荧光腹腔镜肝切除术与开腹肝切除治疗肝细胞癌对患者免疫功能及预后的影响

Effects of fluorescence-assisted laparoscopic hepatectomy and open hepatectomy for hepatocellular carcinoma on immune function and prognosis of patients.

目的探讨荧光腹腔镜肝切除术与开腹肝切除治疗肝细胞癌对患者的免疫功能及预后的影响。方法选取2018年2月至2020年2月于安康市人民医院诊治的82例肝细胞癌患者,按照随机数表法分为观察组和对照组各41例。观察组患者予以荧光腹腔镜肝切除术治疗,对照组患者予以开腹肝切除,比较两组患者的手术时间、术中出血量、首次进食时间、住院时间、免疫球蛋白(IgA、IgG、IgM)、T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)、肝功能[丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)];同时比较两组患者的术后并发症、死亡率、复发率及生存时间;并采用Cox回归模型分析影响1年生存率的相关因素。结果观察组患者的术中出血量为(136.52±15.21)mL,明显少于对照组的(282.33±20.52)mL,差异有统计学意义(P<0.05);观察组患者术后首次进食时间、住院时间分别为(2.35±1.02)d、(7.45±1.32)d,明显短于对照组的(3.77±1.32)d、(11.52±3.05)d,差异均有统计学意义(P<0.05);术后3 d,观察组患者的IgA、IgG、IgM、CD3+、CD4+、CD4+/CD8+明显高于对照组,而CD8+明显低于对照组,差异均有统计学意义(P<0.05);术后1 d和术后1个月,观察组患者的ALT、AST明显低于对照组,差异均有统计学意义(P<0.05);观察组患者的术后并发症发生率和死亡率分别为7.32%、2.44%,明显低于对照组的29.27%、14.63%,差异均有统计学意义(P<0.05);观察组患者的术后生存时间为(10.32±1.25)个月,明显长于对照组的(9.52±1.08)个月,差异有统计学意义(P<0.05);经Cox分析结果显示,开腹肝切除术是影响肝细胞癌患者1年生存率的独立危险因素(P<0.05)。结论荧光腹腔镜肝切除术与开腹肝切除术治疗肝细胞癌效果均较好,但前者疗效更为理想,能减轻免疫功能的影响,且预后转归更优。

Objective To investigate the effect of fluorescence-assisted laparoscopic hepatectomy and open hepatectomy for hepatocellular carcinoma on the immune function and prognosis of patients.Methods A total of 82 patients with hepatocellular carcinoma who were diagnosed and treated in Ankang People's Hospital from February 2018 to February 2020 were selected and divided into an observation group and a control group,with 41 patients in each group,according to the random number table.Patients in the observation group were treated with fluorescence-assisted laparo-scopic hepatectomy,and those in the control group were treated with open hepatectomy.The operation time,intraopera-tive blood loss,first feeding time,length of hospital stay,immunoglobulin(IgA,IgG,IgM),T lymphocyte subsets(CD3+,CD4+,CD8+,CD4+/CD8+),liver function[alanine aminotransferase(ALT),aspartate aminotransferase(AST)]were compared between the two groups,as well as postoperative complications,mortality,recurrence rate,and survival time.Cox regression model was used to analyze the related factors affecting the 1-year survival rate.Results The intraopera-tive blood loss of the observation group was(136.52±15.21)mL,which was significantly less than(282.33±20.52)mL of the control group(P<0.05).The first feeding time,length of hospital stay were(2.35±1.02)d and(7.45±1.32)d in the ob-servation group,which were significantly shorter than(3.77±1.32)d and(11.52±3.05)d in the control group(P<0.05).On the 3rd day,the IgA,IgG,IgM,CD3+,CD4+,CD4+/CD8+of the observation group were significantly higher than those of the control group,while CD8+was significantly lower than that of the control group,with statistically significant dif-ferences(P<0.05).At 1 d and 1 month after treatment,ALT and AST of the observation group were significantly lower than those of the control group(P<0.05).The postoperative complication rate and mortality of the observation group were 7.32%and 2.44%,respectively,significantly lower than 29.27%,14.63%in the control group(P<0.05).The postoperative survival time of the observation group was(10.32±1.25)months,which was significantly longer than(9.52±1.08)months of the control group(P<0.05).Cox analysis showed that open hepatectomy was an independent risk factor affecting the 1-year survival rate of patients with hepatocellular carcinoma(P<0.05).Conclusion Fluorescence-assisted laparoscop-ic hepatectomy and open hepatectomy are both effective in the treatment of hepatocellular carcinoma,but the former is more effective,can reduce the impact of immune function,and has better prognosis.