多措施联合的腹腔镜肝切除术治疗肝癌合并肝硬化并门静脉高压症的临床应用研究

Clinical application research on multi-measure laparoscopic liver resection in the treatment of liver cancer complicated with cirrhosis and portal hypertension

摘要:

目的 探究腹腔镜肝切除术（LLR）联合多措施治疗伴有肝硬化及门静脉高压症的肝癌患者的临床应用效果。方法 选取2022年10月－2024年7月该院收治的伴有肝硬化及门静脉高压症的肝癌患者60例，随机分为两组。研究组（30例）行多措施联合的LLR，对照组（30例）行常规LLR联合脾切除和门奇静脉断流术。比较两组患者手术相关情况（术中出血量、输血量、手术时间和住院时间）；比较两组患者术前和术后7 d的肝功能［谷草转氨酶（GOT）、总胆红素（TBiL）和谷丙转氨酶（GPT）］和血常规指标［血小板（PLT）、血红蛋白（Hb）和白细胞（WBC）］；统计两组患者术后并发症发生情况。结果 研究组术中出血量和输血量明显少于对照组，手术时间和住院时间明显短于对照组，差异均有统计学意义（P < 0.05）。术后7 d，两组患者GPT、TBiL和GOT水平明显低于术前，且研究组明显低于对照组，差异均有统计学意义（P < 0.05）。术后7 d，两组患者PLT和WBC明显高于术前，但研究组PLT明显高于对照组，差异均有统计学意义（P < 0.05）。两组患者术后并发症总发生率比较，差异无统计学意义（P > 0.05）。结论 肝癌合并肝硬化并门静脉高压症患者实施多措施联合的LLR治疗，具有较高的临床应用价值，可有效地提高患者康复质量。值得临床推广应用。

Abstract:

Objective To explore the clinical application effect of laparoscopic liver resection (LLR) combined with multiple measures in the treatment of liver cancer patients with cirrhosis and portal hypertension.Methods 60 liver cancer patients with cirrhosis and portal hypertension from October 2022 to July 2024 were selected and randomly divided into two groups. The study group (30 cases) underwent multi-measure combined LLR, while the control group (30 cases) underwent conventional LLR combined with splenectomy and porto-azygous disconnection. Compare the surgery-related conditions (intraoperative blood loss, blood transfusion volume, operation time and hospital stay) of the two groups of patients; The liver functions [glutamic-oxaloacetic transaminase (GOT), total bilirubin (TBiL), and glutamic-pyruvic transaminase (GPT)] and blood routine indicators [platelets (PLT), hemoglobin (Hb), and white blood cells (WBC)] of the two groups of patients before the operation and 7 days after the operation were compared; The occurrence of postoperative complications in the two groups of patients was statistically analyzed.Results The intraoperative blood loss and blood transfusion volume in the study group were significantly less than those in the control group, and the operation time and hospital stay were significantly shorter than those in the control group. The differences were statistically significant (P < 0.05). Seven days after the operation, the levels of GPT, TBiL and GOT in both groups were significantly lower than those before the operation, but those in the study group were significantly lower than those in the control group, and the differences were statistically significant (P < 0.05). Seven days after the operation, the PLT and WBC of both groups were significantly higher than those before the operation, and the PLT of the study group was significantly higher than that of the control group. The differences were statistically significant (P < 0.05). There was no statistically significant difference in the total incidence of postoperative complications between the two groups of patients (P > 0.05).Conclusion The implementation of multi-measure combined LLR treatment for patients with liver cancer complicated with cirrhosis and portal hypertension has high clinical value and can effectively improve the rehabilitation quality of patients. It is worthy of clinical promotion and application.