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目的 探讨拉米夫定防治乙肝病毒在肝癌围手术期活跃的效果。方法 对 72例肝癌合并HBV感染者随机分组 ,研究组的 38例在围手术期每日 1次给予拉米夫定 10 0mg ,进行定量HBVDNA及其它检查。对照组在围手术期不进行抗乙肝病毒治疗。结果 对照组的HBVDNA量 ,在术后 1周内、2周内较术前的增高值具显著性意义 (P <0 0 1) ,研究组中术后 1周内、2周内HBVDNA量较术前的HBVDNA量降低值亦有显著性意义 (P <0 0 1) ,皆低于安全治愈阈值 ;两组的术前、术后Child分级 ,术前、术后ALT比较差异无显著性意义 (P >0 0 5 )。术后 2周内并发症发生率比较 ,差异有显著性意义 (P <0 0 5 )。结论 外科治疗可激活HBV的复制能力 ,须加强肝癌围手术期对HBV的防范。拉米夫定有强大的抗HBV功能 ,可短期内迅速降低HBVDNA的量至安全范围。应用拉米夫定可以预防和治疗肝癌围手术期乙肝病毒的活跃。但其短期内改善肝脏功能的效果不明显。
Objective To investigate the effect of lamivudine on the prevention and treatment of hepatitis B virus in the perioperative period of liver cancer. Methods 72 cases of hepatocellular carcinoma with HBV infection were randomly divided into two groups. 38 patients in the study group were given lamivudine 100 mg once daily during the perioperative period for quantitative HBV DNA and other tests. The control group did not undergo anti-HBV treatment during the perioperative period. Results The amount of HBV DNA in the control group was significantly higher than the preoperative value within 1 week and 2 weeks after surgery (P < 0.01). The amount of HBV DNA in the study group within 1 week and 2 weeks after surgery was higher than that in the control group. Preoperative reduction in HBV DNA levels was also significant (P < 0.01), both below the safe cure threshold; there was no significant difference in preoperative and postoperative Child grading between the two groups, preoperative and postoperative ALT. (P > 0 0 5 ). The incidence of complications within 2 weeks after surgery was significantly different (P < 0.05). Conclusion Surgical treatment can activate the replication of HBV, and it is necessary to strengthen the prevention of HBV during the perioperative period of liver cancer. Lamivudine has a strong anti-HBV function and can quickly reduce the amount of HBV DNA to a safe range in the short term. Application of lamivudine can prevent and treat liver cancer perioperative hepatitis B virus activity. However, the effect of improving liver function in the short term is not obvious.