腹腔镜肝切除术对原发性肝癌患者肝功能、血清CD73和血清性别决定区Y框蛋白9的影响

Effects of laparoscopic hepatectomy on liver function, serum CD73, and serum SOX9 in patients with primary liver cancer

摘要:

目的 探讨腹腔镜肝切除术（LH）对原发性肝癌患者肝功能、血清CD73和血清性别决定区Y框蛋白9（SOX9）表达水平的影响。方法 选取该院收治的原发性肝癌患者90例，随机分为LH组（45例）和经皮微波消融术（PMA）组（45例）。LH组给予LH治疗，PWA组给予PWA治疗。比较两组患者肝功能［天冬氨酸转氨酶（AST）、甲胎蛋白（AFP）、丙氨酸转氨酶（ALT）和总胆红素（TBiL）］、手术相关指标、血清CD73和SOX9水平、应激指标［C反应蛋白（CRP）、白细胞介素-6（IL-6）、去甲肾上腺素（NE）和肾上腺素（E）］，以及生存情况。结果 PMA组住院时间、手术时间和肛门排气时间明显短于LH组，术中出血量少于LH组，差异均有统计学意义（P < 0.05）；与术前比较，两组患者术后1 h血清TBiL、AFP、AST、ALT、CRP、IL-6、NE和E水平明显升高，差异均有统计学意义（P < 0.05）；两组患者术后1 h血清CD73水平明显降低，血清SOX9 mRNA水平明显升高，且LH组SOX9 mRNA水平高于PMA组，差异均有统计学意义（P < 0.05）；术后随访，LH组生存者37例，占比82.22%（37/45）；MWA组生存者28例，占比62.22%（28/45），LH组生存率明显高于PMA组，差异有统计学意义（χ² = 5.70，P < 0.05）；两组患者术后并发症发生率比较，差异无统计学意义（P > 0.05）。结论 PMA与LH治疗原发性肝癌效果相近，PMA更加微创，利于术后恢复，LH可更加有效地提高患者生存率，且行LH的患者，术后血清SOX9 mRNA水平更高。

Abstract:

Objective To investigate the influence of laparoscopic hepatectomy (LH) on liver function and the expression levels of CD73 and sex determining region Y-box protein 9 (SOX9) in patients with primary liver cancer.Methods 90 patients with primary liver cancer were randomly divided into two groups, which were respectively named LH group (45 cases) and percutaneous micro-wave ablation (PMA) group (45 cases) according to their final treatment methods. The LH group was given LH treatment, and the PMA group was given PMA treatment. The liver function [aspartate aminotransferase (AST), alpha-fetoprotein (AFP), alanine aminotransferase (ALT), total bilirubin (TBiL)], surgery-related indicators, serum CD73 and SOX9 levels, stress indicators [C-reactive protein (CRP), interleukin-6 (IL-6), norepinephrine (NE) , epinephrine (E)] and survival situation were compared.Results The length of hospital stay, intraoperative blood loss, operative time and anal exhaust time in PMA group were less than those in LH group, and the differences were statistically significant (P < 0.05); compared with the preoperative level, the serum levels of TBiL, AFP, AST, ALT, CRP, IL-6, NE, and E in both groups were obviously increased 1 h after operation, with statistical significance (P < 0.05); 1 h after operation, the serum CD73 in the two groups was obviously decreased, SOX9 mRNA in the two groups was obviousby increased, and the SOX9 mRNA in LH group was higher than that in the PMA group, with statistical significance (P < 0.05); the patients were followed up, and there were 37 survivors in the LH group, accounting for 82.22% (37/45); there were 28 survivors in the PMA group, accounting for 62.22% (28/45), and the survival rate in the LH group was obviously higher than that in the PMA group, with statistical significance (χ² = 5.70, P < 0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P > 0.05).Conclusion PMA and LH have similar effects in the treatment of primary liver cancer, PMA is more minimally invasive and conducive to postoperative recovery, and LH can more effectively improve the survival rate of patients, and the level of SOX9 mRNA in peripheral blood after LH surgery is higher.