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目的探讨腹腔镜肝癌手术阻断第一肝门血流对患者免疫功能的影响。方法原发性肝癌患者168例采用三种术式:后腹腔镜肝脏切除,术中阻断第一肝门血流(A组,52例);腹腔镜肝脏切除,术中不阻断第一肝门血流(B组,56例);C组60例,开腹肝脏切除,术中阻断第一肝门血流。比较三组手术相关资料,检测治疗前后外周血单核细胞中CD4+细胞、CD8+细胞和自然杀伤(NK)细胞比例以及血清IL-2、IL-4和IFN-γ浓度。结果 A组和C组手术出血量显著少于B组(P<0.05)。A组住院时间显著短于B组和C组(P<0.05)。A组和C组ALT低于B组(P<0.05)。A组治疗前后外周血CD4+细胞、CD8+细胞和NK细胞比例以及血清IL-2、IL-4和IFN-γ浓度均无统计学差异(P>0.05);但B组和C组治疗后上述指标均明显低于治疗前(P<0.05)。结论后腹腔镜肝脏切除,术中阻断第一肝门血流,创伤小、出血少、较少影响肝功能和患者免疫功能。
Objective To investigate the effect of laparoscopic liver cancer surgery on the first hepatic portal blood flow in patients with immune function. Methods A total of 168 patients with primary liver cancer underwent three procedures: retroperitoneal laparoscopic hepatectomy, intraoperative blocking of the first hepatic portal blood flow (group A, n = 52), laparoscopic liver resection without interruption of the first Hepatic portal blood flow (group B, 56 cases); Group C 60 cases, resection of open liver, intraoperative blocking of the first portal blood flow. The levels of CD4 + cells, CD8 + cells and natural killer (NK) cells in peripheral blood mononuclear cells and serum IL-2, IL-4 and IFN-γ levels in the three groups were compared before and after treatment. Results The blood loss in group A and group C was significantly less than that in group B (P <0.05). The length of stay in group A was significantly shorter than that in group B and C (P <0.05). ALT in group A and group C was lower than that in group B (P <0.05). There was no significant difference in the proportion of CD4 + cells, CD8 + cells and NK cells in peripheral blood before and after treatment in group A as well as the concentrations of IL-2, IL-4 and IFN-γ in serum (P> 0.05) Were significantly lower than before treatment (P <0.05). Conclusions Retroperitoneal laparoscopic resection of the liver, intraoperative blocking of the first hepatic portal vein, trauma, less bleeding, less affect the liver function and immune function.