腹腔镜下肝切除与开腹肝切除术对原发性大肝癌患者远期疗效、胃肠功能及氧化应激反应的影响

Comparison of the effects of laparoscopic liver resection and open liver resection on long-term efficacy, gastrointestinal function and oxidative stress in patients with primary large liver cancer

摘要:

目的 对比腹腔镜下肝切除与开腹肝切除术对原发性大肝癌患者远期疗效、胃肠功能及氧化应激反应的影响。方法 回顾性分析2013年2月－2016年7月97例在该院接受手术治疗并随访至2019年10月的原发性大肝癌患者的病例资料。根据治疗方式分为对照组（n = 50）和观察组（n = 47），对照组行开腹肝切除术，观察组行腹腔镜下肝切除术。对比两组患者手术一般情况、远期疗效、胃肠功能、氧化应激反应及并发症发生情况。结果 两组患者手术时间与术中出血量比较，差异均无统计学意义（P > 0.05），观察组患者术后引流时间及术后住院时间均明显较对照组短（P < 0.05）。无复发生存期分析结果显示：对照组中位无复发生存时间为17个月（95%CI：14.532～19.468），观察组中位无复发生存时间为23个月（95%CI：20.845～25.155），两组比较，差异无统计学意义（P > 0.05）。总生存期分析结果显示：对照组中位总生存时间为31个月（95%CI：27.931～36.092），观察组总生存时间为34个月（95%CI：29.743～37.068），两组比较，差异无统计学意义（P > 0.05）。两组患者术后胃泌素（GAS）及胃动素（MTL）水平均明显下降，但对照组下降幅度更大，两组患者术后胆囊收缩素（CCK）水平明显升高，对照组较观察组升高更明显（P < 0.05）。两组患者术后超氧化物歧化酶（SOD）水平明显下降，对照组下降幅度较观察组更大，两组患者术后丙二醛（MDA）与晚期氧化蛋白产物（AOPP）水平明显升高，对照组较观察组升高更明显（P < 0.05）。两组患者术后均未出现胆漏、出血和肝功能衰竭等严重并发症，对照组出现7例（14.00%）Clavien-Dindo分级在Ⅰ至Ⅱ级的轻度并发症，观察组出现6例（12.77%），两组比较，差异无统计学意义（P > 0.05）。结论 采用腹腔镜下肝切除与开腹肝切除术治疗原发性大肝癌，两者远期疗效及并发症发生情况比较，差异均无统计学意义，但腹腔镜手术对患者胃肠功能和氧化应激反应的影响较开腹手术小。

Abstract:

Objective To compare the effects of laparoscopic liver resection and open liver resection on the long-term efficacy, gastrointestinal function, and oxidative stress response of patients with primary large liver cancer.Methods A retrospective analysis was performed on 97 cases of primary large liver cancer who underwent surgical treatment from February 2013 to July 2016 and were followed up to October 2019. The patients were divided into 2 groups according to the different treatment methods. The control group (50 cases) underwent open liver resection and the observation group (47 cases) underwent laparoscopic liver resection.Results There was no significant difference in surgical time and intraoperative blood loss between the two groups (P > 0.05). The postoperative drainage time and postoperative hospital stay of the observation group were significantly shorter than those in the control group (P < 0.05). The results of relapse free survival analysis showed that: the median relapse free survival time of the control group was 17 months, 95%CI: 14.532 ~ 19.468, the median relapse free survival time of the observation group was 23 months, 95%CI: 20.845 ~ 25.155, there was no significant difference between the two groups (P > 0.05). The results of total survival analysis showed that: the median survival time of the control group was 31 months, 95%CI: 27.931 ~ 36.092, the median survival time of the observation group was 34 months, 95%CI: 29.743~37.068, there was no significant difference between the two groups (P > 0.05). After operation, the levels of GAS and MTL in the two groups were significantly decreased, but the the control group was more significant, the levels of cholecystokinin (CCK) increased significantly in the two groups after surgery, but the control group was more significant (P < 0.05). After operation, the SOD level of the two groups decreased significantly, but the control group decreased more than that in observation group, the MDA and AOPP levels of the two groups increased significantly, but the observation group was more significant (P < 0.05). There were no serious complications such as bile leakage, bleeding and liver failure in two groups. There were 7 cases (14.00%) in the control group and 6 cases (12.77%) in the observation group with mild complications of Clavien-Dindo grade Ⅰ ~ Ⅱ, which had no significant difference (P > 0.05).Conclusion Laparoscopic hepatectomy and open hepatectomy have the same long-term effect and complications in patients with primary large liver cancer, but the effect of laparoscopy on gastrointestinal function and oxidative stress response is less.