完全腹腔镜和开腹肝切除手术治疗原发性肝细胞肝癌的近期和远期疗效比较  

Short-term and long-term efficacy of laparoscopic versus open liver resection in the treatment of hepatocellular carcinoma

作　　者：张浩[1] 董科[1] 俞小炯[1] 许建[1] 汪旭[1] YU Xiaojiong;ZHANG Hao;DONG Ke;XU Jian;WANG Xu(Hepatobiliary and Pancreatic Surgery Center,Sichuan Academy of Medical Sciences & Sichuan Provincial People′ s Hospital,Chengdu 610072,China)

机构地区：[1]四川省医学科学院·四川省人民医院肝胆胰外科,成都市610072

出　　处：《实用医学杂志》2017年第12期1943-1948,共6页The Journal of Practical Medicine

基　　金：四川省科技厅重点研发项目(编号:2017SZ0069)

摘　　要：目的:探讨腹腔镜肝切除术(LLR)治疗肝细胞肝癌(HCC)的近期和远期疗效。方法:收集同期LLR和开腹肝切除术(OLR)治疗HCC的临床资料,比较相关临床指标。结果:两组患者在年龄、性别、Child-Pugh分级、肝硬化、甲胎蛋白以及肝炎携带等方面均无统计学差异(均P<0.05)。LLR组中转开腹1例,OLR组围手术期死亡1例。与OLR组相比,LLR组平均手术时间较长(P<0.05)、术中失血量较大(P<0.05)。除规则肝切除亚组术后肝功能指标大部分恢复更快外(大部分P<0.05),其余亚组肝功能指标大部分无显著差异。但LLR组术后VAS评分更低,下床活动时间)、术后进食时间、术后住院时间更短(均P<0.05)。两组患者术后并发症的发生、分布以及严重并发症发生率比较,均无差异(均P>0.05)。LLR和OLR术后无瘤生存率(χ~2=0.55,P=0.46)及累积生存率(χ~2=1.06,P=0.30)比较差异没有显著性。结论:LLR治疗HCC创伤小,恢复快,远期疗效好,是一种安全、有效的手术方法。Objective To explore the short?term and long?term efficacy of laparoscopic versus open liverresection(LLR)in the treatment of hepatocellular carcinoma(HCC).Methods The perioperative and follow?updata ofLLR(n=43)and OLR(n=73)for the treatment of HCC at the same period were analyzed respectively.Results There were no significant differences in the age,gender,Child?Pugh classification,liver cirrhosis,AFP,and hepatic virus affection between the2groups.1case in the LLR group was converted for the open surgeryand another one case in the OLR group died in the perioperative time.However,compared with OLR group,theintraoperative blood loss of LLR group(P<0.05)was larger and the mean operative time(P<0.05)was longer.The liver function indicators of the regular hepatectomy subgroup were recovered more quickly(P<0.05),but theindicators of remaining subgroups were not significantly different.The postoperative ambulation time(P<0.05),the postoperative eating time(P<0.05),the postoperative hospital stay(P<0.05)were all shorter.The VASscore was lower(P<0.05).There was no difference in the incidence and distribution of complications and the inci?dence of severe complications between the two groups(all P>0.05).The first and third year disease?free survivalrates were82.2%,53.8%for LLR and91.5%,75.9%for OLR,respectively(χ2=0.55,P=0.46).The first andthird5year overall survival rates were94.2%,79.3%for LLR and94.9%,47.3%for OLR,respectively(χ2=1.06,P=0.30).Conclusion LLR for HCC treatment is a safe and effective way with the advantages of minimal opera?tive trauma,quick recovery and significant short?term efficacy.

关 键 词：腹腔镜肝切除术 开腹肝切除术 肝细胞肝癌 

分 类 号：R735.7[医药卫生—肿瘤]