腹腔镜解剖性肝段切除术治疗肝细胞癌的临床分析  

Efficacy of laparoscopic anatomical segmentectomy for hepatocellular carcinoma

作　　者：杨开金[1] 李建伟[1] 陈健[1] 范毓东[1] 郭鹏[1] 王小军[1] 郑树国[1] 

机构地区：[1]第三军医大学西南医院全军肝胆外科研究所,重庆400038

出　　处：《第三军医大学学报》2016年第10期1127-1132,共6页Journal of Third Military Medical University

基　　金：第三军医大学西南医院临床创新基金(SWH2013LC04)~~

摘　　要：目的探讨腹腔镜解剖性肝段切除术治疗肝细胞癌的临床疗效。方法回顾性分析2011年1月至2014年4月西南医院肝胆外科采用腹腔镜解剖性肝段切除术治疗的29例肝细胞癌患者临床资料。结果 29例患者中3例中转开腹,中转开腹率为10.3%,26例成功施行腹腔镜解剖性肝段切除术,切除部位例数分别为：Ⅰ段3例、Ⅱ段2例、Ⅲ段3例、Ⅳ段4例、V段6例、Ⅵ段7例、Ⅶ段2例、Ⅷ段2例。手术时间（220.17±61.56）min,术中出血量（311.72±127.70）m L,围手术期输血率3.44%,肿瘤直径（3.66±1.14）cm,切缘（2.11±0.87）cm,术后开始进食时间（1.69±0.71）d,术后住院时间（8.72±2.95）d,围手术期无死亡病例,术后并发症发生率为10.3%。术后病理检查均为肝细胞肝癌,其中高分化癌6例、中分化癌20例、低分化癌3例。29例患者均获得随访,随访时间为12-48个月,中位随访时间为26个月。术后1、3年总体生存率分别为92.8%、81.7%,无瘤生存率分别为89.5%、71.7%。将本研究病例按切除部位分为左前下段组（Ⅱ/Ⅲ/Ⅳb/Ⅴ/Ⅵ段）（19例）与后上段组（Ⅰ/Ⅳa/Ⅶ/Ⅷ段）（10例）,对比提示两组手术时间、术中失血量、肝门阻断率、肝门阻断时间、术后住院时间差异有统计学意义（P〈0.05）,而围手术期输血率、中转开腹率、术后开始进食时间、切缘、并发症发生率差异无统计学意义（P〉0.05）。两组1、3年总体生存率及无瘤生存率差异无统计学意义。结论在选择性病例中,腹腔镜解剖性肝段切除术治疗肝细胞肝癌安全、可行,近期效果好、早期复发率低,且初步证实腹腔镜解剖性肝段切除术不仅适用于左前下段肝癌的治疗,亦可运用于手术难度和风险较大的后上段肝癌的外科治疗。Objective To evaluate the clinical efficacy of laparoscopic anatomical segmentectomy for hepatocellular carcinoma（ HCC）. Methods Clinical data of 29 patients with HCC who received laparoscopic hepatectomy in the Southwest hospital from January 2011 to April 2014 were retrospectively analyzed. Results Three patients were converted to laparotomy,and the rate of conversion to laparotomy was 10. 3%. Twentysix patients received laparoscopic anatomical segmentectomy,and the resection segments were as follows：segment Ⅰ 3 cases,segment Ⅱ 2 cases,segment Ⅲ 3 cases,segment Ⅳ 4 cases,segment V 6 cases,segment Ⅵ 7 cases,segment Ⅶ 2 cases,and segment Ⅷ 2 cases. The operation time was 220. 17 ±61. 56 min,blood loss 311. 72 ± 127. 70 m L,perioperative blood transfusion rate 3. 44%,tumor diameter3. 66 ± 1. 14 cm,resection margin 2. 11 ± 0. 87 cm,time to diet 1. 69 ± 0. 71 d,postoperative hospital stay8. 72 ± 2. 95 d,postoperative complication rate 10. 3% and no perioperative death was observed. HCC were confirmed in all the patients, including 6 cases of highly differentiated HCC,20 cases of moderately differentiated HCC,and 3 cases of lowly differentiated HCC. Twenty-nine patients were followed up for 12 to48 months,and the median follow-up time was 26 months. Overall survival rate and tumor-free survival rate were 92. 8% and 81. 7%,respectively,in the 1st year,and 89. 5% and 71. 7%,respectively,in the 3rd year. The patients were divided into the anterolateral liver segment group（ segment Ⅱ / Ⅲ / Ⅳb / Ⅴ / Ⅵ）（ AL group： 19 cases） and the posterosuperior liver segment group（ segment Ⅰ / Ⅳ a / Ⅶ / Ⅷ）（ PS group： 10cases）. Statistically significant differences were found between the PS group and AL group in terms of operation time,intraoperative blood loss,inflow occlusion rate,duration of inflow occlusion and postoperative hospital stay,but there were no statistically significant differences in the perioperative blood transfusion rate,conversion to laparotomy rate,time

关 键 词：肝细胞癌 腹腔镜 解剖性肝段切除术 

分 类 号：R572[医药卫生—消化系统] R730.56[医药卫生—内科学]