沿肝静脉主干入路的开腹解剖性肝脏切除术治疗原发性肝癌的疗效及安全性

目的:探讨沿肝静脉主干入路的开腹AR治疗原发性肝癌疗效及对患者围术期指标、术后并发症的影响。方法:回顾性分析2016年1月-2022年10月期间在我院就诊并接受开腹解剖性肝切除术的158例原发性肝癌患者临床资料，采用倾向性匹配按照1∶1比例对基线资料进行匹配，共获得52对基线资料差异无统计学意义的样本，其中行沿肝静脉主干入路开腹AR的患者为研究组，行常规入路开腹AR的患者为常规组。比较两组围术期情况及术前、术后7 d检测丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、总胆红素（TBIL）、白蛋白（ALB）、免疫球蛋白（Ig）A、IgG、IgM、CD4+T细胞、CD8+T细胞、白介素6（IL-6）、IL-10和肿瘤坏死因子α（TNF-α）水平以及术后相关并发症情况。结果:研究组术中出血量低于常规组，差异有统计学意义（P＜0.05），两组手术时间、术中输血患者占比、肝门阻断时间及住院时间差异无统计学意义（P>0.05）。两组术后7 d血清ALT、AST和TBIL水平明显升高（P＜0.05），血清ALB水平明显降低（P＜0.05），且研究组血清ALT、AST和TBIL水平低于常规组，血清ALB水平高于常规组，差异有统计学意义（P＜0.05）；两组术后7 d外周血IgA、IgG、IgM和CD8+T细胞水平明显低于术前（P＜0.05），CD4+T细胞水平明显高于术前（P＜0.05），且研究组外周血IgG、CD8+T细胞水平高于常规组，CD4+T细胞水平低于常规组，差异有统计学意义（P＜0.05）；两组术后7 d血清IL-6、IL-10和TNF-α水平明显高于术前（P＜0.05），且研究组血清IL-6、IL-10和TNF-α水平低于常规组，差异有统计学意义（P＜0.05）；两组术后并发症比较差异无统计学意义（P>0.05）。结论:沿肝静脉主干入路的开腹AR治疗原发性肝癌安全可行，可减少术中出血量，减轻肝功能、免疫功能损害和炎症反应，对促进患者康复具有积极作用。

Efficacy and safety of open anatomic resection via the main hepatic vein approach in primary liver cancer

Objective:To explore the efficacy of open AR via the main hepatic vein approach in the treatment of primary liver cancer and its influence on perioperative indicators and postoperative complications of patients.Methods:The clinical data of 158 patients with primary liver cancer who were admitted to our hospital and underwent open anatomical resection were retrospectively analyzed between January 2016 and October 2022.Using propensity matching to match the baseline data in a 1∶1 ratio,52 pairs of samples with no statistically significant differences in baseline data were obtained.Patients who underwent open AR via the main hepatic vein approach were enrolled as study group,and patients who performed open AR via routine approach were included in routine group.The perioperative status,levels of alanine aminotransferase (ALT),aspartate aminotransferase (AST),total bilirubin (TBIL),albumin (ALB),immunoglobulin (Ig) A,IgG,IgM,CD4+T cells,CD8+T cells,interleukin-6 (IL-6),IL-10 and tumor necrosis factor-α (TNF-α) before surgery and at 7 d after surgery and postoperative related complications were compared between the two groups.Results:The intraoperative blood loss in the study group were lower than in the routine group with statistically significant differences (P＜0.05).There were no statistical differences between the two groups in the operative time,percentage of patients with intraoperative blood transfusion,hepatic portal block time and hospital stay between the two groups (P>0.05).At 7 d after surgery,serum ALT,AST and TBIL levels were significantly increased (P＜0.05) while serum ALB level was significantly decreased (P＜0.05),and the levels of serum ALT,AST and TBIL were lower in study group than those in routine group while the level of ALB was higher than that in routine group (P＜0.05).The levels of peripheral blood IgA,IgG,IgM and CD8+T cells in both groups at 7 d after surgery were significantly lower than those before surgery (P＜0.05) while the level of CD4+T cells was significantly higher than that before surgery (P＜0.05),and the levels of peripheral blood IgG and CD8+T cells in study group were higher than those in routine group while the level of CD4+T cells was lower than that in routine group (P＜0.05).Serum levels of IL-6,IL-10 and TNF-α were significantly higher in both groups at 7 d after surgery than before surgery (P＜0.05),and the levels of serum IL-6,IL-10 and TNF-α in study group were lower compared with those in routine group (P＜0.05).There were no statistical differences in the incidence rates of postoperative complications between both groups (P>0.05).Conclusion:Open AR via the main hepatic vein approach is safe and feasible in the treatment of primary liver cancer,and it can reduce the intraoperative blood loss and alleviate the liver function,immune function damage and inflammatory response.In addition,it has a positive effect on promoting the rehabilitation of patients.