肝切除术联合腹腔热灌注化疗对肝癌患者术后复发性肝癌的预后分析

摘要/Abstract

摘要： 目的探讨肝切除术联合腹腔热灌注化疗(hepatectomy combined with intraperitoneal hyperthermic chemotherapy,HIPEC)对肝癌患者的影响。方法选择106例肝癌患者随机分为观察组与对照组,各53例,分别接受肝切除术联合腹腔热灌注化疗治疗和肝切除术治疗,比较两组临床疗效、治疗前后的肿瘤标志物[癌胚抗原(CEA)、恶性肿瘤特异性生长因子(TSGF)]、免疫功能[CD3⁺、CD4⁺、CD8⁺]、肝功能[天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、总胆红素(TBil)、直接胆红素(DBil)]、术后复发转移情况。结果治疗后,在治疗总有效率上,与对照组(66.04%)相比,观察组(90.57%)较高(P<0.05);在CEA、TSGF水平上,观察组较低[(4.06±0.92)比(8.31±1.57),(35.28±5.02)比(52.89±6.17),P<0.05];在CD3⁺、CD4⁺水平上,观察组较高[(73.94±6.83)比(65.89±6.11),(39.25±4.73)比(33.12±4.06),P<0.05];而CD8⁺水平上,观察组较低[(25.54±3.15)比(29.75±3.68),P<0.05];在AST、ALT、TBil、DBil水平上,观察组较低[(23.78±2.79)比(29.06±3.15),(34.66±3.29)比(43.89±4.08),(33.58±3.42)比(55.29±5.37),(16.84±2.12)比(24.05±2.69),P<0.05];观察组肝内复发率、腹腔种植转移率分别为30.19%、7.55%,低于对照组(69.81%,47.17%,P<0.05)。结论肝切除术联合腹腔热灌注化疗在提高肝癌患者的治疗总有效率、改善肿瘤标志物和免疫功能水平、降低肝功能损害以及减少肝内复发和腹腔种植转移方面,表现出更显著的临床优势。

关键词: 肝切除术, 腹腔热灌注化疗, 肝癌, 肿瘤标志物, 免疫功能, 肝功能

Abstract: Objective To explore the impact of hepatectomy combined with intraperitoneal hyperthermic chemotherapy (HIPEC) on patients with hepatocellular carcinoma. Methods A total of 106 liver cancer patients who were randomly divided into a control group (53 cases) and an observation group (53 cases), using a random number table. The control group received hepatectomy, while the observation group underwent hepatectomy combined with hyperthermic intraperitoneal chemotherapy. The clinical efficacy, tumor markers [carcinoembryonic antigen (CEA), tumor-specific growth factor (TSGF), immune function (CD3⁺, CD4⁺, CD8⁺), liver function [aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin (TBil), direct bilirubin (DBil)], and postoperative recurrence and metastasis were compared between the two groups. Results The observation group showed a significantly higher total effective rate (90.57%) post-treatment, compared to that of 66.04% in the control group (P<0.05). The levels of CEA and TSGF in the observation group were significantly lower [(4.06±0.92) ng/mL vs. (8.31±1.57) ng/mL, (35.28±5.02) U/mL vs. (52.89±6.17) U/mL, P<0.05]. The immune function markers CD3⁺ and CD4⁺ levels were significantly higher in the observation group [(73.94±6.83)% vs. (65.89±6.11)%, (39.25±4.73)% vs. (33.12±4.06)%, P<0.05], while CD8⁺ levels were lower in the observation group [(25.54±3.15)% vs (29.75±3.68)%, P<0.05]. Liver function parameters (AST, ALT, TBil, DBil) were significantly lower in the observation group [(23.78±2.79) U/L vs. (29.06±3.15) U/L, (34.66±3.29) U/L vs. (43.89±4.08) U/L, (33.58±3.42) μmol/L vs. (55.29±5.37) μmol/L, (16.84±2.12) μmol/L vs. (24.05±2.69) μmol/L, P<0.05]. The recurrence rate in the liver and peritoneal implantation metastasis rate in the observation group were 30.19% and 7.55%, respectively, which were notably lower than those of 69.81% and 47.17% in the control group’s (P<0.05). Conclusion Hepatectomy combined with intraperitoneal hyperthermic chemotherapy shows significant clinical advantages in improving the overall treatment efficacy, enhancing tumor markers and immune function, reducing liver function damage, and decreasing the rates of intrahepatic recurrence and abdominal implantation metastasis in patients with hepatocellular carcinoma.

