腹腔镜精准肝切除治疗原发性肝癌的疗效观察

Clinical outcome of laparoscopic precise liver resection in the treatment of primary liver cancer

目的对比腹腔镜精准肝切除术与常规肝切除治疗原发性肝癌的疗效。方法回顾性分析2014年5月至2016年12月收治的72例原发性肝癌患者的临床资料,根据术式不同分为精准肝切除组和常规肝切除组,每组36例。采用统计学软件SPSS19.0处理和分析,手术相关指标、肝功能及免疫学指标等计数资料以(x±s)表示,采用独立t检验;患者性别、肝功能分级及肿瘤分期等计数资料采用卡方检验,P<0.05表示差异有统计学意义。结果两组手术时间比较无明显差异(P>0.05),精准肝切除组患者住院时间及术中出血量明显低于常规肝切除组(P<0.05);术后肝功能指标AST、ALT低于常规肝切除组,ALB和TBIL高于常规肝切除组(P<0.05)。术后7 d,两组患者CD3^+、CD4^+及CD4^+/CD8^+水平均明显下降,但精准肝切除组水平高于常规肝切除组,差异有统计学意义(P<0.05)。术后CD8^+水平无明显变化,至术后14 d时两组患者T细胞水平基本恢复正常。结论腹腔镜精准肝切除治疗原发性肝癌具有术中出血量少、住院时间短、对患者肝功能和免疫功能影响较低等优点,值得临床推广应用。

Objective To compare the clinical outcome of laparoscopic precise liver resection and open conventional hepatectomy in the treatment of primary hepatic carcinoma. Methods From May 2014 to December 2016, clinical data of 72 patients with primary liver cancer were analyzed retrospectively, who were divided into precise hepatectomy group （ n=36 cases） and conventional hepatectomy group （ n=36 cases） . Statistical analysis were performed by using SPSS 19.0 software. Measurement data, such as operation indicators, including operation time, the amount of blood loss, length of hospital stay, the postoperative parameters of liver function and immune status, were expressed as x±s , and were examined by using independent t test. Count data such as the gender, the Child／｜Pugh staging and tumor staging of patients were examined by chi square test. A P value 〈0.05 was considered as statistically significant difference. Results There was no significant difference of operation time between the precise hepatectomy group and the conventional hepatectomy group. Compared with conventional hepatectomy group, the length of hospital stay and the amount of blood loss in the precise hepatectomy group were significantly decreased（ P 〈0.05）. The postoperative AST and ALT level in the precise hepatectomy group were significantly lower than those in the conventional hepatectomy group. The postoperative ALB and TBIL level in the precise hepatectomy group were significantly higher than those in the conventional hepatectomy group （ P〈0.05）. At postoperative day 7, subsets of CD3^＋, CD4^＋ and CD4^＋/CD8^＋ were significantly decreased in both groups after operation, however the decreasing degrees of them in precise hepatectomy group were significantly less than those in conventional hepatectomy group （ P〈0.05）, and there were significant postoperative changes of CD8^＋ subsets in both groups. About 2 weeks after operation these T lymphocyte subsets in both groups returned to their preoperative levels. Conclusion Laparoscopic precise hepatectomy for primary liver cancer has several advantages including less intraoperative blood loss, shorter hospital stay, better liver function and immune function, which is worthy of clinical application.