| 王国良,徐贤刚,刘隽,等.精准肝切除术对原发性肝癌患者免疫功能及血清炎性因子的影响[J].安徽医药,2018,22(10):1884-1887. |
| 精准肝切除术对原发性肝癌患者免疫功能及血清炎性因子的影响 |
| Effect of precise hepatectomy on immune function and serum inflammatory factors in patients with primary liver cancer |
| 投稿时间：2017-02-19 |
| DOI： |
| 中文关键词: 肝肿瘤 肝切除术 免疫学试验 白细胞介素类 肿瘤坏死因子α |
| 英文关键词: Liver neoplasms Hepatectomy Immunologic tests Interleukins Tumor necrosis factor-alpha |
| 基金项目:贵州省科技厅联合基金项目(黔科合LS字[2011]018号) |
| 作者 | 单位 | E-mail | | 王国良 | 贵州省人民医院肝胆胰外科,贵州 贵阳 550002 | | | 徐贤刚 | 贵州省人民医院肝胆胰外科,贵州 贵阳 550002 | | | 刘隽 | 贵州省人民医院肝胆胰外科,贵州 贵阳 550002 | liujun2018@126.com | | 倪平志 | 贵州省人民医院肝胆胰外科,贵州 贵阳 550002 | | | 汤可立 | 贵州省人民医院肝胆胰外科,贵州 贵阳 550002 | | | 黄建钊 | 贵州省人民医院肝胆胰外科,贵州 贵阳 550002 | | | 柳严 | 贵州省人民医院肝胆胰外科,贵州 贵阳 550002 | | | 刘延 | 贵州省人民医院肝胆胰外科,贵州 贵阳 550002 | | | 王俊 | 贵州省人民医院肝胆胰外科,贵州 贵阳 550002 | | | 刘江伟 | 贵州省人民医院肝胆胰外科,贵州 贵阳 550002 | |
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| 中文摘要: |
| 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%)(χ2=6.117,9.762,7.289,2.704,6.117,3.904,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。 |
| 英文摘要: |
| 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 pleural effusion,abdominal infection,pulmonary infection,liver failure,bile leakage,and postoperative bleeding in the pleural effusion was significantly lower in the observation group than that in the control group [(2.44% vs.19.51%),(2.44% vs. 26.83%),(2.44% vs. 21.95%),(0.00% vs. 26.83%),(2.44% vs.19.51%),(2.44% vs. 14.63%)] (χ2=6.117,9.762,7.289,2.704,6.117,3.904,P<0.05,P<0.001). Conclusions Accurate hepatectomy can help protect the immune function of patients with primary liver cancer,relieve postoperative inflammatory reaction,reduce complications and promote rehabilitation of patients. |
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