Clinical value of laparoscopic single-site surgery for benign ovarian tumors and the prognostic value of combination of HE4, CA125 and β-HCG
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摘要:
目的探讨血清人附睾蛋白4（HE4）、血清糖类抗原125(CA125)及人绒毛膜促性腺激素（β-HCG）水平联合预测经脐单孔腹腔镜手术治疗卵巢良性肿瘤疗效的临床价值。 方法回顾分析2017年1月~2019年3月于我院妇产科确诊为卵巢良性肿瘤的120例患者，依据患者选择手术方式的不同分为两组：观察组选择单孔腹腔镜手术治疗，共72例，年龄21~63岁（32.98±9.34岁），肿瘤直径3.69~9.78 cm（5.46±3.65 cm）；对照组选择传统多孔腹腔镜手术治疗，共48例，年龄19~68岁（33.02±9.35岁），肿瘤直径3.82~9.93 cm（5.61±3.68 cm）。检测两组血清HE4、CA125及β-HCG水平，并观察两组疗效，进行比较分析。 结果两组患者手术过程顺利，无术中与术后并发症。观察组与对照组比较，术中出血情况、排气时间差异无统计学意义（P>0.05）；观察组的手术时间比对照组长（P<0.05），但观察组的住院时间较对照组短（P<0.05），且患者满意度评分均高于对照组（P<0.05）。两组术前血清HE4、CA125及β-HCG水平比较差异无统计学意义（P>0.05），两组术后血清HE4、CA125及β-HCG水平较术前降低，差异有统计学意义（P<0.05）。观察组术后12 h的HE4、CA125及β-HCG水平比术后1、3 d降低（P<0.05），术后1、3 d之间差异无统计学意义（P>0.05）；对照组术后12 h、1 d、3 d差异均有统计学意义（P<0.05）。ROC分析显示，HE4、CA125、β-HCG的曲线下面积分别为：0.901、0.820、0.736；各项指标联合检测的曲线下面积为0.957。 结论血清HE4、CA125及β-HCG水平联合检测可有效评价单孔腹腔镜手术治疗卵巢良性肿瘤的临床疗效，且达到预期疗效的同时，提高了患者满意度，值得临床推广。 Abstract:ObjectiveTo investigate the clinical value of serum human epididymis protein 4 (HE4), serum carbohydrate antigen 125(CA125), and β-Human chorionic gonadotropin(β-HCG）levels in combination to predict the efficacy of laparoscopic single-site surgery in the treatment of benign ovarian tumor. MethodsFrom January 2017 to March 2019, 120 cases of benign ovarian tumors were diagnosed after treatment in the department of obstetrics and gynecology of our hospital. The patients were divided into two groups according to different surgical methods. The observation group chosed single-hole laparoscopic surgery for 72 patients, with the age from 21 to 63 years old (average 32.98±9.34) and the tumor diameter from 3.69~9.78 cm (average 5.46±3.65 cm), while the control group chosed traditional multi-site laparoscopic surgery for 48 patients, with the age from 19 to 68 years old (average 33.02±9.35) and the tumor diameter from 3.82 to 9.93 cm (average 5.61±3.68 cm). Serum levels of HE4, CA125 and β-HCG in the two groups were detected, and the effects of the two groups was observed for comparative analysis. ResultsThe operation of the two groups was smooth, without intraoperative or postoperative complications. The difference in intraoperative bleeding and exhaust time between the observation group and the control group was not significant (P>0.05). The operation time of the observation group was longer than that of the control group (P<0.05). The length of time of the observation group was shorter than that of the control group (P<0.05), and the patient satisfaction score was higher than that of the control group (P<0.05). The difference in serum HE4, CA125 and β-HCG between the two groups before surgery was not significant (P>0.05). The postoperative serum HE4, CA125 and β-HCG between the two groups were significantly lower than those before surgery (P<0.05). The levels of HE4, CA125 and β-HCG in the observation group at 12 hours after the operation were significantly lower than those at 1 day and 3 days after the operation (P<0.05). The difference between 1 day and 3 days after the operation was not significant(P>0.05). The differences in the control group at 12 hours, 1 day and 3 days after surgery were significant(P<0.05). ROC analysis showed that the AUC of all indexes were: HE4 (0.901), CA125 (0.820) and β-HCG（0.736）, AUC of all indexes was 0.957. ConclusionThe combined detection of serum HE4, CA125 and β-HCG levels can effectively evaluate the clinical efficacy of laparoscopic single-site surgery in the treatment of benign ovarian tumors. It can achieve the expected efficacy and improve patient satisfaction. -
图 1 两组术前、术后CT及并发症情况
A：观察组术前；B：对照组术前；C：观察组术后；D：对照组术后；E：术中切除前情况；F：术中切除剥离肿瘤过程；G：术中肿瘤切除情况；H：术中切除后情况；A-D为CT增强影像，E-H为腹腔镜下观察图.
Figure 1. CT and complications before and after operation in two groups
表 1 两组临床疗效的比较（Mean±SD）
Table 1. Comparison of clinical efficacy between two groups
类目 术中出血量（mL） 术后排气时间（h） 手术时间（min） 术后住院时间（d） 患者满意度评分（分） 观察组（n=72） 18.02±7.98 10.49±2.57 68.52±15.38 2.21±1.03 4.70±0.92 对照组（n=48） 27.75±11.46 15.89±3.09 53.91±12.87 4.38±1.84 3.65±0.58 t 4.170 4.961 2.653 3.493 6.641 P 0.006 0.004 0.033 0.008 0.000 
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表 2 两组HE4、CA125及β-HCG水平的比较（Mean±SD）
Table 2. Comparison of HE4、CA125 and β-HCG levels between two groups
指标 组别 术前 术后12 h 术后第1天 术后第3天 HE4（pmol/L） 观察组（n=72） 272.02±29.98# 68.18±9.23*a 43.67±4.15* 45.01±4.54 对照组（n=48） 269.91±29.83# 145.43±18.01a 98.57±11.02 46.83±4.56 CA125（U/mL） 观察组（n=72） 106.23±13.46# 47.86±4.09*a 30.99±3.17* 31.70±3.18 对照组（n=48） 104.79±13.42# 76.71±9.79a 52.84±4.80b 31.98±3.19 β-HCG（mU/mL） 观察组（n=72） 19.88±10.30# 5.94±2.06*a 2.95±1.73* 3.01±1.74 对照组（n=48） 19.64±10.29# 10.42±6.67a 6.97±2.73 3.25±1.79 *P<0.05 vs对照组; #P<0.05 vs术后12 h、1 d、3 d；aP<0.05vs术后1 d、3 d.
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表 3 HE4、CA125及β-HCG单独与联合检测诊断卵巢良性肿瘤的价值
Table 3. Value of HE4、CA125 and β-HCG alone and in combination for diagnosis of benign ovarian tumors
类目 AUC 标准误 P 渐进95%置信区间 HE4 0.901 0.028 0.000 0.853-0.969 CA125 0.820 0.047 0.000 0.711-0.914 β-HCG 0.736 0.053 0.002 0.627-0.835 三者联合 0.957 0.0207 0.000 0.916-0.984
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