腹腔镜肝癌根治术治疗肝癌的临床疗效及对NGF、MMP-13水平的影响
|
摘要
目的:研究腹腔镜肝癌根治术治疗肝癌的临床疗效及对神经生长因子(nerve growth factor,NGF)、基质金属蛋白酶-13(matrix metalloproteinase-13,MMP-13)水平的影响。方法:选取2012年1月至2016年12月我院收治的原发性肝癌患者65例,分别采用开腹肝癌切除术(对照组)和腹腔镜肝癌根治术(观察组),分析两组患者治疗后的临床效果。结果:观察组患者手术时间、排气时间、拔管时间、绝对卧床时间、住院时间均短于对照组;术后3 d时,观察组患者MMP-13、ICAM-1、NGF、PⅢP、PCT水平低于对照组;术后1个月,观察组患者肝功能指标水平低于对照组,差异有统计学意义(P <0. 05)。随访1年后,观察组患者复发率和转移率分别为15. 15%、3. 03%;对照组分别为28. 13%、12. 50%;观察组患者复发率和转移率低于对照组,但组间比较无统计学差异(P> 0. 05)。结论:腹腔镜肝癌根治术较开腹肝癌切除术治疗肝癌更有利于促进肝功能的恢复,可降低MMP-13及NGF水平,且恢复快,住院时间短,但复发率和转移率比较,无明显差异。
Objective: To study the clinical efficacy of laparoscopic radical hepatectomy for hepatocellular carcinoma and its effect on NGF and MMP-13 level. Methods: From January 2012 to December 2016,65 patients with primary liver cancer in our hospital were treated with open hepatectomy( control group) and laparoscopic radical hepatectomy( observation group). Results: In the observation group,the operation time,the exhaust time,the extubation time,the absolute bed time and the time of hospitalization were shorter than those of the control group. After 3 d,MMP-13,ICAM-1,NGF,PⅢP,and the PCT level in the observation group were lower than that of the control group. The level of liver function index in the observation group was lower than that of the control group at 1 month after the operation,and the difference was statistically significant( P < 0. 05). With after one year's visit,the recurrence rate and metastasis rate of the patients in the observation group were 15. 15% and 3. 03%,and that in the control group were28. 13% and 12. 50%,respectively. The recurrence rate and the metastasis rate in the observation group were lower than those in the control group,but there was no statistical difference between the two groups( P > 0. 05). Conclusion: Laparoscopic radical resection of liver cancer is more beneficial to promote the recovery of liver function than open hepatectomy. It can reduce the level of MMP-13 and NGF. The recovery is faster and the hospitalization time is short. However,there is no significant difference between the recurrence rate and metastasis rate.
Objective: To study the clinical efficacy of laparoscopic radical hepatectomy for hepatocellular carcinoma and its effect on NGF and MMP-13 level. Methods: From January 2012 to December 2016,65 patients with primary liver cancer in our hospital were treated with open hepatectomy( control group) and laparoscopic radical hepatectomy( observation group). Results: In the observation group,the operation time,the exhaust time,the extubation time,the absolute bed time and the time of hospitalization were shorter than those of the control group. After 3 d,MMP-13,ICAM-1,NGF,PⅢP,and the PCT level in the observation group were lower than that of the control group. The level of liver function index in the observation group was lower than that of the control group at 1 month after the operation,and the difference was statistically significant( P < 0. 05). With after one year's visit,the recurrence rate and metastasis rate of the patients in the observation group were 15. 15% and 3. 03%,and that in the control group were28. 13% and 12. 50%,respectively. The recurrence rate and the metastasis rate in the observation group were lower than those in the control group,but there was no statistical difference between the two groups( P > 0. 05). Conclusion: Laparoscopic radical resection of liver cancer is more beneficial to promote the recovery of liver function than open hepatectomy. It can reduce the level of MMP-13 and NGF. The recovery is faster and the hospitalization time is short. However,there is no significant difference between the recurrence rate and metastasis rate.
引文
[1]Guro H,Cho JY,Han H,et al.Current status of laparoscopic liver resection for hepatocellular carcinoma[J].Clinical and Molecular Hepatology,2016,22(2):212-218.
[2]Cho JY,Han H,Yoon Y,et al.Outcomes of laparoscopic right posterior sectionectomy in patients with hepatocellular carcinoma in the era of laparoscopic surgery[J].Surgery,2015,158(1):135-141.
[3]Zeng YS.Effect of laparoscopic hepatectomy on primary liver cancer[J].Modern Instruments and Medical Science,2015,21(4):115-116.[曾尤松.腹腔镜肝切除治疗原发性肝癌的疗效观察[J].现代仪器与医疗,2015,21(4):115-116.]
[4]Huang WW,Zhang YQ,Hou HL,et al.A comparative study of the clinical effects of laparoscopy and laparotomy in the treatment of liver cancer[J].Chinese Modern Doctor,2017,55(21):40-42.[黄文文,张涌泉,侯海玲,等.腹腔镜与开腹手术治疗肝癌的临床效果对比研究[J].中国现代医生,2017,55(21):40-42.]
