腹腔镜下不同肝切除方式治疗原发性肝癌的临床疗效分析  

Clinical analysis of different hepatectomy under laparoscope in the treatment of primary liver cancer

作　　者：张立献[1] 张伟[2] 王国珍 韩雪[1] 蒋光林 ZHANG Li-xian;HANG Wei;WANG Cuo-zhen;HAN Xue;JIANG Cuang-lin(Department of General Surgery, North China Petroleum Administration General Hospital of Hebei Provence 062552, China;Internal medicine, North China Oilfield underground hospital of Hebei Provence 062552, China;Hemodialysis room, Kang Ji Xin Tu Hospital of Renqiu City 062552, China)

机构地区：[1]华北石油管理局总医院普外科,任丘062552 [2]华北油田井下医院内科,任丘062552 [3]河北省任丘市康济新图医院血透室,任丘062552

出　　处：《肝胆外科杂志》2018年第2期119-122,共4页Journal of Hepatobiliary Surgery

摘　　要：目的分析腹腔镜下不同肝切除方式治疗对原发性肝癌(PLC)患者围术期指标、术后并发症及1年无瘤生存率的影响。方法 120例PLC患者根据腹腔镜下肝切除方式不同分为解剖组和非解剖组各60例,分别行腹腔镜下解剖性肝切除术、腹腔镜下非解剖性肝切除术。观察围术期指标,评估残余肝功能,并统计术后并发症发生情况及随访1年内肝内复发、肝外转移及1年无瘤生存率情况。结果与非解剖组相比,解剖组手术时间明显延长,但术中失血量和输血量明显少、术后住院时间明显缩短,差异有统计学意义(P<0.05)。两组术前各项肝功能指标比较无统计学意义(P>0.05),但解剖组术后7 d谷丙转氨酶(ALT)、谷草转氨酶(AST)、胆红素(TBIL)水平显著低于非解剖组,差异有统计学意义(P<0.05)。解剖组、非解剖组术后并发症发生率为11.67%、26.67%,比较有统计学意义(P<0.05)。术后1年随访期内,两组肝内复发、肝外转移率比较无统计学意义(P>0.05),但解剖组1年无瘤生存率76.67%明显较非解剖组的58.33%高,差异有统计学意义(P<0.05)。结论腹腔镜下解剖性肝切除虽然延长了手术时间,但可控制失血量与输血量,减轻对PLC患者残余肝功能的损伤,减少手术并发症,并对1年无瘤生存率的提高亦有积极影响。Objective To analyze the effect of different laparoscopic hepatectomy on perioperative indicators, postoperative complications and 1-year tumor-free survival of patients with primary liver cancer （PLC）. Methods 120 patients with PLC were divided into anatomical group and non-anatomical group according to different laparoscopic hepatectomy, 60 cases in each group. The two groups were treated with laparoscopic anatomical hepatectomy and laparoscopic non-anatomical hepatectomy respectively. Perioperative indicators were observed, and the residual liver function was assessed. Postoperative complications, intrahepatic recurrence and extrahepatic metastasis within 1 year of follow-up and 1-year tumor-free survival rate were statistically analyzed. Results Compared with the non- anatomical group, the operative time of the anatomical group was obviously longer, the intraoperative blood loss and blood transfusion volume were significantly less and the postoperative length of hospital stay was shorter （ P 〈 0. 05 ）. There was no significant difference of liver function indexes between the two group before operation （ P 〉 0.05 ）. Levels of alanine aminotransferase （ ALT）, as- partate aminotransferase （AST） and bilirubin （TBIL） in the anatomical group at 7d after operation were significantly lower than those in non-anatomical group （ P 〈 0. 05 ）. There was a significant difference in the incidence of postoperative complications between the an- atomical group and the non - anatomical group （ 11.67% vs 26. 67% ） （P 〈0. 05）. During 1 year of follow-up, there was no signifi- cant difference in recurrence rate or extrahepatic metastasis rate between the two groups （ P 〉 0. 05 ）, but the 1 -year tumor-free survival rate of the anatomical group was significantly higher than that in the non-anatomical group （76. 67% vs 58. 33% ） （P 〈0. 05）. Conclusion Although the during of laparoscopic anatomical hepatectomy is long, it can control blood loss and blood transfusion volume a

关 键 词：解剖性肝切除 原发性肝癌 围术期 并发症 无瘤生存 

分 类 号：R735.7[医药卫生—肿瘤]