单发小肝癌的术式选择及免疫状态改善分析

Selection of operation mode-and improvement on immune status in single small hepatocellular carcinoma

目的探讨不同手术方式治疗单发小肝癌的近期肝功能恢复情况及其对患者免疫水平的改善作用。方法选择2015年2月至2018年2月山西医科大学第一医院收治的100例单发小肝癌患者,按照随机数字表法分为两组。对照组50例接受开腹肝切除术,研究组50例实施腹腔镜肝切除术。对比两组手术相关指标、并发症,并观察手术前后肝功能指标[天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、胆红素(TBIL)]、细胞免疫水平变化。结果研究组手术时间、术后拔管时间长于对照组,术中出血量、术后12h视觉模拟评分量表(VAS)评分、住院时间及肛门排气时间少于对照组(P<0.05)。术后1、2周,研究组ALT、AST、TBIL水平呈降低趋势(P<0.05);术后2周时AST水平低于术前(P<0.05),ALT、TBIL水平恢复至术前(P>0.05)。术后1周,研究组CD3^+、CD4^+、CD8^+、NK恢复至术前(P>0.05),术后2周时上述指标优于术前(P<0.05)。术后2周,研究组ALT、AST、TBIL水平及CD3^+、CD4^+、NK水平均高于对照组,CD8^+低于对照组,差异有统计学意义(P<0.05);研究组术后并发症发生率(6.0%)低于对照组(22.0%),差异有统计学意义(P<0.05)。结论给予单发小肝癌腹腔镜肝切除术治疗具有术后恢复快、疼痛轻、并发症少等优势,利于促进患者近期肝功能的恢复,改善细胞免疫,减轻创伤反应,缩短住院时间。

Objective To investigate the short-term effects of different surgical procedures on liver function recovery and immune function in patients with small hepatocellular carcinoma (SHCC ). Methods One hundred patients with single SHCC in the First Hospital of Shanxi Medical University from February 2015 to February 2018 were selected.And they were divided into two groups by random number table method,with 50 cases in each group.Patients in control group were treated by open hepatectomy,and patients in research group were treated by laparoscopic hepatectomy.The surgical indexes and complications were compared between the two groups.The changes of liver function indexes, including aspartate aminotransferase (AST),alanine transaminase (ALT),total bilirubin (TBIL),and cellular immune levels were observed.Results The operation time and postoperative extubation time in research group were longer than those of control group,while the intraoperative bleeding volume, postoperative 12h VAS score,hospital stays,anal exhaust time in research group were lower than those in control group (P<0.05).One week and two weeks postoperative,ALT,AST,TBIL levels in research groups showed a decreased tendency (P<0.05);two weeks postoperative,AST level was lower than that before surgery (P<0.05),and the ALT and TBIL levels returned to preoperative level (P>0.05).One week postoperative,CD3^+,CD4^+,CD8^+,NK in research group returned to the level before surgery (P>0.05).And two weeks postoperative,levels of above-mentioned indexes were better than those before surgery (P<0.05).Two weeks postoperative,ALT,AST,TBIL,CD3^+,CD4^+,NK levels in research group were higher than those in control group,while the CD8^+ was lower than that in control group (P<0.05).The incidence of postoperative complications in research group (6.0%)was lower than that in control group (22.0%),P<0.05.Conclusions Laparoscopic hepatectomy in the treatment of single SHCC has advantages of quick recovery,less pain and complications,which can promote recovery of short-term liver function,improve cellular immunity,reduce traumatic reaction and shorten hospital stays.