腹腔镜与开腹肝切除术治疗原发性肝细胞癌的临床疗效对比

Comparison of clinical efficacy of laparoscopic and open hepatectomy for primary hepatocellular carcinoma

目的对比分析腹腔镜与开腹肝切除术治疗原发性肝细胞癌的临床疗效,为临床提供一定的理论参考,以提高原发性肝细胞癌的治疗水平。方法选取蚌埠医学院第一附属医院2014年1月-2017年1月收治的86例原发性肝细胞癌患者作为研究对象,按照随机数字表法分为对照组和观察组各43例。对照组采用开腹肝切除术,观察组实施腹腔镜肝切除术。比较2组各项围术期手术及治疗指标,血清细胞间黏附分子(ICAM-1)、基质金属蛋白酶(MMP-13)、降钙素原(PCT)、白细胞介素6(IL-6)各炎性因子水平,以及术后并发症发生率。结果观察组手术时间、术中出血量、切口长度、术后视觉模拟疼痛(VAS)评分、术后住院时间各手术及治疗指标均低于对照组(均P<0.05)。治疗前,2组ICAM-1、MMP-13、PCT、IL-6水平差异无统计学意义(均P>0.05);治疗后,观察组ICAM-1、MMP-13、PCT、IL-6水平分别为(7.48±2.69)ng/mL、(121.03±23.61)ng/mL、(6.83±1.97)μg/mL、(13.58±4.29)pg/mL,均低于对照组的(13.07±3.86)ng/mL、(168.52±30.27)ng/mL、(8.32±2.67)μg/mL、(16.40±5.38)pg/mL(均P<0.05)。观察组并发症发生率为6.99%,显著低于对照组的23.27%(P<0.05)。结论腹腔镜与开腹肝切除术均为原发性肝细胞癌的常见手术治疗方法,相较于开腹手术,腹腔镜引导下手术治疗效果更好,具有创伤小、术后恢复快等优点,对炎症反应影响轻,安全性高。

Objective To compare and analyze the clinical efficacy of laparoscopic and open hepatectomy in the treatment of primary hepatocellular carcinoma(HCC), so as to provide certain theoretical reference for clinical practice and improve the treatment level of HCC. Methods A total of 86 patients with HCC admitted to our hospital from January 2014 to January 2017 were selected and divided into control group and observation group by numerical random table method, with 43 cases each group. The control group underwent open hepatectomy, while the observation group underwent laparoscopic hepatectomy. The levels of intercellular adhesion molecules-1(ICAM-1), matrix metalloproteinases-13(MMP-13), procalcitonin(PCT), interleukin-6(IL-6), and the incidence of postoperative complications in the two groups were compared. Results The operative time, intraoperative blood loss, incision length, postoperative visual analogue pain(VAS) score, and length of postoperative hospital stay in the observation group were all lower than those in the control group(all P<0.05). Before treatment, the levels of ICAM-1, MMP-13, PCT and IL-6 in the two groups were not significantly different(all P>0.05). After treatment, the levels of ICAM-1, MMP-13, PCT and IL-6 in the observation group were(7.48±2.69) ng/mL,(121.03±23.61) ng/mL,(6.83±1.97) μg/mL and(13.58±4.29) pg/mL, respectively, which were all lower than those in the control group(13.07±3.86) ng/mL,(168.52±30.27) ng/mL,(8.32±2.67) μg/mL and(16.40±5.38) pg/mL(all P<0.05). The complication rate in the observation group was 6.99%, lower than 23.27% in the control group(P<0.05). Conclusion Both laparoscopic and open hepatectomy are common surgical treatment methods for primary HCC. Compared with open surgery, laparoscope-guided surgery is more effective, has the advantages of less trauma, faster postoperative recovery, less impact on inflammatory response, high safety.