开腹肝癌切除术与腹腔镜肝癌切除术对肝细胞癌患者临床预后及血清VEGF、FGF水平和免疫功能的影响  

Effects of laparotomy and laparoscopic surgery on clinical prognosis, serum levels of VEGF, FGF and immune function in patients with hepatocellular carcinoma

作　　者：许建[1] 张浩[1] 俞小炯[1] XU Jian;ZHANG Hao;YU Xiao-jiong(Department of Hepatobiliary Surgery,Sichuan Academy of Medical Sciences&Sichuan Provincial People's Hospital,Chengdu 610072,China)

机构地区：[1]四川省医学科学院.四川省人民医院肝胆外科,成都610072

出　　处：《中国医学前沿杂志（电子版）》2018年第2期113-116,共4页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的探讨并比较开腹肝癌切除术与腹腔镜肝癌切除术对肝细胞癌患者的预后、血清生物学指标及免疫功能的影响,为临床治疗方式的选择提供参考。方法选取2012年1月至2016年12月本院收治的90例肝细胞癌患者为研究对象,根据手术方式的不同将入选患者分为开腹组和腹腔镜组,每组各45例。比较两组患者手术情况和预后、手术前后血清生物学指标[血清血管内皮生长因子(vascular endothelial growth factor,VEGF)、酸性成纤维细胞生长因子(acid fibroblast growth factor,a FGF)、碱性成纤维细胞生长因子(basic fibroblast growth factor,b FGF)]及免疫功能(CD3^+、CD4^+、CD8^+T细胞水平)。结果腹腔镜组患者术中出血量显著少于开腹组(P<0.05),手术切口长度显著短于开腹组(P<0.05),禁食时间、绝对卧床时间及住院天数均显著短于开腹组(P<0.05),两组患者手术时间、术后切口感染率、预后(局部复发率、1年生存率)比较均无显著差异(P>0.05)。术后第3天,腹腔镜组患者血清VEGF、a FGF、b FGF水平及外周血CD8+T细胞水平均显著低于开腹组(P<0.05),外周血CD3^+、CD4^+T细胞水平均显著高于开腹组(P<0.05)。结论与开腹肝癌切除术相比,腹腔镜肝癌切除术可明显减少术中出血量,缩短患者禁食时间、绝对卧床时间及住院天数,对局部复发率和1年生存率无影响,同时对患者免疫功能的影响相对较小。Objective To explore and compare the effects and differences between laparotomy and laparoscopic surgery on prognosis,serum biological indicators and immune function in patients with hepatocellular carcinoma,so as to provide guidance for the choice of clinical treatment.Method 90 patients with hepatocellular carcinoma who were treated in our hospital from January 2012 to December 2016 were enrolled in this study.According to the different surgical methods,the patients were divided into laparotomy group and laparoscopic group,45 cases in each group.The relevant indexes of operation,prognosis,serum biomarkers[vascular endothelial growth factor(VEGF),acid fibroblast growth factor(aFGF),basic fibroblast growth factor(bFGF)]and CD3+,CD4+,CD8+before and after surgery were compared between the two groups.Result The amount of bleeding of laparoscopic group was significantly less than that of laparotomy group(P<0.05),and the length of the incision was significantly shorter than that in laparotomy group(P<0.05),the time of fasting,the absolute bed time and the hospital day were significantly shorter than those in laparotomy group(P<0.05).There were no significant differences in operation time,postoperative infection rates,prognosis effect(local recurrence rate,1-year survival rate)between the two groups(P>0.05).At the third day after operation,the serum levels of VEGF,aFGF,bFGF and peripheral blood CD8+T cells in laparoscopic group were significantly lower than laparotomy group(P<0.05),the levels of CD3+and CD4+T cells in peripheral blood were significantly higher than laparotomy group(P<0.05).Conclusion Compared with laparotomy,laparoscopic surgery can significantly reduce intraoperative bleeding,shorten the patients'fasting time,absolute bed time and hospital day,and does not affect the local recurrence rate and 1-year survival rate,and the effect on the immune function is relatively weak.

关 键 词：开腹肝癌切除术 腹腔镜肝癌切除术 VEDF FGF 免疫功能 

分 类 号：R735.7[医药卫生—肿瘤]