摘要
目的探讨精准肝切除治疗对原发性肝癌患者免疫功能、炎性因子及远期疗效影响。方法回顾性分析2011年8月至2013年12月原发性肝癌于贵州省医行肝叶切除术的患者临床资料,根据手术方式分为精准肝切除术组和Pringle法阻断快速肝切除的对照组各41例。对照组用电刀在距肿瘤边缘1~2 cm作一预切除线,行Pringle法阻断快速肝切除。精准肝切除术组采用术中超声定位肿瘤附近的主要肝静脉支,用电刀在肝表面标记其主要走向。采用超声刀、水刀等逐步由浅及深、由前向后逐步将肝组织离断。比较两组免疫功能、炎性因子、并发症等指标。结果术后3 d,观察组CD3+、CD4+/CD8+、NK含量均明显高于对照组[(60.46±5.82比55.28±5.13)%,1.12±0.11比1.03±0.09,(8.69±1.24比7.33±1.15)pg·mL^(-1)](t=4.275,4.055,4.149,P<0.05);血清肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)含量明显低于对照组[(15.46±2.27比20.38±3.56)ng·mL^(-1),(20.36±3.18比25.78±4.26)mg·L^(-1),(117.52±12.38比131.67±13.49)pg·mL^(-1)](t=7.461,6.528,4.948,P<0.05);随访1年,观察组胸腔积液胸腔感染、腹腔感染、肺部感染、肝功能衰竭、胆漏、术后出血的发生率均明显低于对照组(2.44%比19.51%,2.44%比26.83%,2.44%比21.95%,0.00%比26.83%,2.44%比19.51%,2.44%比14.63%)(χ~2=6.117,9.762,7.289,12.704,6.117,3.904,P<0.05,P<0.001)。结论精准肝切除术有助于保护原发性肝癌患者机体免疫功能,缓解术后炎性反应,减少并发症,促进患者康复。
Objective To explore the effeCT of precise hepateCTomy on immune funCTion,inflammatory faCTors and long-term efficacy in patients with primary liver cancer. Methods The clinical data of patients with primary liver cancer who underwent hepateCTomy in Guizhou Province People＇s Hospital from August 2011 to December 2013 were retrospeCTively analyzed. According to the surgical method,the patients were assigned into the precise hepateCTomy group and the pringle method to block rapid hepateCTomy as control group,41 cases in each group. In the control group,an eleCTrosurgical knife was used to make a pre-reseCTion line 1 to 2 cm from the edge of the tumor,and the pringle method was used to block rapid hepateCTomy. In the precision hepateCTomy group,intraoperative ultrasound was used to locate the main hepatic vein branch near the tumor,and the main direCTion was marked on the liver surface with eleCTric knife. The liver tissues were gradually removed by ultrasonic scalpels,water jets and so on from the shallow and deep or from the front to the back. The immune funCTion,inflammatory faCTors,and complications of the two groups were compared. Results At 3 days after operation,the levels of CD3 ＋,CD4 ＋/CD8 ＋ and NK in the observation group were significantly higher than those in the control group[（ 60. 46 ± 5. 82） % vs.（ 55. 28 ± 5. 13） %,（ 1. 12 ± 0. 11） vs.（ 1. 03 ± 0. 09）,（ 8. 69 ± 1. 24） pg·mL^（-1） vs.（ 7. 33 ± 1. 15） pg·mL^（-1）]（ t = 4. 275,4. 055,4. 149,P〈0. 05）; the levels of serum tumor necrosis faCTor-α（ TNF-α）,C-reaCTive protein（ CRP） and interleukin-6（ IL-6） were significantly lower than those of the control group. [（ 15. 46 ± 2. 27） ng·mL^（-1） vs.（ 20. 38 ± 3. 56） ng·mL^（-1）,（ 20. 36 ± 3. 18） mg·L^（-1） vs.（ 25. 78 ± 4. 26） mg·L^（-1）,（ 17. 52 ± 12. 38） pg·mL^（-1） vs.（ 131. 67 ± 13. 49） pg· mL^（-1）]（ t = 7. 461,6. 528,4. 948,P〈0. 05）; after 1 year of follow-up,the incidence of pleur
作者
王国良
徐贤刚
刘隽
倪平志
汤可立
黄建钊
柳严
刘延
王俊
刘江伟
WANG Guoliang;XU Xiangang;LIU Jun;NI Pingzhi;TANG Keli;HUANG Jianzhao;LIU Yah(Department of Hepatobiliary and Pancreatic Surgery,Guizhou Provincial People＇s Hospital,Guiyang,Guizhou 550002,China)
出处
《安徽医药》
CAS
2018年第10期1884-1888,共5页
Anhui Medical and Pharmaceutical Journal
基金
贵州省科技厅联合基金项目(黔科合LS字[2011]018号)
