腹腔镜肝切除术治疗肝细胞癌的临床体会  

Experience in laparoscopic hepatectomy in treatment of hepatocellular carcinoma

作　　者：田州 张建淮[3] 孙喜太 刘斌 祁付珍[3] 王业波[3] 吴金声[3] 顾殿华[3] TIAN Zhou;ZHANG Jianhuai;SUN Xitai(Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学,南京210000 [2]新沂市中医院,江苏新沂221400 [3]南京医科大学附属淮安第一医院肝胆外科,江苏淮安223300 [4]南京鼓楼医院微创外科,南京210000 [5]徐州医科大学附属医肿瘤外科,江苏徐州221002

出　　处：《临床肝胆病杂志》2018年第8期1712-1716,共5页Journal of Clinical Hepatology

基　　金：江苏省卫计委面上课题(H201668); 淮安市临床医学科技专项(HAS2014011); 淮安市高技术研究重点实验室“肝癌高技术研究重点实验室”(HAP201303); 淮安市科技局产学研联合研究项目(hc201215); 南京市卫计委重点课题(ZKX12014)

摘　　要：目的总结腹腔镜肝切除术治疗肝细胞癌的临床体会。方法选取2008年12月-2015年12月南京医科大学附属淮安第一医院、南京大学附属鼓楼医院、徐州医科大学附属医院收治的肝细胞癌患者临床资料。根据手术方式不同分为腹腔镜肝切除术组(LH组,n=391)和开腹肝切除术组(OR组,n=682)。比较两组手术时间、切口大小、术中出血量、术后恢复情况、术后住院时间、手术费用、住院费用及并发症情况等。计量资料两组间比较采用独立样本t检验;计数资料两组间比较采用χ~2检验。结果LH组与OR组相比,术中出血量[(165.00±79.21)ml vs(457.00±125.00)ml]、切口长度[(4.07±0.31)cm vs(20.48±2.36)cm]、进食时间[(1.50±0.61)d vs(2.43±0.40)d]、术后下床时间[(1.36±0.31)d vs(4.12+0.82)d]、住院时间[(10.09±3.52)d vs(15.36±4.57)d]、手术费用[(9471.00±639.73)元vs(5329.12±461.40)元]及住院费用[(37 315.17±13 194.78)元vs(35 007.6±10 611.20)元]差异均有统计学意义(t值分别为41.64、136.80、30.10、63.98、19.70、122.44、3.13,P值均<0.05)。LH组1、3、5年生存率分别为89.42%、64.32%、43.12%,OR组1、3、5年生存率分别为88.11%、61.45%、38.38%,两组生存率比较,差异无统计学意义(P>0.05)。结论腹腔镜肝切除术具有创伤小、术中出血少、恢复快的优点,可缩短住院时间,未增加术后并发症,对于周围型和微小肝癌及左外叶肝肿瘤,建议作为首选治疗方法之一。Objective To summarize the clinical experience in laparoscopic hepatectomy in the treatment of hepatocellular carcinoma（ HCC）. Methods The patients with HCC who were admitted to Huaian No. 1 People＇s Hospital Affiliated to Nanjing Medical University,Drum Tower Hospital Affiliated to Nanjing University,and The Affiliated Hospital of Xuzhou Medical Hospital from December 2008 to December 2015 were enrolled and their clinical data were collected. According to the surgical procedure,these patients were divided into laparoscopic hepatectomy group with 391 patients（ LH group） and open hepatectomy group with 682 patients（ OR group）. The two groups were compared in terms of time of operation,incision size,intraoperative blood loss,postoperative recovery,length of postoperative hospital stay,surgery costs,hospital costs,and complications. The independent samples t-test was used for comparison of continuous data between two groups,and the chi-square test was used for comparison of categorical data between two groups. Results There were significant differences between the LH group and the OR group in intraoperative blood loss（ 165. 00 ± 79. 21 ml vs 457. 00 ± 125. 00 ml,t = 41. 64,P〈 0. 05）,length of incision（ 4. 07 ± 0. 31 cm vs 20. 48 ± 2. 36 cm,t = 136. 80,P 〈0. 05）,time to diet（ 1. 50 ± 0. 61 d vs 2. 43 ± 0. 40 d,t =30. 10,P〈 0. 05）,time to ambulation after surgery（ 1. 36 ± 0. 31 d vs 4. 12 ＋ 0. 82 d,t = 63. 98,P〈 0. 05）,length of hospital stay（ 10. 09 ± 3. 52 d vs 15. 36 ± 4. 57 d,t = 19. 70,P 〈0. 05）,surgery costs（ 9471. 00 ± 639. 73 yuan vs 5329. 12 ± 461. 40 yuan,t =122. 44,P 〈0. 05）,and hospital costs（ 37 315. 17 ± 13 194. 78 yuan vs 35 007. 6 ± 10 611. 20 yuan,t = 3. 13,P 〈0. 05）. The 1-,3-,and 5-year survival rates were 89. 42%,64. 32%,and 43. 12% in the LH group and 88. 11%,61. 45%,and 38. 38% in the OR group,and there were no significant differences between the two groups（ P 〉0. 05）. Conclusion LH has the advantages of little trauma,lo

关 键 词：癌 肝细胞 腹腔镜检查 肝切除术 治疗学 

分 类 号：R735.7[医药卫生—肿瘤]