腹腔镜下肝切除术治疗左外叶肝细胞癌患者的临床效果及远期生存期观察  

The effectiveness of laparoscopic hepatectomy on left lateral hepatocellular carcinoma and the influence on long-term survival of patients

作　　者：符誉[1] 翁杰[1] 韩霖[1] 陈有科 黄小龙[1] 尹秋实[1] Fu Yu;Weng Jie;Han Lin;Chen Youke;Huang Xiaolong;Yin Qiushi(Department of Hepatobiliary Surgery, The First Affiliated Hospital of Hainan Medical College, Haikou 570102, China)

机构地区：[1]海南医学院第一附属医院肝胆外科,海口570102

出　　处：《广西医科大学学报》2018年第12期1645-1649,共5页Journal of Guangxi Medical University

基　　金：海南省自然科学基金项目(No.817331)

摘　　要：目的:观察腹腔镜左肝外叶切除术(LLLR)和开腹左肝外叶切除术(OLLR)治疗左外叶肝细胞癌(HCC)患者的临床效果及远期生存期。方法:选取96例左外叶HCC患者为研究对象,采用随机数字法将其分为对照组和观察组,每组48例。对照组接受OLLR治疗,观察组接受LLLR治疗。比较两组患者的手术效果指标及各并发症发生率,同时比较手术前后的血清ICAM-1、MMP-13水平,以及血清炎症因子和免疫效应因子水平变化。术后随访3年,比较两组患者术后1年、2年及3年的生存率。结果:两组患者手术时间比较差异无统计学意义(t=1.23,P=0.26);观察组患者的术中出血量少于对照组,首次进食时间及住院时间短于对照组(P<0.01)。观察组患者术后血清ICAM-1、MMP-13、PCT、IL-6水平均明显低于对照组,IgA、IgM、IgG水平明显高于对照组(P<0.01)。观察组患者术后并发症总发生率(12.50%)明显低于对照组(35.42%),两组比较差异有统计学意义(χ2=6.92,P=0.01)。观察组和对照组患者术后1年、2年及3年生存率分别为85.41%vs 87.50%、64.58%vs 62.50%、47.92%vs 50.00%,两组生存率比较差异无统计学意义(P>0.05)。结论:LLLR与OLLR均能有效治疗左外叶HCC,但LLLR的创伤性更小,有利于患者术后康复,值得在临床推广应用。Objective:To investigate the clinical effect and survival difference of laparoscopic left hepatic lobectomy(LLLR)and open left hepatic lobectomy(OLLR)in the treatment of left outside hepatocellular carcinoma(HCC).Methods:A total of96HCC patients with left-lateral lobe were divided into a control group and an observation group randomly,with48cases in each group.Patients in the control group received OLLR,and patients in the observation group received LLLR.The intraoperative blood-loss volume,operation time and the incidence of complication were compared.The levels of intercellular adhesion molecule(ICAM)-1,matrix metalloproteinase(MMP)-13,procalcitonin(PCT)and interleukin(IL)-16in serum were measured.All patients were followed up for3years,and the survival rate was recorded.Results:There was no significant difference in the operation time between the two groups(P>0.05).The serum levels of ICAM-1,MMP-13,PCT and IL-16as well as the intraoperative blood-loss volume and the incidence of postoperative complications in the observation group were lower than those in the control group,while the levels of IgA,IgM and IgG were significantly higher,and the time of the first meal and hospital days were shorter(P<0.05).The1-,2-and3-year survival rates of observation group and control group were85.41%vs.87.50%,64.58%vs.62.50%,and47.92%vs.50.00%,respectively.No significant difference in the survival rate between the two groups(P>0.05).Conclusion:Both LLLR and OLLR were effective for the treatment of left outer lobe HCC,and LLLR had the advantages of less surgical trauma and quicker recovery.

关 键 词：肝细胞癌 腹腔镜 左肝外切除术 生存周期 并发症 

分 类 号：R735.7[医药卫生—肿瘤]