腹腔镜与开腹肝脏切除术治疗肝细胞癌的临床疗效分析  

Clinical efficacy of laparoscopic liver resection versus open liver resection for hepatocellular carcinoma

作　　者：池其煜 石铮[1] 翁山耕[1] 郑岩松[1] 张志波[1] 杨明智[1] 陈有挺[1] 

机构地区：[1]福建医科大学附属第一医院肝胆胰外科,福州市350005

出　　处：《中国肿瘤临床》2017年第14期706-711,共6页Chinese Journal of Clinical Oncology

基　　金：国家临床重点专科建设项目(编号:2013-GJLCZD);卫生部医药卫生科技发展研究中心支持项目(编号:W2012RQ18)资助~~

摘　　要：目的:探讨腹腔镜与开腹肝脏切除术治疗肝细胞癌(hepatocellular carcinoma,HCC)的近期及远期临床疗效。方法:回顾性分析2013年1月至2016年5月在福建医科大学附属第一医院行肝细胞癌切除患者的临床资料,为减少选择偏倚采用逐一配对法进行配对,最终纳入腹腔镜组105例,开腹组105例。比较手术及术后的无瘤生存率以及总生存率,并行统计学分析。结果:腹腔镜组术后住院时间更短[(8.68±2.82)d vs.(10.61±2.95)d,P<0.01],肝门阻断率更低(20.0%vs.41.0%,P<0.01),且腹腔引流管拔除时间更早[(4.45±2.53)d vs.(5.40±2.43)d,P<0.01]。腹腔镜组1、2、3年生存率分别为96.88%、87.54%、79.50%,开腹组1、2、3年生存率分别为94.91%、86.29%、76.37%(P=0.670)。腹腔镜组1、2、3年无瘤生存率分别为72.09%、60.16%、52.08%,开腹组1、2、3年无瘤生存率分别为69.48%、56.50%、48.13%(P=0.388)。结论:腹腔镜肝脏切除术(laparoscopic liver resection,LLR)治疗肝细胞癌安全可行,与开腹肝脏切除术(open liver resection,OLR)相比,具有相当的远期疗效,同时腔镜组术后住院时间更短、肝门阻断率更低,且引流管拔除时间更早,显示较好的近期疗效。Objective：To compare the short-and long-term outcomes of laparoscopic liver resection（LLR） with those of open liver resection（OLR） for hepatocellular carcinoma（HCC）.Methods：Clinical data from patients who suffered from HCC and received LLR or OLR from January 2013 to May 2016 in The First Affiliated Hospital of Fujian Medical University were analyzed restrospectively.To overcome selection bias,a 1：1 match was performed via a case-control study.After case-control matching was completed,105 patients were included in each group.Short-term outcomes of operation and postoperation as well as long-term outcomes,including diseasefree survival and overall survival rates,were evaluated.Relevant statistical methods were used for statistical analysis.Results：The postoperative hospital stay of the laparoscopic group was shorter（8.68±2.82 vs.10.61±2.95 days,P〈0.01） and its use of portal triad clamping was less（20.0% vs.41.0%,P〈0.01） than those of the open group.The abdominal drainage tube of the laparoscopic group was also removed at an earlier time than that of the open group（4.45±2.53 vs.5.40±2.43 days,P〈0.01）.The 1-,2-,and 3-year overall survival rates of the laparoscopic group were 96.88%,87.54%,and 79.50%,respectively.By comparison,the 1-,2-,and 3-year overall survival rates of the open group were 94.91%,86.29%,and 76.37%,respectively（P=0.670）.The 1-,2-,and 3-year disease-free survival rates of the laparoscopic group were 72.09%,60.16%,and 52.08%,respectively,while the 1-,2-,and 3-year disease-free survival rates of the open group were 69.48%,56.50%,48.13%,respectively（P=0.388）.Conclusion：LLR is a safe and feasible procedure.LLR in the selected patients with HCC showed similar long-term outcomes to those of OLR.The postoperative hospital stay of these patients who underwent LLR was shorter and their use of portal triad clamping was less than those of the patients who received OLR.The abdominal drainage tube of the former was also removed at an earlier time than that of t

关 键 词：腹腔镜 肝脏切除术 肝细胞癌 短期疗效 长期疗效 

分 类 号：R735.7[医药卫生—肿瘤]