摘要
目的探究腹腔镜肝部分切除术治疗肝癌的近远期疗效及对血清肿瘤标志物影响。方法回顾性分析2014年2月~2017年2月72例原发性肝癌患者临床资料,根据手术方式不同分为腹腔镜组39例(腹腔镜肝部分切除术)与开腹组33例(开腹肝部分切除术),比较两组围术期情况、围术期肝功能指标[血清总胆红素(TBIL)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)]、手术前后血清肿瘤标志物[甲胎蛋白(AFP)同型半胱氨酸(Hey)、甲胎蛋白异质体3(AFP-L3)]、术后并发症发生率,随访3年,记录患者复发情况及3年总生存率。结果腹腔镜组切口长度、术中出血量、术后禁食时间、绝对卧床时间及住院时间均显著小于或短于开腹组(P<0.05);术后第ld第5d,两组血清TBIL、AST、ALT水平呈先升高后下降趋势,且腹腔镜组术后第5d血清TBIL、AST、ALT水平均显著低于开腹组(P<0.05);术后第7d、1个月,两组血清AFP、Hey、AFP-L3水平均呈明显低于术前(P<0.05),但腹腔镜组与开腹组同时间点血清AFP、Hey、AFP-I3水平比较差异均无统计学意义(P>0.05);腹腔镜组并发症总发生率5.13%,低于开腹组的27.27%(P<0.05);随访3年内,腹腔镜组复发率35.90%.3年总生存率为74.36%,与开腹组的33.33%.69.70%比较差异均无统计学意义(P>0.05)。结论腹腔镜肝部分切除术与开腹肝部分切除术治疗肝癌远期疗效相当,但前者可减小手术创伤、降低术后并发症发生率,利于患者早期恢复。
Objective To explore the shor-term efficacy and long-term efficacy of laparoscopic partial hepatectomy on hepato-cellular carcinoma and its influence on serum tumor markers.Methods The clinical data of 72 patients with primary hepatocellular carcinoma from February 2014 to February 2017 were retrospectively analyzed.They were divided into laparoscopie group(39 cases,laparoscopic partial hepatectomy)and open group(33 cases,open partial hepatectomy)according to the different surgical methods.The perioperative conditions,perioperative liver function indicators[serum total bilirubin(TBIL),aspartate aminotransferase(AST),alanine aminotransferase(ALT)],serum tumor markers before and after surgery[alpha-fetoprotein(AFP),homocysteine(Hey),al-pha-fetoprotein variant 3(AFP-L3)]and incidence rates of postoperative complications were compared between the two groups.At 3 years of follow-up,the recurrence and 3-year overall survival rate were recorded.Results The incision length,intraoperative blood loss,postoperative fasting time,absolute bedridden time and hospital stay in laparoscopic group were significantly smaller or shorter than those in open group(P<0.05).On the 1st d and 5thd after surgery,the levels of serum TBIL,AST and ALT were increased first and then decreased,and the levels of serum TBIL,AST and ALT on the 5th d after surgery in laparoscopic group were significantly lower than those in open group(P<0.05).On the 7th d and 1 month after surgery,the levels of serum AFP,Hey and AFP-L3 in the two groups were significantly lower than those before surgery(P<0.05),but there were no statistically significant differences in the levels of serum AFP,Hcy and AFP-I3 between laparoscopic group and open group at the same time point(P>0.05).The total inei-dence rate of complications in laparoscopic group was lower than that in open group(5.13%vs27.27%)(P<0.05).Within 3 years of follow-up,there were no statistically significant differences in the recurrence rate and 3-year overall survival rate between laparoscop-ic group and open group(35.90%vs 33.33%,74.36%Vvs 69.70%)(P>0.05).Conclusion Laparoscopic partial hepatectomy has equivalent long-term efficacy with open hepatectomy in the treatment of hepatocellular carcinoma,but the former one can reduce surgical trauma,lower the incidence rates of postoperative complications,and facilitate early recovery of patients.
作者
黎官印
杨羽
马海
彭勇
何振兴
屈岳育
LI Guan-yin;YANG Yu;MA Hai(The Nanchong Cental Hospital,Nanchong 637000,China)
出处
《肝胆外科杂志》
2023年第5期336-340,共5页
Journal of Hepatobiliary Surgery
基金
南充市市校合作科研专项(18SXHZ0435)
川北医学院科研发展计划项目(CBY18-A-YB08)。
关键词
肝癌
腹腔镜肝部分切除术
开腹手术
血清肿瘤标志物
hepatocellular carcinoma
laparoscopic partial hepatectomy
open surgery
serum tumor markers
