腹腔镜与传统开腹手术对肝细胞癌短期治疗效果的临床研究

Clinical study of short-term therapeutic effect of laparoscopic and traditional open surgery on hepatocellular carcinoma

摘要:

目的 探讨腹腔镜与开腹手术治疗肝细胞癌（HCC）的疗效与安全性。方法 以该院2017年5月－2019年7月182例HCC患者为研究对象，依据患者治疗方式分为腹腔镜组90例、开腹组92例；腹腔镜组给予腹腔镜肝切除术，开腹组给予开腹肝切除术；比较两组患者手术指标、肝功能指标、免疫指标、术后并发症及随访情况。结果 腹腔镜组切口长度［（6.24±1.33）和（14.45±2.62）cm］、术中出血量［（108.51±22.62）和（193.85±32.73）mL］、肛门排气时间［（2.23±0.71）和（3.47±0.94）d］、引流时间［（5.24±1.12）和（6.73±1.36）d］、住院时间［（14.84±3.01）和（18.45±3.62）d］与开腹组相比，均有明显减少（P < 0.05），腹腔镜组手术时间（133.62±25.71）min略长于开腹组（130.14±24.82）min，但差异无统计学意义（P > 0.05）。术后3 d，腹腔镜组谷丙转氨酶（GPT）［（302.36±61.52）和（458.35±82.43）u/L］、总胆红素（TBIL）［（35.24±17.62）和（43.76±8.57）μmol/L］、谷草转氨酶（GOT）［（245.26±51.38）和（368.53±62.35）u/L］与开腹组相比，均明显降低（P < 0.05）。术后3 d，腹腔镜组CD3⁺［（61.38±5.93）%和（57.21±5.13）%］、CD4⁺［（42.44±5.31）%和（37.84±5.23）%］、CD4⁺/CD8⁺［（1.58±0.28）和（1.33±0.27）］与开腹组相比，均明显升高（P < 0.05），腹腔镜组CD8⁺（26.72±4.31）%与开腹组（28.06±4.45）%相比，差异无统计学意义（P > 0.05）。腹腔镜组并发症发生率（3.33%）明显低于开腹组（11.96%）（P < 0.05）。随访1年，腹腔镜组5例（5.56%）死亡、5例（5.56%）复发，开腹组4例（4.35%）死亡、6例（6.52%）复发，两组比较，差异均无统计学意义（P > 0.05）。结论 腹腔镜手术治疗HCC能够明显改善手术指标、肝功能及免疫功能，并降低患者并发症发生率，而随访情况与开腹手术并无明显差异。

Abstract:

Objective To investigate the efficacy and safety of laparoscopic and laparotomy in treatment of hepatocellular carcinoma (HCC).Methods 182 HCC patients from May 2017 to July 2019 were selected as the research object, and they were divided into the laparoscopic group with 90 cases and the laparotomy group with 92 cases according to the treatment methods of the patients; The laparoscopic group was given laparoscopic hepatectomy (LH), and the Open group was given open liver resection (OH); The surgical indexes, liver function indexes, postoperative complications and follow-up situation were compared between the two groups. The surgical indicators, liver function indicators, immune index, postoperative complications and follow-up situation were compared between the two groups.Results Compared with the open group, the incision length [(6.24 ± 1.33) cm vs (14.45 ± 2.62) cm], intraoperative blood loss [(108.51 ± 22.62) mL vs (193.85 ± 32.73) mL], anal exhaust time [(2.23 ± 0.71) d vs (3.47 ± 0.94) d], drainage time [(5.24 ± 1.12) d vs (6.73 ± 1.36) d], hospital stay [(14.84 ± 3.01) d vs (18.45 ± 3.62) d] of laparoscopic group was significantly shorter, the operation time of the laparoscopic group is longer than that in open group, but there is no statistical difference [(133.61 ± 25.71) min vs (130.14 ± 24.82) min, P > 0.05]. 3 days after operation, GPT [(302.36 ± 61.52) u/L vs (458.35 ± 82.43) u/L], TBIL [(35.24 ± 17.62) μmol/L vs (43.76 ± 8.57) μmol/L], GOT [(245.26 ± 51.38) u/L vs (368.53 ± 62.35) u/L) of laparoscopic group was significantly lower than open group (P < 0.05). 3 days after surgery, CD3⁺[(61.38 ± 5.93)% vs (57.21 ± 5.13)%], CD4⁺[(42.44 ± 5.31)% vs (37.84 ± 5.23)%], CD4⁺/CD8⁺ [(1.58 ± 0.28) vs (1.33 ± 0.27)] level of laparotomy group was significantly higher than open group (P < 0.05), and CD8⁺ level of laparoscopic group was lower than that of open group, but the difference was not significant [(26.72±4.31)% vs (28.06 ± 4.45)%, P > 0.05]. The incidence of complications in the laparoscopic group was significantly lower than that in the open group (3.33% vs 11.96%, P < 0.05). After 1 year of follow-up, 5 patients (5.56%) died and 5 patients (5.56%) relapsed in the laparoscopic group, and 4 patients (4.35%) died and 6 patients (6.52%) relapsed in the open group. There was no significant difference between the two groups (P > 0.05).Conclusion LH treatment of hepatocellular carcinoma can significantly improve the surgical index, liver function and immune function, and reduce the complication of patients. There is no significant difference between follow-up and open hepatectomy.