LLLR与OLLR治疗左外叶肝细胞癌临床效果及远期生存率比较

摘要

目的 比较腹腔镜左肝外切除术(LLLR)与开腹左肝外切除术(OLLR)治疗左外叶肝细胞癌(HCC)患者的临床效果及生存期.方法 我院2011年4月~2013年6月收治的左外叶HCC患者94例,采用随机数字表法将其分为对照组47例和观察组47例,分别接受OLLR和LLLR治疗.比较两组患者手术指标及并发症发生情况.采用ELISA法检测血清细胞间黏附分子(ICAM)-1、基质金属蛋白酶(MMP)-13和IL-6,常规检测血清炎症因子和免疫球蛋白水平变化.术后随访3年,比较两组患者术后1a、2a和3a生存率.结果 观察组术中出血量为(134.94±23.51)ml,显著低于对照组[(290.18±30.76)ml,P<0.01],首次进食时间为(2.29±0.51)d,显著短于对照组[(3.80±0.87)d,P<0.01],住院时间为(7.43±2.39)d,显著短于对照组[(11.42±3.08)d,P<0.01];手术后,观察组血清ICAM-1为(8.08±2.13)ng/ml,显著低于对照组[(13.27±2.60)ng/ml,P<0.01],MMP-13为(113.65±21.92)ng/ml,显著低于对照组[(171.02±27.85)ng/ml,P<0.01],降钙素原(PCT)为(7.23±0.74)μg/L,显著低于对照组[(11.24±1.53)μg/L,P<0.01],IL-6为(11.49±2.78)pg/L,显著低于对照组[(19.06±3.27)pg/L,P<0.01],IgA为(2.63±0.46)g/L,显著高于对照组[(1.49±0.41)g/L,P<0.01],IgM为(1.92±0.33)g/L,显著高于对照组[(1.40±0.27)g/L,P<0.01],IgG为(9.72±1.53)g/L,显著高于对照组[(6.40±0.85)g/L,P<0.01];观察组并发症发生率(12.8%)明显低于对照组(42.5%,P<0.05);两组患者术后1 a、2 a和3 a生存率比较,均无明显差异(P>0.05).结论 LLLR能明显降低左外叶HCC患者的手术创伤,减少术后并发症,而对患者生存率无明显影响.%Objective To compare laparoscopic left hepatic resection (LLLR) and laparoscopic left hepatic resection (OLLR) in treatment of patients with left lateral lobe hepatocellular carcinoma (HCC). Methods 94 patients with left lateral HCC in our hospital between April 2011 and June 2013 were recruited in this study, and they were randomly divided into control and observation group,with 47 cases in each group. The patients in control group received OLLR,and those in observation group were treated with LLLR. Serum ICAM-1,MMP-13 and IL-6 levels were detected by ELISA. All patients were followed-up for 3 years,and the survival rates at 1 year,2 years and 3 years after operation were recorded. Results The amount of bleeding in the observation group was (134.94±23.51) ml,significantly lower than in the control group [(290.18±30.76) ml,P<0.01],eating after operation was (2.29±0.51) d,significantly shorter than in the control group [(3.80±0.87) d,P<0.01], hospitalization stay was (7.43±2.39) d,significantly shorter than in the control group [(11.42±3.08) d,P<0.01];serum ICAM-1 levels after operation in observation group was (8.08±2.13) ng/ml,significantly lower than in the control group [(3.27±2.60) ng/ml,P<0.01],MMP-13 was (113.65±21.92) ng/ml,significantly lower than in the control group [(171.02±27.85) ng/ml,P<0.01],PCT was (7.23±0.74) g/L,significantly lower than in the control group [(11.24±1.53) g/L,P<0.01],IL-6 was (11.49±2.78) pg/L, significantly lower than in the control group [(19.06±3.27) pg/L,P<0.01];serum IgA,IgM and IgG levels were significantly higher than in the control group (P<0.01);the incidence of complica-tions in the observation group (12.8%) was signifi-cantly lower than in the control group (42.5%,P<0.05);there was no significant difference as respect to the survival rates between the two groups in three year follow-up. Conclusion LLLR is an alternative approaches in the treatment of patients with left lateral lobe HCC,as it could significantly reduce the postoperative complications,inflammatory reactions and protect the immune functions with the similar long-term efficacy.