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目的:比较腹腔镜左肝外切除术(LLLR)和开腹左肝外切除术(OLLR)治疗左外叶肝细胞癌(HCC)的临床效果及生存期。方法:选取我院2013年6月-2014年8月收治的左外叶HCC患者82例,随机分为对照组和观察组,每组41例。对照组患者行OLLR治疗,观察组患者行LLLR。观察并比较两组患者的手术时间、术中出血量、首次进食时间、住院时间、并发症发生率、术后一年和两年生存率,以及治疗前后血清ICAM-1,MMP-13,PCT,IL-6,IgA,IgM及IgG水平的变化情况。结果:观察组患者术中出血量、首次进食时间及住院时间均短于对照组(P<0.01);手术后,观察组患者血清ICAM-1,MMP-13,PCT及IL-6水平均低于对照组,而血清IgA,IgM及IgG水平均高于对照组(P<0.01);观察组并发症发生率(17.08%)低于对照组(41.47%)(x~2=5.89,P=0.01);两组患者术后1年和2年的生存率比较,差异无统计学意义(P>0.05)。结论:LLLR治疗HCC具有创伤小、并发症低及预后快等优点,能有效抑制术后炎症反应,对患者免疫功能影响低,可显著降低肿瘤侵袭力,远期生存率较高,值得在临床推广。
Objective: To compare the clinical effects and survival of patients with left-sided hepatocellular carcinoma (HCC) treated with laparoscopic left-hysterectomy (LLLR) and open left-hysterectomy (OLLR). Methods: Totally 82 patients with left-lateral lobe HCC admitted to our hospital from June 2013 to August 2014 were randomly divided into control group and observation group, with 41 cases in each group. Control group patients underwent OLLR treatment, observation group patients underwent LLLR. The operation time, intraoperative blood loss, time to first meal, hospital stay, complication rate, one-year and two-year survival rate after operation and the serum levels of ICAM-1, MMP-13 and PCT in the two groups were observed and compared , IL-6, IgA, IgM and IgG levels. Results: The blood loss, time to first meal and hospital stay in observation group were shorter than those in control group (P <0.01). After operation, the levels of serum ICAM-1, MMP-13, PCT and IL-6 in observation group were lower (P <0.01). The complication rate in the observation group (17.08%) was lower than that in the control group (41.47%) (x ~ 2 = 5.89, P = 0.01). There was no significant difference in survival rate between two groups after 1 year and 2 years (P> 0.05). Conclusion: The treatment of HCC with LLLR has the advantages of small trauma, low complication and rapid prognosis, which can effectively inhibit postoperative inflammatory response, has a low impact on immune function, can significantly reduce invasiveness of tumor and has a long-term survival rate, which is worthy of clinical application Promotion.