完全腹腔镜与开腹手术治疗复发性肝癌的疗效及外周血SDF-1/CXCR4的动态变化

Curative effect of total laparoscopy and open resection on recurrent liver cancer and dynamic changes of SDF-1/CXCR4 in peripheral blood

目的:探讨完全腹腔镜与开腹手术治疗复发性肝癌的疗效及外周血SDF-1/CXCR4的动态变化。方法:将2014年2月至2018年1月收治的70例复发性肝癌患者通过随机数表法分为两组,腹腔镜组(n=35)行完全腹腔镜切除术,开腹组(n=35)行开腹切除术。观察两组治疗情况、术后疼痛评分、外周血基质细胞衍生因子1(SDF-1)及其受体CXCR4的动态变化、预后情况。结果:腹腔镜组手术出血量、住院时间、术后镇痛药物使用时间、进食时间均优于开腹组,差异有统计学意义(P<0.05)。术后第1天、第3天、第5天、第7天,开腹组疼痛评分均高于术前1 d,并高于同时点腹腔镜组(P<0.05)。术后,两组SDF-1、CXCR4均低于术前水平,差异有统计学意义(P<0.05);腹腔镜组低于开腹组,差异有统计学意义(P<0.05)。两组肝癌转移、复发及1年死亡率差异无统计学意义(P>0.05)。结论:完全腹腔镜手术治疗复发性肝癌在手术出血量、住院时间、术后疼痛方面优于开腹切除术,同时可更快地降低患者体内外周血SDF-1、CXCR4水平。

Objective:To explore the curative effect of total laparoscopy and open resection on recurrent liver cancer(RLC)and dynamic changes of SDF-1/CXCR4 in peripheral blood.Methods:Seventy RLC patients who were admitted to the hospital from Feb.2014 to Jan.2018 were divided into two groups by random number table method,with 35 cases in each group.The laparoscopic group was treated with total laparoscopy,while open group was treated with open resection.After the end of surgery,the treatment condition,postoperative pain score,dynamic changes in stromal cell derived factor 1(SDF-1)in peripheral blood and its receptor CXCR4,and prognosis in both groups was observed.Results:The intraoperative blood loss,hospitalization time,postoperative usage time of analgesic medication and eating time in laparoscopic group were better than those in open group(P<0.05).At 1 d,3 d,5 d and 7 d after surgery,pain scores in open group were higher than those at 1 d before surgery,and higher than those in laparoscopic group at the same time points(P<0.05).After surgery,levels of SDF-1 and CXCR4 in both groups were decreased(P<0.05).After surgery,levels of SDF-1 and CXCR4 in laparoscopic group were lower than those in open group(P<0.05).There was no significant difference in liver cancer metastasis,recurrence or 1-year mortality between the two groups(P>0.05).Conclusions:Total laparoscopy is superior to open resection in treatment of RLC patients in terms of reducing intraoperative blood loss,hospitalization time and postoperative pain.At the same time,it can reduce level of SDF-1/CXCR4 in peripheral blood more quickly.