复发肝癌腹腔镜再切除的临床分析  

Clinical analysis of completely laparoscopic re-hepatectomy for recurrent hepatocellular carcinoma

作　　者：张杰[1] 周仲国[1] 周东升[1] 崔伯康[1] 张耀军[1] 陈敏山[1] 

机构地区：[1]中山大学肿瘤防治中心肝胆科,广州510060

出　　处：《中华腔镜外科杂志（电子版）》2015年第1期14-17,共4页Chinese Journal of Laparoscopic Surgery(Electronic Edition)

基　　金：广州市健康医疗协同创新重大专项(201400000001-3)

摘　　要：目的分析复发肝癌完全腹腔镜下再切除的可行性和安全性。方法回顾性分析中山大学肿瘤防治中心肝胆科2014年3～10月行腹腔镜下肝癌切除术患者共49例的临床资料，其中复发肝癌10例为研究组，初次手术行腹腔镜肝癌切除术39例为对照组，分别比较两组的手术时间、术中失血量、术后下床活动时间、术后肛门排气时间、住院时间、住院费用等。同时，将研究组按复发部位分为同侧复发组（6例）和对侧复发组（4例），分别进行比较。结果所有患者均顺利完成手术，无中转开腹，术后无严重并发症发生。对照组与研究组相比，两组在手术时间、术中失血量、术后下床活动时间、术后肛门排气时间、住院时间、住院费用等指标均差异无统计学意义。在研究组中，对侧复发组在手术时间[（140．0±52．0）min vs（160．0±41．4）min，P=0．012）]、术中失血量（100．04-45．5）ml vs[（300．04-82．0）ml，P=0．000）]方面均明显少于同侧复发组（P〈0．05）。结论复发肝癌行腹腔镜再切除是安全、可行的，对侧复发再切除较容易，而同侧复发再切除难度较大，需严格把握手术的适应证。Objective To analyze the clinical feasibility and safety of laparoscopic re-hepatectomy for recurrent hepatocellular carcinoma （HCC）. Methods Between Mar. 2014 to Oct. 2014, 49 patients were treated with laparoseopic liver resection for HCC in our department. Among them, 10 cases with recurrent HCC （re-HCC） and 39 cases with initial HCC were divided into two groups receptively. For the 10 cases with re-HCC, 6 cases with ipsilateral recurrence and 4 cases with contralateral recurrence were also divided into two groups respectively. The operative time, intraoperative blood loss, postoperative ambulation time, hospital time and hospital costs were compared between groups. Results All patients were successfully operated without laparotomy, and there were no serious complications. There were no significant difference between initial surgery group and re-HCC group in operative time, intraoperative blood loss, postoperative ambulation time, hospital time and hospital costs respectively. The group with contralateral re- HCC was superior to the group with the ipsilateral re-HCC in less operative time [ （140.0 ± 52.0 rain） vs （ 160.0 ± 41.4） min, P = 0. 012 ） ] and intraoperative blood loss [ （ 100.0 ± 45.5 ） ml vs （ 300. 0± 82.0） ml, P = 0. 000） ]. Conclusion Laparoseopic rehepatectomy for recurrent HCC is feasible and safe. Re-resection for eontralateral recurrence was easier than that for ipsilateral recurrence.

关 键 词：腹腔镜肝切除 肝癌 复发 

分 类 号：R735.7[医药卫生—肿瘤]