腹腔镜肝癌切除术对原发性肝癌患者血清生物学指标及术后康复的影响
|
摘要
目的探讨腹腔镜肝癌切除术对原发性肝癌患者血清生物学指标及术后康复的影响。方法收集2016年1月至2018年7月在四川省巴中市中医院进行手术治疗的110例原发性肝癌患者为研究对象,按随机数字表法分为观察组和对照组,每组各55例。对照组采用传统开腹手术治疗,观察组采用腹腔镜下肝癌切除术治疗。对两组患者手术情况、术后康复情况、并发症发生率,以及两组患者手术治疗前后的免疫功能指标、血清生物学指标等进行综合对比。结果观察组患者的术中失血量、手术切口长度、手术时间、术后肛门排气时间、下床活动时间、住院时间均少于对照组患者,差异有统计学意义(P<0.05)。观察组患者术后CD3+、CD4+、CD4+/CD8+均高于对照组,而CD8+则低于对照组患者,差异有统计学意义(P<0.05)。观察组患者术后血清生物学指标血管内皮生长因子、酸性成纤维细胞生长因子、碱性成纤维细胞生长因子水平均低于对照组患者,差异有统计学意义(P<0.05)。观察组患者术后并发症发生率为9.09%,对照组患者并发症发生率为23.64%,差异有统计学意义(P<0.05)。结论原发性肝癌患者实施腹腔镜下肝癌切除术能够缩短患者术后康复时间,提高手术治疗的安全性,且能进一步降低患者血管内皮生长因子、酸性成纤维细胞生长因子、碱性成纤维细胞生长因子水平。
Objective To study the effect of laparoscopic hepatectomy on serum malignant biological indexes and postoperative rehabilitation in patients with primary liver cancer.Methods A total of 110 patients with primary liver cancer who underwent surgical treatment in Traditional Chinese Medicine Hospital of Bazhong City from January 2016 to July 2018 were collected and divided into observation group and control group according to random number table method,55 cases in each group.Patients in the control group were treated by traditional laparotomy,while patients in the observation group were treated by laparoscopic hepatectomy.The operation status,postoperative rehabilitation status,incidence of complications,immune function index and serum malignant biological index of the two groups were compared comprehensively.Results The amount of blood loss,length of incision,operation time,postoperative anal exhaust time,ambulation time and hospitalization time in the observation group were lower than those in the control group(P<0.05).The positive rate of CD3+,CD4+cells and the ratio of CD4+/CD8+in the observation group were higher than those in the control group,but the positive rate of CD8+cells was lower than that in the control group,and the differences were statistically significant(P<0.05).The serum levels of vascular endothelial growth factor,acidic fibroblast growth factor and basic fibroblast growth factor in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The incidence of postoperative complications were 9.09%in the observation group and 23.64%in the control group,the difference was statistically significant(P<0.05).Conclusion Laparoscopic hepatectomy for primary liver cancer could shorten the postoperative recovery time,improved the safety of surgical treatment,improved the immune function of patients and further reduced the level of serum malignant biological indicators.
Objective To study the effect of laparoscopic hepatectomy on serum malignant biological indexes and postoperative rehabilitation in patients with primary liver cancer.Methods A total of 110 patients with primary liver cancer who underwent surgical treatment in Traditional Chinese Medicine Hospital of Bazhong City from January 2016 to July 2018 were collected and divided into observation group and control group according to random number table method,55 cases in each group.Patients in the control group were treated by traditional laparotomy,while patients in the observation group were treated by laparoscopic hepatectomy.The operation status,postoperative rehabilitation status,incidence of complications,immune function index and serum malignant biological index of the two groups were compared comprehensively.Results The amount of blood loss,length of incision,operation time,postoperative anal exhaust time,ambulation time and hospitalization time in the observation group were lower than those in the control group(P<0.05).The positive rate of CD3+,CD4+cells and the ratio of CD4+/CD8+in the observation group were higher than those in the control group,but the positive rate of CD8+cells was lower than that in the control group,and the differences were statistically significant(P<0.05).The serum levels of vascular endothelial growth factor,acidic fibroblast growth factor and basic fibroblast growth factor in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).The incidence of postoperative complications were 9.09%in the observation group and 23.64%in the control group,the difference was statistically significant(P<0.05).Conclusion Laparoscopic hepatectomy for primary liver cancer could shorten the postoperative recovery time,improved the safety of surgical treatment,improved the immune function of patients and further reduced the level of serum malignant biological indicators.
引文
[1]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,2017,29(34):33-35.
[2]JAE H H,YOUNG K Y,HO J C,et al.Clinical advantages of single port laparoscopic hepatectomy[J].World JGastroenterol,2018,24(3):379-386.
[3]邓维,李强,张睿杰,等.开腹肝癌切除术与腹腔镜肝癌切除术治疗肝细胞癌患者临床疗效的比较[J].中国老年学杂志,2016,36(17):4226-4228.
