<0.05），但免疫球蛋白G（IgG）、IgA和IgM、分化簇4+（CD4+）、CD8+及CD4+/CD8+水平明显高于对照组（p<0.05）。治疗前后，观察组肿瘤大小小于对照组（p<0.05）。观察组治疗后AFP水平正常和肿瘤消失的病例数明显多于对照组（p<0.05），治疗期间转氨酶升高、胆红素升高、瘤内出血、胆管损伤和胃肠道穿孔的发生率明显低于对照组（p<0.05）。此外，观察组疾病稳定（SD）率明显高于对照组，1年生存率也高于对照组（p<0.05）。
胆囊旁肝癌行RFA可有效降低肿瘤标志物水平，改善肝功能，增强免疫力，手术并发症少，疗效高，对延长患者生存期有积极影响。
