腹腔镜肝切除术对左外叶肝细胞癌患者免疫功能的影响及其远期疗效

目的:比较腹腔镜左肝外切除术(LLLR)和开腹左肝外切除术(OLLR)治疗左外叶肝细胞癌(HCC)的临床效果及生存期。方法:选取我院2013年6月-2014年8月收治的左外叶HCC患者82例,随机分为对照组和观察组,每组41例。对照组患者行OLLR治疗,观察组患者行LLLR。观察并比较两组患者的手术时间、术中出血量、首次进食时间、住院时间、并发症发生率、术后一年和两年生存率,以及治疗前后血清ICAM-1,MMP-13,PCT,IL-6,IgA,IgM及IgG水平的变化情况。结果:观察组患者术中出血量、首次进食时间及住院时间均短于对照组(P0.01);手术后,观察组患者血清ICAM-1,MMP-13,PCT及IL-6水平均低于对照组,而血清IgA,IgM及IgG水平均高于对照组(P0.01);观察组并发症发生率(17.08%)低于对照组(41.47%)(x~2=5.89,P=0.01);两组患者术后1年和2年的生存率比较,差异无统计学意义(P0.05)。结论:LLLR治疗HCC具有创伤小、并发症低及预后快等优点,能有效抑制术后炎症反应,对患者免疫功能影响低,可显著降低肿瘤侵袭力,远期生存率较高,值得在临床推广。

Effects of Laparoscopic Hepatectomy on Immune Function of Patients with Left External Lobe Hepatocellular Carcinoma and Its Long-term Efficacy

ABSTRACT Objective: To compare the clinical efficacy and survival rate of laparoscopic left hepatic resection (LLLR) and laparoscopic left hepatic resection (OLLR) on the treatment of left lateral lobe hepatocellular carcinoma (HCC). Methods: 84 patients with left lateral lobe HCC who were treated in our hospital from June 2013 to August 2014 were selected and randomly divided into the control group and the observation group, with 41 cases in each group. The patients in the control group were treated with OLLR, while the patients in the observation group were treated with LLLR. Then the blood loss, the first time for diet, the hospitalization, the incidence of complications and the survival rate of operation for one and two yeas, and the serum levels of ICAM-1, MMP-13, PCT, IL-6, IgA, IgM and IgG between the two groups were observed and compared. Results: The blood loss, the first time for diet and the hospitalization in the observation group were significantly lower than those of the control group (P<0.01); After operation, the serum levels of ICAM-1, PCT, MMP-13 and IL-6 in the observation group were significantly lower than those of the control group, while the serum levels of IgA, IgM and IgG were significantly higher (P<0.01); The incidence of complications in the observation group was 17.08%, which was significantly lower than 41.47% of the control group (x²=5.89, P=0.01); There was no statistically significant difference about the survival rate of operation for one year and two years between the two groups (P>0.05). Conclusion: LLLR has obvious clinical efficacy on the treatment of HCC with small trauma, low complication and better prognosis, which can effectively inhibit the inflammatory reactions of patients, reduce the tumor invasive, and improve the survival rate, and it is worthy of clinical application