[5]Nie JH.Comparison of effects between laparoscopic hepatectomy and open hepatectomy for primary hepatocellular carcinoma[J].Mod Diagn Treat,2014,24(23):5427-5428.[聂剑宏.腹腔镜肝切除和开腹肝切除术治疗原发性肝癌的临床疗效比较[J].现代诊断与治疗,2014,24(23):5427-5428.]
[6]Cao J,Zhang HW,Zhang L,et al.The feasibility of laparoscopic assisted two step hepatectomy combined with hepatic disconnection and portal vein ligature in the treatment of primary liver cancer[J].Chinese Journal of Practical Surgery,2014,34(01):77-80.[曹君,张红卫,张磊,等.腹腔镜辅助联合肝脏离断和门静脉结扎二步肝切除术治疗原发性肝癌可行性研究[J].中国实用外科杂志,2014,34(01):77-80.]
[7]Kwon Y,Han H,Yoon Y,et al.Are large hepatocellular carcinomas still a contraindication for laparoscopic liver resection[J]?Journal of Laparoendoscopic&Advanced Surgical Techniques,2015,25(2):98-102.
[8]Deng W,Li Q,Zhang RJ,et al.Comparison of the clinical efficacy of hepatectomy and laparoscopic hepatectomy in the treatment of hepatocellular carcinoma[J].Chinese Journal of Gerontology,2016,36(17):4226-4228.[邓维,李强,张睿杰,等.开腹肝癌切除术与腹腔镜肝癌切除术治疗肝细胞癌患者临床疗效的比较[J].中国老年学杂志,2016,36(17):4226-4228.]
[9]Li SY.Clinical efficacy of laparoscopic hepatectomy,radiofrequency ablation and open hepatectomy for primary liver cancer compared with[J].Chinese Health Standard Management,2017,8(07):52-54.[李慎玉.腹腔镜肝切除术、射频消融术及开腹肝切除术对原发性肝癌的临床疗效比较[J].中国卫生标准管理,2017,8(07):52-54.]
[10]Peng XR,Xie AW,Wu XJ,et al.Clinical comparison of hepatectomy and laparoscopic hepatectomy for the treatment of hepatocellular carcinoma[J].Jilin Medicine,2018,39(3):539-540.[彭欣然,谢敖文,吴新军,等.开腹肝癌切除术与腹腔镜肝癌切除术治疗肝细胞癌患者临床比较[J].吉林医学,2018,39(3):539-540.]
[11]Zhang Xu,Qian Haixin.Therapeutic effect study of liver cancer resection between laparoscopic surgery and open surgery[J].Modern Oncology,2017,25(13):2086-2088.[张旭,钱海鑫.肝癌腹腔镜及开腹治疗的临床疗效比较[J].现代肿瘤医学,2017,25(13):2086-2088.]
[12]Sakoda M,Ueno S,Iino S,et al.Anatomical laparoscopic hepatectomy for hepatocellular carcinoma using indocyanine green fluorescence imaging[J].Journal of Laparoendoscopic&Advanced Surgical Techniques,2014,24(12):878-882.
[13]Herman P,Perini MV,Coelho FF,et al.Laparoscopic resection of hepatocellular carcinoma:When,why,and how?A single-center experience[J].Journal of Laparoendoscopic&Advanced Surgical Techniques,2014,24(4):223-228.
[14]Cai XJ,Peng SY,Yu H,et al.The feasibility of complete laparoscopic ALPPS treatment for primary liver cancer with liver cirrhosis[J].Chinese Journal of Practical Surgery,2014,34(07):637-640.[蔡秀军,彭淑牖,虞洪,等.完全腹腔镜下行ALPPS治疗伴肝硬化的原发性肝癌可行性临床探讨[J].中国实用外科杂志,2014,34(07):637-640.]
[15]Xiao L,Xiang L,Li J,et al.Laparoscopic versus open liver resection for hepatocellular carcinoma in posterosuperior segments[J].Surgical Endoscopy,2015,29(10):2994-3001.
[16]Ouyang ZS,Tang ZH,Lv LJ,et al.Clinical comparison of laparoscopic hepatectomy and hepatectomy for the treatment of primary liver cancer[J].Chinese General Surgery Journal,2017,26(01):126-130.[欧阳正晟,唐朝晖,吕丽娟,等.腹腔镜肝切除与开腹肝切除治疗原发性肝癌的临床比较[J].中国普通外科杂志,2017,26(01):126-130.]
[2]Cho JY,Han H,Yoon Y,et al.Outcomes of laparoscopic right posterior sectionectomy in patients with hepatocellular carcinoma in the era of laparoscopic surgery[J].Surgery,2015,158(1):135-141.
[3]Zeng YS.Effect of laparoscopic hepatectomy on primary liver cancer[J].Modern Instruments and Medical Science,2015,21(4):115-116.[曾尤松.腹腔镜肝切除治疗原发性肝癌的疗效观察[J].现代仪器与医疗,2015,21(4):115-116.]