Key words: Hepatectomy, Intraperitoneal hyperthermic chemotherapy, Hepatocellular carcinoma, Tumor markers, Immune function, Liver function

李壮, 刘勇, 朱峰. 肝切除术联合腹腔热灌注化疗对肝癌患者术后复发性肝癌的预后分析[J]. 肝脏, 2025, 30(7): 930-933.

LI Zhuang, LIU Yong, ZHU Feng. An analysis on the prognosis and recurrence of patients with hepatocellular carcinoma after hepatectomy combined with intraperitoneal hyperthermic chemotherapy[J]. Chinese Hepatolgy, 2025, 30(7): 930-933.

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参考文献

[1] 孙启刚, 符策雄, 郑进方. 绕肝悬吊前入路右半肝切除术在肝癌手术中的应用研究[J]. 临床外科杂志,2021,29(8):748-750.
[2] 徐林, 刘文. 肠内营养对老年肝癌肝切除术患者肝功能、免疫细胞及炎症因子的影响[J]. 中国老年学杂志,2018,38(4):849-851.
[3] 何津, 张大为, 张跃伟, 等. 复方苦参注射液预防原发性肝癌患者肝切除术后复发的临床观察[J]. 中成药,2018,40(1):243-244.
[4] 何坤, 胡泽民, 阮嘉后, 等. 肝切除联合腹腔热灌注化疗在肝癌自发破裂出血中的应用[J]. 肝胆胰外科杂志,2017,29(6):464-467.
[5] 段昌虎, 刘晓晨, 段建峰, 等. 肝癌破裂出血急诊TAE序贯手术切除联合腹腔热灌注化疗等综合治疗的研究分析[J]. 肝脏,2022,27(4):455-459.
[6] 李民, 熊俊. 《原发性肝癌诊疗规范(2017年版)》解读[J]. 中国普通外科杂志,2019,28(7):785-789.
[7] 蔡泽丰, 祖庆泉, 周春高, 等. TACE联合MWA治疗肝切除术后复发性肝癌的疗效及预后分析[J]. 现代生物医学进展,2023,23(23):4578-4583.
[8] 郝春海, 田立斌, 何津. 复方苦参注射液对原发性肝癌患者术后复发的预防作用及生存函数分析[J]. 中西医结合肝病杂志,2020,30(4):303-306.
[9] 房芳, 李俊娜, 王前. 载药微球经动脉导管化疗栓塞与腹腔镜精准肝切除术治疗原发性肝癌的疗效比较[J]. 中西医结合肝病杂志,2024,34(7):596-599.
[10] 何泳铸, 何坤, 王泽亮, 等. 腹腔热灌注化疗在肝癌破裂出血术后肿瘤复发中的应用价值[J]. 中华肝胆外科杂志,2020,26(6):431-434.
[11] 冀柏宇, 金栋, 郝芬林, 等. NLR与经导管动脉化疗栓塞联合局部消融治疗肝切除术后复发性肝癌患者预后的相关性[J]. 实用放射学杂志,2022,38(8):1342-1346.
[12] Alzahrani N, Ung L, Valle S J, et al. Synchronous liver resection with cytoreductive surgery for the treatment of liver and peritoneal metastases from colon cancer: results from an Australian centre[J]. ANZ J Surg.2017,87(11):E167-E172.
[13] Flood M P, Waters P S, Kelly M E, et al. Outcomes following synchronous liver resection, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal liver and peritoneal metastases: a bi-institutional study[J]. Surg Oncol.2021,37:101553.
[14] 王辉, 边晨峰. 顺铂联合吉西他滨循环热灌注化疗对肝癌腹腔积液患者恶性肿瘤特异性生长因子、癌胚抗原水平的影响[J]. 中国药业,2021,30(3):63-65.
[15] 李俊, 王学文, 罗国松. 腹腔镜下解剖性肝切除术对原发性肝癌患者手术指标、无瘤生存率及肝功能的影响[J]. 实用医院临床杂志,2022,19(6):85-88.
[16] 王峻, 刘洪, 王四明. 肝癌切除术序贯腹腔热灌注化疗在肝癌自发性破裂出血中的临床应用[J]. 中国普通外科杂志,2023,32(7):1014-1022.