手助腹腔镜肝切除技术在困难肝切除中的临床价值研究

Clinical value of hand-assisted laparoscopic hepatectomy in difficult hepatectomy

摘要:

目的??探讨手助腹腔镜肝切除技术在困难肝切除中的临床价值研究。方法??选取2013年5月- 2015年5月在该院行腹腔镜下肝组织切除术的肝癌患者80例为研究对象，随机分为对照组和观察组，对照组给予完全腹腔镜下切除术，观察组在此基础上给予手助。比较两组患者术中出血量和手术时间的差异；比较两组患者手术标本中细胞间黏附分子-1（ICAM-1）的阳性表达率；比较手术前和手术半年后两组患者血管内皮生长因子（VEGF）、可溶性细胞间黏附分子-1（sICAM-1）、碱性磷酸酶（ALP）、γ-谷氨酰转肽酶（GGT）和甲胎蛋白（AFP）水平的差异。结果??观察组在术中出血较对照组明显减少，而在手术时间方面两组差异无统计学意义（P >0.05）；观察组和对照组患者的肝癌组织和癌旁组织中ICAM-1的阳性表达率差异无统计学意义（P >0.05）；术后半年，观察组患者VEGF阳性表达率、sICAM-1、ALP、GGT和AFP水平较对照组明显降低。结论??手助腹腔镜肝切除技术可有效降低患者术中失血量，并可有效降低患者术后sICAM-1、ALP、GGT和AFP水平，提示该技术在降低复发率方面有积极的意义。

Abstract:

Objective?To evaluate the clinical value of hand-assisted laparoscopic liver resection technique in difficult hepatectomy. Methods?80 cases from May 2013 to May 2015 with liver cancer were randomly divided into control group and observation group. The control group was given a completely laparoscopic surgery, while observation group received hand-assisted laparoscopic hepatectomy. The blood loss, the operation time, the positive expression rate of ICAM-1, the difference of VEGF, sICAM-1 and ALP, GGT and AFP level before and after surgery were observed and compared. Results?There were significant differences of blood loss in observation group than that in control group, while there were no significant difference on the operation time between the two groups; there has no statistical differences in hepatocellular carcinoma and positive expression of ICAM-1 adjacent tissues between the two groups; six months after surgery, the positive expression of VEGF, sICAM-1, ALP, GGT and AFP levels in observation group was significantly lower than that in control group. Conclusions?Hand-assisted laparoscopic liver resection technique can effectively reduce blood loss, lower postoperative sICAM-1, ALP, GGT and AFP levels, suggesting a positive significance in reducing the recurrence rate.