腹腔镜与开腹肝部分切除术治疗肝癌的疗效比较及对外周血单核细胞Wntβ-catenin信号通路的影响

Comparison of Laparoscopic and Open Partial Hepatectomy in the Treatment of Liver Cancer and its Effect on Wntβ-catenin Signaling Pathway in Peripheral Blood Monocytes

目的:观察腹腔镜与开腹肝部分切除术治疗肝癌的疗效及对外周血单核细胞Wntβ-catenin信号通路的影响。方法:回顾性分析2020年2月~2021年11月期间在盐城市第一人民医院接受治疗的104例肝癌患者的临床资料。据各自施行的手术方式分为开腹组和腹腔组,例数分别为51例和53例。对比开腹组、腹腔组的围术期指标、血清肿瘤标志物[甲胎蛋白(AFP)、癌胚抗原(CEA)和糖类抗原199(CA199)]、外周血单核细胞Wntβ-catenin信号通路相关指标,观察两组患者并发症总发生率。结果:腹腔组的首次进食时间、住院时间短于开腹组,术中出血量少于开腹组,手术时间长于开腹组(P<0.05)。两组术后7 d血清AFP、CEA、CA199水平较术前下降(P<0.05)。两组术前、术后7 d外周血单核细胞Wnt、Tcf-4、β-catenin信使RNA(m RNA)表达量,组间对比无统计学差异(P>0.05)。两组术后7 d外周血单核细胞Wnt、Tcf-4、β-catenin表达量较术前下降(P<0.05)。腹腔组的并发症总发生率低于开腹组(P<0.05)。结论:腹腔镜与开腹肝部分切除术治疗肝癌均可有效降低血清肿瘤标志物水平,抑制外周血单核细胞Wntβ-catenin信号通路活化,但腹腔镜在减轻手术创伤、促进患者术后恢复、降低并发症发生率中更具优势。

Objective:To observe the effect of laparoscopic and open partial hepatectomy in the treatment of liver cancer and its effect of Wntβ-catenin signaling pathway in peripheral blood monocytes.Methods:The clinical data of 104 cases of patients with liver cancer who were treated in Yancheng first people’s hospital from February 2020 to November 2021 were retrospectively analyzed.According to their operation methods,they were divided into open group and abdominal group,with 51 cases and 53 cases,respectively.Perioperative indexes,serum tumor markers[alpha-fetoprotein(AFP),carcinoembryonic antigen(CEA)and carbohydrate antigen 199(CA199)]and Wntβ-catenin signaling pathway related indexes in peripheral blood monocytes were compared between the open group and the abdominal group,and the total incidence of complications in two groups was observed.Results:The time of first feeding and hospital stay in the abdominal group were shorter than those in the open group,the amount of intraoperative blood loss was less than that in the open group,and the operation time was longer than that in the open group(P<0.05).The levels of serum AFP,CEA and CA199 in two groups decreased at 7 d after operation compared with those before operation(P<0.05).The expression levels of Wnt,Tcf-4 andβ-catenin messenger RNA(m RNA)in peripheral blood monocytes of the two groups before operation and 7 d after operation showed no significant difference between the two groups(P>0.05).The expression levels of Wnt,Tcf-4 andβ-catenin m RNA in peripheral blood monocytes of two groups at 7 d after operation decreased compared with these before operation(P<0.05).The total incidence of complications in abdominal group was lower than that in open group(P<0.05).Conclusion:Laparoscopic and open partial hepatectomy in the treatment of liver cancer can effectively reduce the level of serum tumor markers,and inhibit Wntβ-catenin signaling pathway of peripheral blood monocytes is activated,but laparoscopy has more advantages in reducing surgical trauma,promoting postoperative recovery of patients and reducing the incidence of complications.