腹腔镜规则肝叶切除和开腹对原发性肝癌患者C-反应蛋白和凝血功能的影响

Effects of laparoscopic hepatectomy and open hepatectomy on C-reactive protein and blood coagulation function in patients with primary liver cancer

目的比较腹腔镜规则肝叶切除和开腹对原发性肝癌(PLC)患者C-反应蛋白和凝血功能的影响。方法将2010年9月至2015年1月入住本院的109例PLC患者按照入院时间先后交替随机分为开腹组(OH组,54例)与腹腔镜规则肝叶切除组(LH组,55例)。比较两组患者术中、术后情况及手术前后血清CRP和血浆凝血功能指标水平。结果①LH组与OH组患者的手术时间、需输血例数及术中第一肝门阻断时间等差异均无统计学意义(t=1.029,P=0.338;χ~2=0.109,P=0.728;t=1.382,P=0.178),LH组切口长度显著小于OH组(t=15.592,P=0.008);②LH组患者术后进流质时间、留置引流管时间和术后住院时间均显著小于OH组(t值分别为10.293、12.338、6.594,P值分别为0.001、0.008、0.018),两组患者术后并发症发生率的差异无统计学意义(χ~2=0.897,P=0.562);③两组患者术后血清CRP、APTT及TT均较术前显著降低(P均<0.05),且两组患者术后血清CRP、APTT及TT水平差异均有统计学意义(t值分别为3.459、4.002、3.081,P值分别为0.040、0.037、0.045),但两组患者术后PT水平差异无统计学意义(t=0.189,P=0.302);④LH组患者术后1年生存率显著高于OH组(90.9%vs 75.9%,χ~2=4.763,P=0.022)。结论与开腹肝叶切除术相比,腹腔镜肝叶切除术可有效改善原发性肝癌患者血清CRP和凝血功能。

Objective To compare the effects of laparoscopic hepatectomy （LH） and open hepatectomy （OH）on C-reactive protein and blood coagulation function in patients with primary liver cancer （PLC）. Methods Total of 109 patients with PLC admitted to our hospital from September 2015 to January 2010 were randomly selected and divided into LH group （54 cases） and OH group （55 cases）. The serum levels of CRP and blood coagulation functions between the two groups of patients were compared. Results ①The operation time, number of blood transfusion and intraoperative first pringle time of the two groups had no statistically significant difference （t = 1.029, P = 0.338; χ^2 = 0.10, P = 0.728; t =1.382, P = 0.178）, the incision length of patients in LH group was significantly less than that of OH group （t = 15.592, P = 0.008）; ②After the operation, the time of taking liquid food, drainage tube indwelling time and hospital stay in LH group were significantly smaller than those of OH group （t = 10.293, 12.338, 6.594; P = 0.001, 0.008, 0.018）, and the incidence of postoperative complications of the two groups had no statistical difference （χ^2 = 0.897, P =0.562）;③The postoperative serum CRP, APTT and TT in both groups were significantly lower than those before the surgery （P 〈 0.05）, the differences of the above indexes between the two groups were statistically significant （t = 3.459,4.002, 3.081; P = 0.040, 0.037, 0.045）, and the PT level of the two groups had no statistical difference （t = 0.189, P = 0.302）; ④The one-year survival rate of LH group was higher than that of the OH group （90.9% vs 75.9%, χ^2 = 4.763, P = 0.022）. Conclusion Compared with OH, LH can effectively improve the level of serum CRP and blood coagulation function of patients with PLC.