腹腔镜超声于肝癌腹腔镜切除术中的应用及对患者的影响

目的　探究腹腔镜超声于肝癌腹腔镜切除术中的应用及对患者切缘情况、肿瘤凋亡有关分子及预后的影响。方法　选取2016年2月至2018年6月日照市岚山区人民医院小肝癌患者79例，其中男59例、女20例，年龄（53.57±10.16）岁，依据治疗方案不同分为腹腔镜超声组（40例）、常规组（39例）。常规组行常规肝癌腹腔镜切除术，腹腔镜超声组行腹腔镜超声下手术。比较两组手术与切缘情况、并发症、术后3年生存情况与术前、术后2周、4周肿瘤凋亡有关分子［凋亡相关因子（Fas）、凋亡相关因子配体（FasL）、半胱氨酸天冬氨酸蛋白酶-3（Caspase-3）］表达量、血清肿瘤标志物［甲胎蛋白（AFP）、磷脂酰肌醇蛋白聚糖3（GPC3）、癌胚抗原（CEA）］、肝功能指标［天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、总胆红素（TBIL）］水平，其中计量资料行t检验，不同时间点、组别及交互作用下计量资料应用重复测量分析，计数资料行χ²检验。结果　腹腔镜超声组术中出血量较常规组少，术后下床活动时间、住院时间均较常规组短，平均与最短环周切缘距离均较常规组长，两组比较差异均有统计学意义（均P<0.05）；腹腔镜超声组术后2周、4周肿瘤组织中的Fas［（129.42±14.68）、（142.95±16.74）］、Caspase-3 mRNA［（137.30±17.08）、（151.24±18.23）］表达量均高于常规组［（112.85±12.79）、（125.47±14.96）、（121.16±13.71）、（132.09±16.54）］（F=17.185、14.769，均P<0.001），FasL mRNA表达量［（74.85±6.73）、（65.68±5.25）］低于常规组［（86.36±7.52）、（79.09±6.16）］（F=19.059，P<0.001）；腹腔镜超声组术后并发症率为10.00%（4/40），低于常规组的28.21%（11/39）（χ²=4.255，P=0.039）；腹腔镜超声组术后3年总生存率为77.50%（31/40）、无瘤生存率为42.50%（17/40），与常规组的66.67%（26/39）、35.90%（14/39）相比，差异均无统计学意义（χ²=1.153、0.361，P=0.283、0.548）。结论　腹腔镜超声应用于肝癌腹腔镜切除术患者可保证环周切缘，减轻手术创伤，调节肿瘤凋亡有关分子表达，降低肿瘤恶性程度，改善肝功能，减少并发症，促进患者恢复。

Application of laparoscopic ultrasound in laparoscopic resection of liver cancer and its influence on patients

Objective　To explore the application of laparoscopic ultrasound in laparoscopic resection of liver cancer and its influence on patients' margins, tumor apoptosis-related molecules, and prognosis. Methods　Seventy-nine patients with small hepatocellular carcinoma treated at People's Hospital of Lanshan District from February 2016 to June 2018 were selected, including 59 males and 20 females, with an age of (53.57±10.16). They were divided into a laparoscopic ultrasound group (40 cases) and a conventional group (39 cases) according to different treatment plans. The conventional group underwent conventional laparoscopic resection of liver cancer, and the laparoscopic ultrasound group were surgically treated under laparoscopic ultrasonography. The operation and incision margins, complications, postoperative 3-year survival rates, expressions of tumor apoptosis-related molecules apoptosis-related factors (Fas), apoptosis-related factor ligands (Fas), and FasL), and caspase-3 (Caspase-3)], and levels of serum tumor markers alpha-fetoprotein (AFP), glypican 3 (GPC3), and carcinoembryonic antigen (CEA)] and liver function indicators aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin (TBIL)] were compared between these two groups. The measurement data were subjected to t test. MANOVA of repeated measuring was used between different time points and groups. The χ² test was used for the enumeration data. Results　The intraoperative bleeding volume was lower, the postoperative ambulation time and hospital stay were shorter, and the average and shortest distances from the circumferential incision edge were longer in the laparoscopic ultrasound group than in the conventional group, with statistical differences (all P<0.05). Two and four weeks after the operation, the expressions of Fas (129.42±14.68) vs. (112.85±12.79) and (142.95±16.74) vs. (125.47±14.96); F=17.185, P<0.001] and Caspase-3 mRNA (137.30±17.08) vs. (121.16±13.71) and (151.24±18.23) vs. (132.09±16.54); F=14.769, P<0.001] in the tumor tissue were higher and the expressions of FasL mRNA (74.85±6.73) vs. (86.36±7.52) and (65.68±5.25) vs. (79.09±6.16); F=19.059, P<0.001] were lower in the laparoscopic ultrasound group than in the conventional group (all P<0.05). The incidence of postoperative complications was 10.00% (4/40) in the laparoscopic ultrasound group, and was 28.21% (11/39) in the conventional group (χ²=4.255, P=0.039). The 3-year overall survival rate after the operation and the tumor-free survival rate were 77.50% (31/40) and 42.50% (17/40) in the laparoscopic ultrasonography group, and were 66.67% (26/39) and 35.90% (14/39) in the conventional group, with no statistical differences (χ²=1.153 and 0.361, P=0.283 and 0.548). Conclusion　The application of laparoscopic ultrasound in patients undergoing laparoscopic resection of liver cancer can ensure the circumferential margins, reduce surgical trauma, regulate the expression of tumor apoptosis-related molecules, decrease tumor malignancy, improve liver function, reduce complications, and promote the patients' recovery.