腹腔镜下胃癌D2根治术联合射频消融应用于胃癌肝转移的临床疗效

Clinical effect of laparoscopic D2 radical gastrectomy combined with radiofrequency ablation for liver metastasis of gastric cancer

摘要:

目的 探讨腹腔镜下胃癌D2根治术联合射频消融肝转移瘤应用于胃癌肝转移的临床疗效。方法 选取该院2017年1月－2020年1月收治的可切除胃癌肝转移需行胃癌D2根治术联合射频消融的患者62例，随机分为对照组和观察组，每组各31例。对照组采用开腹胃癌D2根治术联合射频消融治疗，观察组采用腹腔镜下胃癌D2根治术联合射频消融治疗。比较两组患者手术指标、血清肿瘤标志物指标、免疫相关指标和并发症情况。结果 对照组术中出血量多于观察组，肠功能恢复时间、住院时间明显长于观察组（P < 0.05），手术时间短于观察组（P < 0.05）；术后两组患者血清甲胎蛋白（AFP）、癌胚抗原（CEA）水平降低（P < 0.05），观察组血清AFP、CEA水平均低于对照组（P < 0.05）；术后两组患者CD4⁺、CD8⁺、CD4⁺/CD8⁺水平均较术前降低（P < 0.05），观察组CD4⁺、CD4⁺/CD8⁺水平明显高于对照组（P < 0.05）；观察组并发症发生率12.90%低于对照组41.94%（P < 0.05）。结论 腹腔镜下胃癌D2根治术联合射频消融治疗胃癌肝转移有利于患者术后康复，可明显改善血清肿瘤标志物水平及机体免疫功能，降低围术期并发症发生率。

Abstract:

Objective To investigate the clinical effect of laparoscopic D2 radical gastrectomy combined with radiofrequency ablation for liver metastasis of gastric cancer.Methods 62 patients with liver metastasis of resectable gastric cancer treated from January 2017 to January 2020 were selected and randomly divided into control group and observation group with 31 cases in each group. The control group was treated with open D2 radical gastrectomy combined with radiofrequency ablation, and the observation group was treated with laparoscopic D2 radical gastrectomy combined with radiofrequency ablation. The operation indexes, serum tumor markers, immune related indexes and complications were compared between the two groups.Results The intraoperative blood loss in the control group was more than that in the observation group, the intestinal function recovery time and hospitalization time of the control group were significantly longer than those of the observation group (P < 0.05), and the operation time was shorter than that of the observation group (P < 0.05); the levels of serum alpha fetoprotein (AFP) and carcinoembryonic antigen (CEA) decreased in the two groups after operation (P < 0.05), and the serum AFP and CEA level of the observation group were lower than those of the control group (P < 0.05); the postoperative CD4⁺, CD8⁺, CD4⁺/CD8⁺ levels of the two groups were lower than those before operation, the levels of CD4⁺, CD4⁺/CD8⁺ in the observation group were significantly higher than those in the control group (P < 0.05); the incidence of complications in the observation group was 12.90%, which was lower than 41.94% in the control group (P < 0.05).Conclusion Laparoscopic D2 radical gastrectomy combined with radiofrequency ablation in treatment of liver metastasis of gastric cancer is conducive to postoperative rehabilitation, significantly improve serum tumor markers and immune function, and reduce the incidence of perioperative complications.