关键词: 腹腔镜下射频消融, 经皮射频消融, 原发性肝癌, 抗肿瘤免疫, 并发症

Abstract: Objective  To investigate the effects of laparoscopic radiofrequency ablation (LRFA) and percutaneous radiofrequency ablation (PRFA) on anti-tumor immunity, complication rate and recurrence rate in patients with primary liver cancer.Methods A total of 81 patients with primary liver cancer treated in Dazhou Central Hospital from January 2020 to August 2022 were selected and divided into observation group (LRFA, n=42) and control group (PRFA, n=39) according to the treatment plan. Compare the total ablation rate, postoperative complication rate, recurrence rate of the two groups, as well as tumor necrosis factor-α (TNF-α), carbohydrate antigen 199 (CA199), interleukin-6 (IL-6), Golgi protein 73 (GP73), Creactive protein (CRP), alpha-fetoprotein (AFP) and peripheral blood T lymphocyte subpopulation levels before and after surgery.Results There was no significant difference between the observation group (95.24%) and the control group (92.31%) (P>0.05). At 1 d postoperatively, IL-6 was (124.63±45.41) pg/ml and (168.28±51.26) pg/ml, CRP was (19.14±5.03) ng/L and (28.26±7.47) ng/L, and TNF-α was (94.32±18.49) pg/ml and (108.41±20.11) pg/ml; at 3 d postoperatively, IL-6 was (92.37±24.11) pg/ml and (105.83±27.45) pg/ml in the observation group and the control group, respectively, CRP was (14.87±4.37) ng/L and (17.25±5.06) ng/L, and TNF-α was (75.41±12.10) pg/ml and (82.64±16.83) pg/ml, which were all higher than that of preoperative period (P<0.05). At 7 d postoperatively, CD3+ in the observation group and control group were (66.27±7.82)% and (65.14±7.63)%, AFP was (156.23±30.27)μg/ml and (160.84±32.33)μg/ml, GP73 was (65.21±10.26)μg/L and (67.44±11.03) μg/L, CA199 was (44.89±11.41) U/L and (45.12±13.07) U/L, CD4 was (32.02±6.03)% and (31.53±6.11)%, and CD4+/CD8+ was (1.31±0.39) and (1.29±0.37) respectively; at 14 d postoperatively, CD3+ was (71.25±6.83)% and (70.89±6.76)%, AFP was (48.52±18.31)μg/ml and (50.11±19.12)μg/ml, GP73 was (48.25±8.46)μg/L and (49.12±10.12)μg/L, CA199 was (19.27±5.16)U/L and (20.07±5.39)U/L, and CD4 was (38.25±7.7)U/L and (20.07±5.39)U/L, respectively, in the observation and control groups. g/L, CA199 was (19.27±5.16)U/L and (20.07±5.39)U/L, CD4 was (38.25±7.45)% and (37.61±7.92)%, and CD4+/CD8+ was (1.49±0.42) and (1.47±0.45), respectively, which were higher than that of preoperative period (P<0.05), but the difference between the two groups was not statistically significant (P>0.05). The postoperative complication rate of 42.86% and recurrence rate of 2.38% in the observation group were lower than 66.67% and 17.95% in the control group (P<0.05). The 12month postoperative survival rate of 97.62% in the observation group was not statistically significant compared with 94.87% in the control group (P>0.05).Conclusion  The efficacy of LRFA and PRFA in the treatment of primary hepatocellular carcinoma is comparable, which can effectively improve the body’s anti-tumor immunity and reduce the release of serum tumor markers; however, LRFA has less stressful reaction, reduces the occurrence of postoperative complications, and has a lower recurrence rate, which is especially advantageous in the treatment of hepatocellular carcinoma at special sites.

Key words: primary liver cancer, laparoscopic radiofrequency ablation, percutaneous radiofrequency ablation, anti-tumor immunity, complication