完全腹腔镜肝切除术治疗肝细胞癌合并肝硬化的研究  

Pure laparoscopic hepatectomy for hepatocellular carcinoma with liver cirrhosis

作　　者：范瑞芳[1] 王湘辉[1] 袁克文[1] 肖毅[1] 张超[1] 胡鹏[1] 上官建营[1] 项红军[1] 李红梅[1] 许淑梅[1] 

机构地区：[1]兰州军区兰州总医院肝胆外科,甘肃兰州730050

出　　处：《西北国防医学杂志》2013年第6期504-506,共3页Medical Journal of National Defending Forces in Northwest China

基　　金：甘肃省自然科学研究基金计划项目资助(0803RJZA061)

摘　　要：目的:探讨完全腹腔镜肝切除术(PLH)治疗肝细胞癌合并肝硬化的可行性、安全性及疗效。方法:2003-07～2012-07的17例肝细胞癌合并肝硬化患者在全麻下行PLH,共治疗20个肿瘤,平均肿瘤直径(4.4±1.4)cm。肝功能ChildPugh A级6例,B级11例。结果:17例均顺利完成PLH。平均手术时间(143.4±50.3)min,平均术中出血量(334.1±221.9)ml。无一例中转开腹,未出现大出血、严重胆漏、肝功能衰竭等并发症。术后平均住院时间(6.4±2.4)d。术后随访12～73个月(平均39.3个月),1例肿瘤切除边缘复发,5例发现肝内新病灶,1例肺转移。经皮射频消融治疗4例,肝动脉化学栓塞(TACE)2例,6例死于肿瘤复发或肝功能衰竭。结论:PLH治疗肝细胞癌合并肝硬化安全可行,治疗效果肯定,具有局部创伤小、全身炎症反应轻、术后恢复快等优势,最适于肝脏表浅部位的肿瘤。Objective：To evaluate the feasibility, safety and efficacy of pure laparoscopic hepatectomy （PLH） for patients with hepatocellular carcinoma （HCC） and liver cirrhosis （ LC ）. Methods： From July 2003 to July 2012, 17 cirrhotic HCC patients with 20 tumors, with a tumor diameter of （4.4 ＋ 1.4） cm, were submitted to PLH under general anesthesia. The Child - Pugh score was class A in 6 patients and B in 11. Results： PLH was successfully performed in the 17 patients. The mean operation time was （ 143.4 ＋ 50.3 ） min, and the mean intrao- perative blood loss was（334.1 ＋ 221.9）ml. No patient was transferred into open surgery, and severe complications such as massive bleeding, intractable bile leakage and liver function failure were not observed in all patients. The postoperative hospital stay was（6.4 ＋ 2.4） days. During a median follow - up period of 39.3 months （ range, 12 - 73 months）, recurrent tumor on the resection margin was found in one patient, new hepatic malignant nodules in five, and pulmonary metastasis in one. Four patients received percutaneous radiofrequency ablation （RFA） thera- py, and two patients underwent transcatheter arterial chemoembolization （TACE）. Six patients died from tumor recurrence or liver failure. Conclusion：PLH is a feasible, safe and effective treatment modality for HCC patients with LC, with advantages of small trauma, slight systemic reaction and quick postoperative recovery, which may be suitable for the noncentral liver tumors.

关 键 词：肝细胞癌 肝硬化 腹腔镜 肝切除术 肝功能 复发 

分 类 号：R735.7[医药卫生—肿瘤]