[4]张前进,胡伯年,裴俊烽,等.腹腔镜下射频消融术在肝癌患者中的临床应用价值及其对血清血管内皮生长因子和基质金属蛋白酶-2的影响[J].中国内镜杂志,2016,22(9):10-14.
[5]YANG R,TAO W,CHEN Y Y,et al.Enhanced recovery after surgery programs versus traditional perioperative care in laparoscopic hepatectomy:a Meta-analysis[J].Int J Surg,2016,36(Pt A):274-282.
[6]中华人民共和国卫生和计划生育委员会医政医管局.原发性肝癌诊疗规范(2017年版)[J].中华消化外科杂志,2017,16(7):635-647.
[7]CHEUNG T T,DAI W C,TSANG S H,et al.Pure laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma in 110patients with liver cirrhosis:a propensity analysis at a single center[J].Ann Surg,2016,264(4):612-620.
[8]费国雄,崔龙久,曹梅利,等.血小板及血小板源性5-羟色胺对早期肝癌切除术患者预后的影响:前瞻性队列研究[J].第二军医大学学报,2016,37(6):683-689.
[9]徐治军,许戈良,马金良,等.超声引导下经皮射频消融与腹腔镜肝切除术治疗原发性小肝癌的对比研究[J].中国普通外科杂志,2017,26(1):18-24.
[10]BROWN K M,GELLER D A.What is the Learning Curve for Laparoscopic Major Hepatectomy?[J].J Gastrointest Surg,2016,20(5):1065-1071.
[11]WU D Q,WU L,LI Y,et al.Laparoscopic hepatectomy for colorectal liver metastases located in all segments of the liver[J].J Buon,2017,22(2):437-444.
[12]庄旭升,张欣.益气抗癌方联合含奥沙利铂方案TACE术对原发性肝癌血清肿瘤相关巨噬细胞及相关细胞因子水平的影响[J].中华中医药学刊,2018,34(5):344-347.
[13]CHAN F K,CHENG K C,YEUNG Y P,et al.Learning curve for laparoscopic major hepatectomy:use of the cumulative sum method[J].Surg Laparosc Endosc Percutan Tech,2016,26(3):41-48.
[2]JAE H H,YOUNG K Y,HO J C,et al.Clinical advantages of single port laparoscopic hepatectomy[J].World JGastroenterol,2018,24(3):379-386.
[3]邓维,李强,张睿杰,等.开腹肝癌切除术与腹腔镜肝癌切除术治疗肝细胞癌患者临床疗效的比较[J].中国老年学杂志,2016,36(17):4226-4228.
[4]张前进,胡伯年,裴俊烽,等.腹腔镜下射频消融术在肝癌患者中的临床应用价值及其对血清血管内皮生长因子和基质金属蛋白酶-2的影响[J].中国内镜杂志,2016,22(9):10-14.
[5]YANG R,TAO W,CHEN Y Y,et al.Enhanced recovery after surgery programs versus traditional perioperative care in laparoscopic hepatectomy:a Meta-analysis[J].Int J Surg,2016,36(Pt A):274-282.
[6]中华人民共和国卫生和计划生育委员会医政医管局.原发性肝癌诊疗规范(2017年版)[J].中华消化外科杂志,2017,16(7):635-647.
[7]CHEUNG T T,DAI W C,TSANG S H,et al.Pure laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma in 110patients with liver cirrhosis:a propensity analysis at a single center[J].Ann Surg,2016,264(4):612-620.
[8]费国雄,崔龙久,曹梅利,等.血小板及血小板源性5-羟色胺对早期肝癌切除术患者预后的影响:前瞻性队列研究[J].第二军医大学学报,2016,37(6):683-689.
[9]徐治军,许戈良,马金良,等.超声引导下经皮射频消融与腹腔镜肝切除术治疗原发性小肝癌的对比研究[J].中国普通外科杂志,2017,26(1):18-24.
[10]BROWN K M,GELLER D A.What is the Learning Curve for Laparoscopic Major Hepatectomy?[J].J Gastrointest Surg,2016,20(5):1065-1071.
[11]WU D Q,WU L,LI Y,et al.Laparoscopic hepatectomy for colorectal liver metastases located in all segments of the liver[J].J Buon,2017,22(2):437-444.
[12]庄旭升,张欣.益气抗癌方联合含奥沙利铂方案TACE术对原发性肝癌血清肿瘤相关巨噬细胞及相关细胞因子水平的影响[J].中华中医药学刊,2018,34(5):344-347.
[13]CHAN F K,CHENG K C,YEUNG Y P,et al.Learning curve for laparoscopic major hepatectomy:use of the cumulative sum method[J].Surg Laparosc Endosc Percutan Tech,2016,26(3):41-48.