腹腔镜下肝癌切除术对患者免疫功能和肝功能的影响
|
摘要
目的探讨腹腔镜下肝癌切除术对患者免疫功能和肝功能的影响。方法根据手术方法不同将80例肝癌患者分为微创组(行腹腔镜下肝癌切除术)和开腹组(行传统开腹手术),每组40例。观察并比较两组患者的手术时间、术中出血量、切口长度、引流管留置时间、住院时间,并对两组患者术前、术后1天、术后3天的丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBIL)、间接胆红素(DBIL)水平及外周血CD3~+、CD4~+、CD8~+水平进行比较。结果微创组患者的手术时间明显长于开腹组,切口长度、引流管留置时间、住院时间均明显短于开腹组,术中出血量明显低于开腹组(P﹤0.01);术后1天、术后3天,微创组患者的血清ALT、AST水平及外周血CD8~+水平均低于开腹组,外周血CD3~+、CD4~+、CD4~+/CD8~+水平均高于开腹组,差异均有统计学意义(P﹤0.05)。结论腹腔镜下肝癌切除术对患者免疫功能、肝功能的影响较传统开腹手术小。
Objective To investigate the effects of laparoscopic hepatectomy for liver cancer on immune function and liver function of patients. Method 80 patients with liver cancer were divided into minimally invasive group(laparoscopic hepatectomy was performed) and laparotomy group(traditional laparotomy was performed) according to the surgical methods, with 40 cases in each group. The operation duration, intraoperative blood loss, incision length, drainage tube indwelling time, and hospitalization duration of the two groups were observed and compared. Alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bilirubin(TBIL), indirect bilirubin(DBIL) and peripheral blood CD3~+,CD4~+, and CD8~+ levels before operation, 1 day and 3 days after operation were compared in the two groups. Result The operation duration of the patients in the minimally invasive group was significantly longer than that in the laparotomy group. The incision length, drainage tube indwelling time, hospitalization duration and intraoperative blood loss were significantly lower than those in the laparotomy group(P<0.01). At 1 day and 3 days after operation, serum ALT, AST levels and peripheral blood CD8~+ levels in the minimally invasive group were significantly lower than those in the laparotomy group, and the peripheral blood CD3~+, CD4~+, CD4~+/CD8~+ levels were higher than those in the laparotomy group, all with statistical significance(P<0.05). Conclusion There are less effects of laparoscopic hepatectomy for liver cancer on immune function and liver function of patients compared with traditional laparotomy surgery.
Objective To investigate the effects of laparoscopic hepatectomy for liver cancer on immune function and liver function of patients. Method 80 patients with liver cancer were divided into minimally invasive group(laparoscopic hepatectomy was performed) and laparotomy group(traditional laparotomy was performed) according to the surgical methods, with 40 cases in each group. The operation duration, intraoperative blood loss, incision length, drainage tube indwelling time, and hospitalization duration of the two groups were observed and compared. Alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bilirubin(TBIL), indirect bilirubin(DBIL) and peripheral blood CD3~+,CD4~+, and CD8~+ levels before operation, 1 day and 3 days after operation were compared in the two groups. Result The operation duration of the patients in the minimally invasive group was significantly longer than that in the laparotomy group. The incision length, drainage tube indwelling time, hospitalization duration and intraoperative blood loss were significantly lower than those in the laparotomy group(P<0.01). At 1 day and 3 days after operation, serum ALT, AST levels and peripheral blood CD8~+ levels in the minimally invasive group were significantly lower than those in the laparotomy group, and the peripheral blood CD3~+, CD4~+, CD4~+/CD8~+ levels were higher than those in the laparotomy group, all with statistical significance(P<0.05). Conclusion There are less effects of laparoscopic hepatectomy for liver cancer on immune function and liver function of patients compared with traditional laparotomy surgery.
引文
[1]王笛乐,屈碧辉,胡敏,等.3D腹腔镜肝切除术治疗原发性肝癌的临床应用价值[J].中国普通外科杂志,2017,26(1):13-17.
[2]He F,Lin X,Xie F,et al.The effect of enhanced recovery program for patients undergoing partial laparoscopic hepatectomy of liver cancer[J].Clin Transl Oncol,2015,17(9):694-701.
[3]崔佳宁,王俊杰.原发性肝癌合并门静脉癌栓的治疗进展[J].癌症进展,2017,15(1):10-14.
[4]Mashchenko I,Trtchounian A,Buchholz C,et al.A sling technique for laparoscopic resection of segment seven of the liver[J].JSLS,2018,22(2):e2018.
[5]欧阳正晟,唐朝晖,吕丽娟,等.腹腔镜肝切除与开腹肝切除治疗原发性肝癌的临床比较[J].中国普通外科杂志,2017,26(1):126-130.
