精准肝切除与常规肝切除对肝癌患者T细胞亚群变化影响的比较

目的:比较精准肝切除与常规肝切除对肝癌患者T细胞亚群变化的影响。方法:将47例肝癌患者随机分为两组,分别行精准肝切除术(精准肝切除组,26例)和常规肝切除术(常规肝切除组,21例)。比较两组主要临床指标,及手术前后外周血CD3~+、CD4~+、CD8~+及CD4~+/CD8~+水平。结果:与常规肝切除组比较,精准肝切除组手术时间延长,但失血量少、住院时间短、术后胆汁漏与腹腔出血发生率低(均P0.05);精准肝切除组术后肝功能指标的变化优于常规肝切除组(均P0.05)。术后7 d,两组CD3~+、CD4~+及CD4~+/CD8~+水平均较术前明显下降,但精准肝切除组下降程度明显小于常规肝切除组(均P0.05),两组CD8~+水平均较术前略有升高(均P0.05);术后14 d,两组各T细胞亚群均恢复至术前水平。结论:精准肝切除在术后免疫功能的保护方面优于常规肝切除,从而有利于肝癌患者肝脏功能的恢复。

Comparison of influences between precise and conventional hepatectomy on changes of T lymphocyte subsets of liver cancer patients

Objective: To compare the influences between precise and conventional hepatectomy on changes of T lymphocyte subsets in liver cancer patients. Methods: Forty-seven liver cancer patients were randomly divided into two groups, and underwent precise hepatectomy (precise hepatectomy group, 26 cases) and conventional hepatectomy (conventional hepatectomy group, 21 cases) respectively. The main clinical variables, and the pre- and postoperative CD3+, CD4+ and CD8+ levels as well as CD4+/CD8+ between the two groups were compared. Results: In precise hepatectomy group compared with conventional hepatectomy group, the operative time was prolonged, but the amount of blood loss, length of hospital stay and incidence of postoperative bile leakage and intra-abdominal hemorrhage were all reduced (all P<0.05); the postoperative changes in liver function parameters in precise hepatectomy group were superior to those in conventional hepatectomy group (all P<0.05). At postoperative day (POD) 7, the values of CD3+, CD4+ and CD4+/CD8+ were significantly decreased in both groups compared with their preoperative levels, but the decreasing degrees of them in precise hepatectomy group were significantly less than those in conventional hepatectomy group (all P<0.05), and the CD8+ values were slightly increased in both groups compared with their preoperative levels (both P>0.05); at POD 14 the values of all these T lymphocyte subsets in both groups returned to their preoperative levels. Conclusion: Precise hepatectomy is superior to conventional hepatectomy in protection of immune function, which thereby benefits the recovery of liver function in liver cancer patients.