腹腔镜下肝切除术的临床疗效及对细胞免疫功能的影响

Clinical efficacy of laparoscopic hepatectomy and its influence on cellular immune function

目的:分析腹腔镜下肝切除术的临床疗效及对细胞免疫功能的影响。方法:回顾分析97例行肝切除术肝癌患者的临床资料,分为观察组(n=48,行腹腔镜下肝切除术)与对照组(n=49,行开腹肝切除术)。对比两组术中指标、术后近期疗效、远期疗效、并发症发生情况及手术前后不同时间点的外周血淋巴细胞亚群、血清白介素-6(interleukin-6,IL-6)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)表达水平。结果:两组转移率、复发率、死亡率、并发症发生率差异均无统计学意义(P>0.05);术后72 h,观察组CD3、CD4、CD8、IL-6、TNF-α表达水平基本恢复至术前水平,对照组CD3、CD4、CD8仍低于术前水平,IL-6、TNF-α仍高于术前水平,差异有统计学意义(P<0.05)。结论:腹腔镜下肝切除术治疗肝癌的临床疗效确切,创伤小,安全性较高,近期疗效优于开腹肝切除术,且对患者的细胞免疫功能影响小,术后康复快。

Objective：To investigate the clinical effect of laparoscopic hepatectomy and its influence on cellular immune func- tion. Methods： The clinical data of 97 patients with liver cancer receiving hepatic resection were retrospectively analyzed. The patients were divided into two groups ,48 patients in the observation group received laparoscopic liver resection ;49 patients in the control group received open liver resection. The intraoperative indicators, the short-term and long-term postoperative effect, complication incidence and peripheral blood lymphocyte subsets, serum interleukin-6 （IL-6） , tumor necrosis factor-ct（TNF-ct） at different time points before and after surgery were compared between the two groups. Results：There was no significant difference in metastasis rate, recmxence rate, mortality rate and the complication incidence between two groups （P 〉 0.05 ）. At 72 h after the operation, the expression of CD3, CD4, CD8, IL-6 and TNF-α in the observation group returned to pre-operative level. The CD3, CD4, CD8 in the control group were still less than the preoperative level, and the level of IL-6, TNF-α was still higher than the preoperative level, and the differences were statistical- ly significant （ P 〈 0.05 ）. Conclusions ： Laparoscopic hepatectomy for liver cancer has the advantage of definite therapeutic effect, mini- invasion, high safety and rapid recovery. The short-term therapeutic effect and the influence on cellular immune function of laparoscopic hepatectomy are better than open hepatectomy.