腹腔镜规则性肝叶切除术对原发性肝癌患者术后血清AFP、Hcy水平及生存质量的影响

Effect of laparoscopic regular hepatectomy on levels of serum AFP,Hcy and quality of life in postoperative patients with primary liver cancer

目的:探讨腹腔镜规则性肝叶切除术对原发性肝癌患者术后血清甲胎蛋白(alpha fetoprotein,AFP)、同型半胱氨酸(homocysteine,Hcy)水平及生存质量的影响。方法:回顾性分析2009年10月至2012年10月四川省人民医院接受手术治疗的78例原发性肝癌患者临床资料,将采取腹腔镜规则性肝叶切除术的39例患者作为观察组,将采取开腹手术的39例患者作为对照组。观察两组手术情况、并发症发生情况与术后1年、3年、5年生存情况,比较两组术前、术后1周、术后1个月血清AFP、Hcy水平及术前、术后1年生存质量评分(SF-36)。结果:观察组术中出血量为(192. 1±37. 5) ml,低于对照组的(368. 2±48. 7) ml,观察组住院时间、腹腔引流时间、进食时间分别为(6. 8±2. 1) d、(2. 7±1. 3) d、(1. 5±0. 5) d,短于对照组的(11. 5±2. 7)d、(4. 8±1. 2) d、(3. 0±0. 8) d,差异有统计学意义(P <0. 05);术后1周、术后1个月观察组的血清AFP、Hcy水平低于对照组,差异有统计学意义(P <0. 05);观察组术后并发症发生率(7. 7%)与对照组(17. 9%)相比,差异无统计学意义(P> 0. 05);术后1年观察组SF-36分值为(65. 3±7. 0)分,高于对照组的(58. 5±6. 4)分,差异有统计学意义(P <0. 05);术后1年观察组生存率(86. 5%)高于对照组(65. 7%),差异有统计学意义(P <0. 05)。结论:原发性肝癌患者予以腹腔镜规则性肝叶切除术治疗可明显降低患者术后血清AFP、Hcy水平,减轻手术创伤,促进其术后恢复,延长其生存时间,提高其生存质量。

Objective:To investigate the effect of the laparoscopic regular hepatectomy on the levels of serum alpha fetoprotein (AFP) and homocysteine (Hcy) and the quality of life in postoperative patients with primary liver cancer.Methods:The clinical data of 78 cases of primary liver cancer patients from October 2009 to October 2012 in Sichuan Provincial People's Hospital were retrospectively analyzed.Then 39 patients with laparoscopic regular hepatectomy were taken as the observation group,and 39 patients with laparotomy were taken as the control group.The operation status,complications and the 1-year,3-year and 5-year postoperative survival of the two groups were observed.The levels of serum AFP and Hcy before operation and 1 week and 1 month after the operation,and the quality of life scores (SF-36) before the operation and after the operation for 1 year were compared between the two groups.Results:The amount of the intraoperative bleeding in the observation group was (192.1±37.5) ml,which was lower than that in the control group [(368.2±48.7) ml].The hospitalization time,the abdominal drainage time and the eating time in the observation group were (6.8±2.1) d,(2.7±1.3) d and (1.5±0.5) d,respectively,shorter than those in the control group [(11.5±2.7) d,(4.8±1.2) d,(3.0±0.8) d].The differences were statistically significant (P<0.05).After 1 week and 1 month of the operation,the levels of serum AFP and Hcy in the observation group were lower than those in the control group.The differences were statistically significant (P<0.05).There was insignificant difference in the incidence of postoperative complications between the observation group (7.7%) and the control group (17.9%)(P>0.05).After 1 year of the operation,the score of SF-36 in the observation group was (65.3±7.0) scores,which was higher than that in the control group [(58.5±6.4) scores].The difference was statistically significant (P<0.05).After 1 year of the operation,the survival rate of the observation group was 86.5%,higher than that of the control group (65.7%).The difference was statistically significant (P<0.05).Conclusion:The laparoscopic regular hepatectomy in the treatment of postoperative patients with primary liver cancer can significantly reduce the levels of postoperative serum AFP and Hcy,relieve the surgical trauma,promote the postoperative recovery,prolong the survival time and improve their quality of life.