完全腹腔镜与开腹肝切除术治疗左外叶肝细胞癌的效果比较  

Total laparoscopic hepatectomy versus open hepatectomy in treatment of hepatocellular carcinoma in the left lateral lobe: a case- matched analysis

作　　者：熊勇[1] 王何斌 刘德钦[1] 陈建勋[1] 刘建平[1] 孙昌勤[1] 

机构地区：[1]攀枝花市中心医院肝胆外科,四川攀枝花617067

出　　处：《临床肝胆病杂志》2016年第4期735-738,共4页Journal of Clinical Hepatology

摘　　要：目的探索完全腹腔镜肝切除治疗左外叶肝细胞癌(HCC)的安全性、可行性和有效性。方法选取2012年4月^(-2)015年4月攀枝花市中心医院收治的经术后病理证实为左外叶HCC且行完全腹腔镜左肝外叶切除术(LLLR)的患者25例与同时期的另外25例行开腹左肝外叶切除(OLLR)的HCC患者进行病例配对分析。计量资料2组间比较采用t检验,计数资料2组间比较采用χ~2检验或Fisher确切概率法,生存分析采用Kaplan-Meier法,生存曲线的比较采用log-rank检验。结果 LLLR组与OLLR组在手术时间、术中输血例数、R0切缘例数方面比较差异均无统计学意义(P值均>0.05),但在术中出血量[(216.40±15.39)d vs(273.20±16.65)d]、平均住院时间[(6.92±0.28)d vs(10.32±0.52)d]和手术并发症发生率(20%vs 48%)方面差异有统计学意义(P值均<0.05)。LLLR组与OLLR组在1、3年总体生存率和无进展生存率方面比较差异均无统计学意义(P值均>0.05)。结论 LLLR与OLLR治疗左外叶HCC相比,不仅远期效果相似,而且在手术出血量、手术并发症、住院时间等方面更具优势。Objective To investigate the safety,feasibility,and efficacy of total laparoscopic hepatectomy in the treatment of hepatocellular carcinoma（ HCC） in the left lateral lobe. Methods A case- matched analysis was performed between 25 patients with HCC in the left lateral lobe confirmed by postoperative pathological examination,who were admitted to Panzhihua Central Hospital and underwent total laparoscopic left lobe resection（ LLLR） from April 2012 to April 2015,and 25 patients with HCC who underwent open left lobe resection（ OLLR）during the same period. The t- test was used for comparison of continuous data between the two groups,and the chi- square test or Fisher＇s exact test was used for comparison of catagorical data between the two groups; the Kaplan- Meier method was used for survival analysis,and the log- rank test was used for comparison of survival curves. Results The time of operation,number of patients undergoing intraoperative blood transfusion,and number of patients with R0 resection margin showed no significant differences between the LLLR group and the OLLR group,but intraoperative blood loss（ 216. 4 ± 15. 39 ml vs 273. 2 ± 16. 65 ml）,mean hospital stay（ 6. 92 ± 0. 29 min vs 10. 32 ±0. 52 min）,and postoperative complications（ 5 cases vs 12 cases） showed significant differences between the two groups（ all P〈0. 05）.The 1- and 3- year overall survival rates and progression- free survival showed no significant differences between the LLLR group and the OLLR group. Conclusion LLLR and OLLR have similar long- term efficacy in the treatment of HCC in the left lateral lobe,and LLLR has advantages in the aspects of intraoperative blood loss,postoperative complications,and length of hospital stay.

关 键 词：癌 肝细胞 腹腔镜检查 肝切除术 对比研究 

分 类 号：R735.7[医药卫生—肿瘤]