[4]Huang WW,Zhang YQ,Hou HL,et al.A comparative study of the clinical effects of laparoscopy and laparotomy in the treatment of liver cancer[J].Chinese Modern Doctor,2017,55(21):40-42.[黄文文,张涌泉,侯海玲,等.腹腔镜与开腹手术治疗肝癌的临床效果对比研究[J].中国现代医生,2017,55(21):40-42.]
[5]Nie JH.Comparison of effects between laparoscopic hepatectomy and open hepatectomy for primary hepatocellular carcinoma[J].Mod Diagn Treat,2014,24(23):5427-5428.[聂剑宏.腹腔镜肝切除和开腹肝切除术治疗原发性肝癌的临床疗效比较[J].现代诊断与治疗,2014,24(23):5427-5428.]
[6]Cao J,Zhang HW,Zhang L,et al.The feasibility of laparoscopic assisted two step hepatectomy combined with hepatic disconnection and portal vein ligature in the treatment of primary liver cancer[J].Chinese Journal of Practical Surgery,2014,34(01):77-80.[曹君,张红卫,张磊,等.腹腔镜辅助联合肝脏离断和门静脉结扎二步肝切除术治疗原发性肝癌可行性研究[J].中国实用外科杂志,2014,34(01):77-80.]
[7]Kwon Y,Han H,Yoon Y,et al.Are large hepatocellular carcinomas still a contraindication for laparoscopic liver resection[J]?Journal of Laparoendoscopic&Advanced Surgical Techniques,2015,25(2):98-102.
[8]Deng W,Li Q,Zhang RJ,et al.Comparison of the clinical efficacy of hepatectomy and laparoscopic hepatectomy in the treatment of hepatocellular carcinoma[J].Chinese Journal of Gerontology,2016,36(17):4226-4228.[邓维,李强,张睿杰,等.开腹肝癌切除术与腹腔镜肝癌切除术治疗肝细胞癌患者临床疗效的比较[J].中国老年学杂志,2016,36(17):4226-4228.]
[9]Li SY.Clinical efficacy of laparoscopic hepatectomy,radiofrequency ablation and open hepatectomy for primary liver cancer compared with[J].Chinese Health Standard Management,2017,8(07):52-54.[李慎玉.腹腔镜肝切除术、射频消融术及开腹肝切除术对原发性肝癌的临床疗效比较[J].中国卫生标准管理,2017,8(07):52-54.]
[10]Peng XR,Xie AW,Wu XJ,et al.Clinical comparison of hepatectomy and laparoscopic hepatectomy for the treatment of hepatocellular carcinoma[J].Jilin Medicine,2018,39(3):539-540.[彭欣然,谢敖文,吴新军,等.开腹肝癌切除术与腹腔镜肝癌切除术治疗肝细胞癌患者临床比较[J].吉林医学,2018,39(3):539-540.]
[11]Zhang Xu,Qian Haixin.Therapeutic effect study of liver cancer resection between laparoscopic surgery and open surgery[J].Modern Oncology,2017,25(13):2086-2088.[张旭,钱海鑫.肝癌腹腔镜及开腹治疗的临床疗效比较[J].现代肿瘤医学,2017,25(13):2086-2088.]
[12]Sakoda M,Ueno S,Iino S,et al.Anatomical laparoscopic hepatectomy for hepatocellular carcinoma using indocyanine green fluorescence imaging[J].Journal of Laparoendoscopic&Advanced Surgical Techniques,2014,24(12):878-882.
[13]Herman P,Perini MV,Coelho FF,et al.Laparoscopic resection of hepatocellular carcinoma:When,why,and how?A single-center experience[J].Journal of Laparoendoscopic&Advanced Surgical Techniques,2014,24(4):223-228.
[14]Cai XJ,Peng SY,Yu H,et al.The feasibility of complete laparoscopic ALPPS treatment for primary liver cancer with liver cirrhosis[J].Chinese Journal of Practical Surgery,2014,34(07):637-640.[蔡秀军,彭淑牖,虞洪,等.完全腹腔镜下行ALPPS治疗伴肝硬化的原发性肝癌可行性临床探讨[J].中国实用外科杂志,2014,34(07):637-640.]
[15]Xiao L,Xiang L,Li J,et al.Laparoscopic versus open liver resection for hepatocellular carcinoma in posterosuperior segments[J].Surgical Endoscopy,2015,29(10):2994-3001.
[16]Ouyang ZS,Tang ZH,Lv LJ,et al.Clinical comparison of laparoscopic hepatectomy and hepatectomy for the treatment of primary liver cancer[J].Chinese General Surgery Journal,2017,26(01):126-130.[欧阳正晟,唐朝晖,吕丽娟,等.腹腔镜肝切除与开腹肝切除治疗原发性肝癌的临床比较[J].中国普通外科杂志,2017,26(01):126-130.]