腹腔镜肝切除术与开腹肝切除术治疗肝细胞癌的临床疗效  

Clinical efficacy of laparoscopic versus open hepatectomy for the treatment of hepatocellular carcinoma

作　　者：向伦建[1] 刘燕[1] 程黎[1] 袁云峰[1] 苟剑林[1] Xiang Lunjian;Liu Yah;Cheng Li;Yuan Yunfeng;Gou Jianlin(Department of Hepatobiliary Surgery,Chongqing Three Gorges Central Hospital,Chongqing 404000,China)

机构地区：[1]重庆三峡中心医院肝胆外科,404000

出　　处：《国际外科学杂志》2019年第2期112-118,F0004,共8页International Journal of Surgery

摘　　要：目的 探讨腹腔镜肝切除术和开腹肝切除术治疗肝细胞癌(简称肝癌)的临床疗效。方法 回顾性分析2014年10月—2017年12月重庆三峡中心医院收治的216 例肝癌患者的临床资料,其中施行腹腔镜肝切除术52 例(腹腔镜组),开腹肝切除术164 例;根据倾向性评分最临配比法,在164 例开腹肝切除术病例中选取52 例为开腹组,与腹腔镜组进行对比研究,对比指标有手术时间、肿瘤直径、切缘、第一肝门入肝血流阻断时间、失血量、输血率、术后并发症发生率、腹腔引流管拔除时间、胃肠道功能恢复时间、住院时间及肿瘤学结果。符合正态分布的计量资料结果用均数±标准差(Mean±SD)表示,组间比较采用t检验;偏态分布的计量资料结果用M(范围)表示,组间比较采用Wilcoxon秩和检验。计数资料用χ2检验或Fisher确切概率法;采用Kaplan-Meier法绘制生存曲线,生存率比较用Log-rank检验。Cox回归模型评价影响肝癌患者生存的危险因素。结果 两组患者均康复出院,无围手术期死亡。腹腔镜组与开腹组患者手术时间、肿瘤直径、切缘、第一肝门入肝血流阻断时间分别为(226.1±67.5) min、(49.2±15.5) mm、(14.3±4.9) mm、(34.1±18.1) min和 (227.0±55.7) min、(49.4±16.6) mm、(14.6±4.0) mm、(38.2±16.1) min,差异无统计学意义(P>0.05);腹腔镜组与开腹组失血量、输血率、术后并发症发生率、腹腔引流管拔除时间、胃肠道功能恢复时间、住院时间分别为325(50~1 200) ml、11.5%、15.4%、(4.8±0.9) d、3(2~5) d、(11.9±3.5) d和375(100~2 000) ml、19.2%、23.1%、(5.9±0.8) d、4(3~5) d、(14.9±6.2) d,差异有统计学意义(P<0.05)。腹腔镜组中转开腹率7.7%(4/52)。腹腔镜组1、3 年总体生存率分别为93.4%、83.7%,1、3 年无瘤生存率分别为87.8%、71.2%;开腹组1、3 年总体生存率分别为94.1%、82.5%,1、3 年无瘤生存率分别为88.3%、70.8%,两组相比差异均无统计学意义(P>0.05)�Objective To evaluate the clinical efficacy of laparoscopic hepatectomy and open hepatectomy for the treatment of hepatocellular carcinoma. Methods Two hundred and sixteen patients with hepatocellular carcinoma who were admitted to the Chongqing Three Gorges Central Hospital from October 2014 to December 2017 were enrolled in this study, 52 patients undergoing laparoscopic hepatectomy (laparoscopic group) and 164 patients undergoing open hepatectomy, 52 patients(open group) were matched by propensity score matching method to reduce confounding bias. The operation time, tumor sizes, resection margin, time of hepatic inflow occlusion, volume of blood loss, blood transfusion, postoperative complication rate, drainage tube removal time, postoperative anal exhaust time, duration of postoperative hospital stay and survival rates were compared. T test was used for the measurement data in line with the normal distribution, and the results were represented by (Mean±SD) tandard deviation;Wilcoxon test was used for the measurement data in the skewed distribution, and M(range) was used for represention, and the chi\|square test or Fisher′s exact probability test was used for the counting data. Kaplan-meier method was used to describe the survival curve, and log-rank test was used to compare the survival rate. Cox regression model was used to evaluate the risk factors affecting the survival of patients with hepatocellular carcinoma. Results All patients were recovered with no perioperative death. The operation time, tumor sizes, resection margin, time of hepatic inflow occlusion were (226.1±67.5) min, (49.2±15.5) mm, (14.3±4.9) mm, (34.1±18.1) min and (227.0±55.7) min, (49.4±16.6) mm, (14.6±4.0) mm, (38.2±16.1) min,with no significant differences between the two groups(P>0.05). The volume of blood loss, blood transfusion, postoperative complication rate, drainage tube removal time, postoperative anal exhaust time, duration of postoperative hospital stay were 325(50-1 200) ml, 11.5%, 15.4%, (4.8±0.9) d, 3(2-5) d, (

关 键 词：癌  肝细胞 肝切除术 腹腔镜 

分 类 号：R735.7[医药卫生—肿瘤]