Cao Qing, Yang Liang, Zhou Guanbao, Hu Yue
Hepatobiliary and Pancreatic Surgery, The First Hospital of Ningbo City, Ningbo, China.
Front Oncol. 2023 Mar 22;13:1116984. doi: 10.3389/fonc.2023.1116984. eCollection 2023.
For exploring the clinical efficacy of laparoscopic radical hepatectomy and laparotomy for hepatocellular carcinoma and analysing related factors of postoperative recurrence.
Totally 212 patients with hepatocellular carcinoma admitted to our hospital between April 2017 and December 2020 were enrolled, and all of them were followed up after the operation. According to the treatment modes, the patients were assigned to a laparotomy group (n=106) and a laparoscopic group (n=106). Perioperative indicators, haematological examination results, complications and recurrence were compared between the two groups. The recurrence time of hepatocellular carcinoma after the operation was confirmed by imaging examination with definite mass, and logistic multivariate analysis was used for analyzing the risk factors associated with postoperative recurrence.
Patients in both groups were comparable in terms of general baseline data. The laparoscopic group experienced longer operation time and shorter incision length, less intraoperative blood loss, early time to have the first off-bed activity and time to eat liquid and shorter hospital stay than the laparotomy group (all P<0.05). Seven days after the operation, the laparoscopic group showed notably lower levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), tumour necrosis factor-α (TNF-α), interleukin-8 (IL-8), and C-reactive protein (CRP) than the laparotomy group (all P<0.05), and also showed notably higher levels of immunoglobulin A (IgA), IgG and IgM than the laparotomy group (all P<0.05). Additionally, the laparotomy group showed a higher total incidence rate of complications than the laparoscopic group (19.81% vs. 9.43%, P<0.05). During the one-year follow-up, the laparotomy group was not greatly different from the laparoscopic group in recurrence rate (22.64% (24/106) vs. 16.98% (18/106), P>0.05). Multivariate analysis showed that average tumour diameter and microvascular invasion were risk factors for postoperative recurrence (P<0.05).
Laparoscopic radical hepatectomy for hepatocellular carcinoma can reduce the influence on liver function and immune function, with less damage to tissues, and can ameliorate postoperative inflammatory reaction, and promote postoperative recovery of patients as soon as possible. There are many factors influencing the postoperative recurrence of hepatocellular carcinoma, and average tumour diameter and microvascular invasion are the risk factors.
探讨腹腔镜根治性肝切除术与开腹手术治疗肝细胞癌的临床疗效，并分析术后复发的相关因素。
选取2017年4月至2020年12月在我院收治的212例肝细胞癌患者，所有患者术后均进行随访。根据治疗方式，将患者分为开腹组（n = 106）和腹腔镜组（n = 106）。比较两组患者的围手术期指标、血液学检查结果、并发症及复发情况。术后通过影像学检查发现明确肿块来确定肝细胞癌的复发时间，并采用logistic多因素分析来分析与术后复发相关的危险因素。
两组患者的一般基线资料具有可比性。与开腹组相比，腹腔镜组手术时间更长，切口长度更短，术中出血量更少，首次下床活动时间和进食流食时间更早，住院时间更短（均P < 0.05）。术后7天，腹腔镜组丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、总胆红素（TBIL）、肿瘤坏死因子-α（TNF-α）、白细胞介素-8（IL-8）及C反应蛋白（CRP）水平均显著低于开腹组（均P < 0.05），免疫球蛋白A（IgA）、IgG及IgM水平均显著高于开腹组（均P < 0.05）。此外，开腹组并发症总发生率高于腹腔镜组（19.81% vs. 9.43%，P < 0.05）。在1年的随访期内，开腹组与腹腔镜组的复发率差异无统计学意义（22.64%（24/106）vs. 16.98%（18/106），P > 0.05）。多因素分析显示，肿瘤平均直径和微血管侵犯是术后复发的危险因素（P < 0.05）。
腹腔镜根治性肝切除术治疗肝细胞癌可减少对肝功能和免疫功能的影响，对组织损伤较小，可减轻术后炎症反应，促进患者术后尽快康复。影响肝细胞癌术后复发的因素较多，肿瘤平均直径和微血管侵犯是危险因素。