[6]黄静怡,廖锦堂.肝癌分化程度与临床因素的关系探究[J].湖南师范大学学报(医学版),2016,13(2):55-57;58.
[7]周兵,张建淮,刘斌,等.腹腔镜与开放性肝切除术治疗小肝癌的远期疗效[J].中华肝胆外科杂志,2017,23(1):8-11.
[8]Cheung TT.Technical notes on pure laparoscopic isolated caudate lobectomy for patient with liver cancer[J].Transl Gastroenterol Hepatol,2016,1:56.
[9]Kanazawa A,Tsukamoto T,Shimizu S,et al.Laparoscopic hepatectomy for liver cancer[J].Dig Dis,2015,33(5):691-698.
[10]王良义,林尤冠.腹腔镜肝癌切除术效果及其对患者血清VEGF、FGF水平和免疫功能的影响[J].山东医药,2017,57(34):33-35.
[11]赵一鸣,王鲁.腹腔镜肝切除术在结直肠癌肝转移治疗中的应用[J].中国实用外科杂志,2017,37(5):586-587.
[12]李振宇,方哲平,张法标.腹腔镜联合胸腔镜肝切除治疗膈下第Ⅶ、Ⅷ段肝癌[J].中华肝胆外科杂志,2017,23(8):555-556.
[13]徐继威,温苑章,李嘉,等.腹腔镜精准肝切除临床应用价值分析[J].中国微创外科杂志,2016,16(7):590-593.
[14]郑树国.腹腔镜联合肝脏分隔和门静脉结扎的二步肝切除术在肝硬化肝癌治疗中的应用[J].中华消化外科杂志,2016,15(5):438-440.
[15]Xu Z,Yang Z,Pan J,et al.Individualized laparoscopic B-ultrasound-guided microwave ablation for multifocal primary liver cancer[J].Wideochir Inne Tech Maloinwazyjne,2018,13(1):9-16.
[2]He F,Lin X,Xie F,et al.The effect of enhanced recovery program for patients undergoing partial laparoscopic hepatectomy of liver cancer[J].Clin Transl Oncol,2015,17(9):694-701.
[3]崔佳宁,王俊杰.原发性肝癌合并门静脉癌栓的治疗进展[J].癌症进展,2017,15(1):10-14.
[4]Mashchenko I,Trtchounian A,Buchholz C,et al.A sling technique for laparoscopic resection of segment seven of the liver[J].JSLS,2018,22(2):e2018.
[5]欧阳正晟,唐朝晖,吕丽娟,等.腹腔镜肝切除与开腹肝切除治疗原发性肝癌的临床比较[J].中国普通外科杂志,2017,26(1):126-130.
[6]黄静怡,廖锦堂.肝癌分化程度与临床因素的关系探究[J].湖南师范大学学报(医学版),2016,13(2):55-57;58.
[7]周兵,张建淮,刘斌,等.腹腔镜与开放性肝切除术治疗小肝癌的远期疗效[J].中华肝胆外科杂志,2017,23(1):8-11.
[8]Cheung TT.Technical notes on pure laparoscopic isolated caudate lobectomy for patient with liver cancer[J].Transl Gastroenterol Hepatol,2016,1:56.
[9]Kanazawa A,Tsukamoto T,Shimizu S,et al.Laparoscopic hepatectomy for liver cancer[J].Dig Dis,2015,33(5):691-698.
[10]王良义,林尤冠.腹腔镜肝癌切除术效果及其对患者血清VEGF、FGF水平和免疫功能的影响[J].山东医药,2017,57(34):33-35.
[11]赵一鸣,王鲁.腹腔镜肝切除术在结直肠癌肝转移治疗中的应用[J].中国实用外科杂志,2017,37(5):586-587.
[12]李振宇,方哲平,张法标.腹腔镜联合胸腔镜肝切除治疗膈下第Ⅶ、Ⅷ段肝癌[J].中华肝胆外科杂志,2017,23(8):555-556.
[13]徐继威,温苑章,李嘉,等.腹腔镜精准肝切除临床应用价值分析[J].中国微创外科杂志,2016,16(7):590-593.
[14]郑树国.腹腔镜联合肝脏分隔和门静脉结扎的二步肝切除术在肝硬化肝癌治疗中的应用[J].中华消化外科杂志,2016,15(5):438-440.
[15]Xu Z,Yang Z,Pan J,et al.Individualized laparoscopic B-ultrasound-guided microwave ablation for multifocal primary liver cancer[J].Wideochir Inne Tech Maloinwazyjne,2018,13(1):9-16.