腹腔镜与开腹肝切除术治疗大肝癌的效果比较  

An effect comparison between laparoscopic hepatectomy and open hepatectomy for large hepatocellular carcinoma(more than 5 cm)

作　　者：吴龙风 李岗[1] 曹德明[1] WU Long-feng;LI Gang;CAO De-ruing(Department of Oncology,Hangzhou Tumor Hospital,Hangzhou 310000,China)

机构地区：[1]杭州市肿瘤医院肿瘤外科,浙江杭州310000

出　　处：《肝胆胰外科杂志》2018年第4期288-292,共5页Journal of Hepatopancreatobiliary Surgery

基　　金：浙江省农业社会发展引导项目(20163501Y45)

摘　　要：目的探讨腹腔镜肝切除术(laparoscopic hepatectomy,LH)治疗直径大于5 cm肝癌的效果。方法回顾性分析杭州市肿瘤医院2011年2月至2014年6月符合纳入标准的62例肝癌患者的临床病例资料,按照治疗方法不同分为LH组和开腹肝切除术(open hepatectomy,OH)组,两组各31例,对比两组在围手术期间手术操作情况及术后恢复情况,同时统计分析患者短期生存状态。结果 LH组和OH组在年龄、性别、肿瘤位置、血清AFP水平、Edmondson-Steiner病理分级、肿瘤包膜有无、血管有无浸润、ChildPugh分级、手术时间、R0切缘、二级以上并发症等方面差异无统计学意义(P>0.05)。手术后,LH组在谷草转氨酶、谷丙转氨酶、术中失血量、住院时间、排气时间、引流管放置时间方面均少于OH组,差异具有统计学意义(P<0.05);LH组和OH组3年无瘤生存率(recurrence free survival,RFS)为74.2%vs 77.4%(P=0.765),3年总体生存率(overall survival,OS)为80.6%vs 83.9%(P=0.795),组间差异无统计学意义(P>0.05)。结论腹腔镜肝切除术治疗直径大于5 cm的肝癌,具有和开腹同样的治疗效果,并且腹腔镜具有加速患者康复的优势。Objective To investigate the effect of laparoscopic hepatectomy（LH） in the treatment for hepatocellular carcinoma（HCC） with diameter more than 5 cm.Methods Clinical data of 62 cases with hepatocellular carcinoma according to inclusion criteria from Feb.2011 to Jun.2014 in Hangzhou Tumor Hospital was retrospectively analyzed.According to different treatments,patients were divided into LH group and OH group,31 cases in each group the operation and postoperative recovery condition during perioperation were compared.In addition,the short-term survival was analyzed.Results There was no significant difference on age,gender,tumor location,the serum level of AFP,Edmondson-Steiner classification,pathological grade,tumor envelope,Child-Pugh classification,operation time,R0 margin,complications（greater than grade two） between LH and OH group（P〉0.05）.However,after surgery,the ALT,AST,blood loss,exhaust time,hospitalization duration,indwelling drainage duration in LH group were lower than those in OH group,the differences were statistically significant（P〈0.05）.The recurrence free survival（RFS） of 3 years in LH group and OH group were 74.2% vs 77.4%（P=0.765） and overall survival（OS） were 80.6% vs 83.9%（P=0.795） respectively.There was no significant difference between two groups（P〉0.05）.Conclusion LH for HCC with diameter greater than 5 cm has the similar effect with OH.Further more,LH can accelerate postoperative recovery of patients.

关 键 词：腹腔镜 癌 肝细胞 肝切除术 

分 类 号：R735.7[医药卫生—肿瘤]