广西医学

目的基于倾向评分匹配（PSM）法比较开腹肝切除术（OH）与腹腔镜下肝静脉导向解剖性肝切除术（HVOAH）治疗左外叶肝细胞癌的效果。方法回顾性分析260例左外叶肝细胞癌患者的临床资料，根据手术方式分为OH组154例和HVOAH组106例。使用PSM法对OH组和HVOAH组患者进行1 ∶1匹配后，比较两组患者的围术期指标（手术时间、术中出血量、住院时间、术中输血情况、术后首次进食时间），术前及术后7 d的炎症指标［血清降钙素原、白细胞介素 6（IL-6）］、肝功能指标（ALT、AST、总胆红素）及免疫指标（外周血CD4+T淋巴细胞、CD8+T淋巴细胞、CD4+/CD8+值），以及术后并发症发生率。采用Kaplan-Meier法绘制生存曲线，比较两组的生存情况。结果经PSM法匹配后，两组各纳入82例患者，两组患者的一般临床资料差异均无统计学意义（均P＞0.05）。HVOAH组患者手术时间长于OH组，但术中出血量、住院时间、术后首次进食时间均少于或短于OH组（均P＜0.05）。术后7 d，HVOAH组患者血清降钙素原、IL-6、ALT、AST、总胆红素水平及外周血CD8+T淋巴细胞水平均低于OH组，而外周血CD4+T淋巴细胞水平、CD4+/CD8+值均高于OH组（均P＜0.05）。HVOAH组患者术后并发症总发生率低于OH组患者（P＜0.05）。两组患者术后1年、3年的总生存率及无进展生存率差异均无统计学意义（均P＞0.05）。结论与OH相比，腹腔镜下HVOAH治疗对左外叶肝细胞癌患者机体的炎症刺激、肝功能及免疫功能的损害更小，术后并发症发生率更低，患者术后恢复更快，手术安全性更高。

ObjectiveTo compare the effect of open hepatectomy (OH) versus laparoscopic hepatic vein-oriented anatomic hepatectomy (HVOAH) for the treatment of hepatocellular carcinoma in left lateral lobe based on propensity score matching (PSM) method. MethodsThe clinical data of 260 patients with hepatocellular carcinoma in left lateral lobe were retrospectively analyzed, and they were divided into OH group (154 cases) or HVOAH group (106 cases) according to surgical methods. After using PSM method to match patients in the OH group and HVOAH group by 1 ∶1, the perioperative indices (operation duration, intraoperative bleeding volume, length of hospital stay, intraoperative blood transfusion, postoperative first feeding time), and pre- and 7-day postoperative serum inflammatory indices (procalcitonin, interleukin 6 ［IL-6］), liver function indices (ALT, AST, and total bilirubin), immune function indices (CD4+ T lymphocyte, CD8+ T lymphocyte, and CD4+/CD8+ value in peripheral blood), and the incidence rate of postoperative complications were compared between patients of the two groups. The survival status was compared between patients of the two groups by using Kaplan-Meier method to draw the survival curve. ResultsAfter PSM method matching, 82 patients were enrolled in each group, and there was no statistically significant difference in general clinical data between the two groups (all P＞0.05). The operation duration of the HVOAH group was longer than that of the OH group, but intraoperative bleeding volume, length of hospital stay, and postoperative first feeding time of the HVOAH group were less or shorter than those of the OH group (all P＜0.05). After 7 days of operation, the levels of serum procalcitonin, IL-6, ALT, AST, total bilirubin, and CD8+ T lymphocyte of peripheral blood in the HVOAH group were lower than those in the OH group, while CD4+ T lymphocyte level, and CD4+/CD8+ value of peripheral blood in the HVOAH group were higher than those in the OH group (all P＜0.05). The total incidence rate of postoperative complications in the HVOAH group was lower than that in the OH group (P＜0.05). There were no statistically significant difference in 1- and 3-year overall survival rate and progression-free survival rate between the two groups (all P＞0.05). ConclusionCompared with OH, laparoscopic HVOAH for the treatment of patients with hepatocellular carcinoma in left lateral lobe has less inflammatory stimulation, damages of liver function and immune function of the body, a lower incidence rate of postoperative complications, faster postoperative recovery of patients, exerting a higher operative safety.