腹腔镜肝癌肝切除学习曲线及临床疗效  

Learning curve and clinical efficacy of laparoscopic liver resection for liver cancer

作　　者：李宇[1] 程亚丽[1] 张谞丰[1] 王博[1] 杨威[1] 白纪刚[1] 郭成[1] 仵正[1] 吕毅[1] 刘学民[1] Li Yu;Cheng Yali;Zhang Xufeng;Wang Bo;Yang Wei;Bai Jigang;Guo Cheng;Wu Zheng;Lyu Yi;Liu Xuemin(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院肝胆外科,710061

出　　处：《中华肝脏外科手术学电子杂志》2021年第1期48-52,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：教育部创新团队发展计划(IRT_16R57)。

摘　　要：目的探讨肝癌腹腔镜肝切除(LLR)的学习曲线及临床疗效。方法回顾性分析2012年1月至2019年12月西安交通大学第一附属医院行LLR的284例肝癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男202例,女82例;年龄30~79岁,中位年龄55岁。Child-Pugh分级A级256例,B级28例,ICGR15为0.04~0.20。2012~2017年为LLR学习期,2018~2019年为稳定期。观察患者术中、术后情况和生存情况。肝切除率、并发症发生率等比较采用χ^2检验。生存分析采用Kaplan-Meier法和Log-rank检验。结果258例完成LLR,中转开腹26例,大范围肝切除98例。手术时间中位数120(30~480)min,术中出血量400(10~2000)ml。51例输血,术中输注红细胞4(1~6)U。稳定期大范围肝切除率48.8%(80/164),明显高于学习期的19.1%(18/94)(χ^2=22.3,P<0.05)。稳定期手术相关并发症发生率3.0%(5/164),明显低于学习期9.6%(9/94)(χ^2=4.6,P<0.05)。本组患者1、3年总体生存率分别为95.8%、88.2%,1、3年无瘤生存率分别为77.1%、49.0%。结论LLR治疗肝癌安全可行,长期效果满意,学习期应选择合适病例,并注意并发症防治。Objective To investigate the learning curve and clinical efficacy of laparoscopic liver resection(LLR)for liver cancer.Methods Clinical data of 284 patients with liver cancer who underwent LLR in the First Affiliated Hospital of Xi'an Jiaotong University from January 2012 to December 2019 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,202 patients were male and 82 were female,aged from 30 to 79 years with a median age of 55 years.256 patients were classified as Child-Pugh grade A and 28 cases grade B.The ICGR15 was 0.04-0.20.The learning period of LLR for our surgeons was from 2012 to 2017,and the stable period was from 2018 to 2019.The intraoperative and postoperative conditions and survival of patients were observed.The liver resection rate and the incidence of postoperative complications were compared by Chisquare test.Survival analysis was performed by Kaplan-Meier method and Log-rank test.Results 258 cases underwent LLR,including 26 cases converted to open surgery and 98 cases of extensive liver resection.The median operation time was 120(30-480)min,and the intraoperative blood loss was 400(10-2000)ml.51 patients received blood transfusion with an intraoperative transfusion of 4(1-6)U red blood cells.The extensive liver resection rate in the stable period was 48.8%(80/164),significantly higher than 19.1%(18/94)during the learning period(χ^2=22.3,P<0.05).The incidence of surgical complications in stable period was 3.0%(5/164),significantly lower than 9.6%(9/94)in learning period(χ^2=4.6,P<0.05).The 1-,3-year overall survival rates were 95.8%and 88.2%,and the 1-,3-year disease-free survival rates were 77.1%and 49.0%,respectively.Conclusions LLR is a safe and feasible treatment for liver cancer,which yields satisfactory long-term clinical efficacy.During the learning period,proper cases should be selected.Extensive attention should be paid to the prevention and treatment for postoperative complications.

关 键 词：腹腔镜 肝切除术 癌 肝细胞 手术后并发症 预后 

分 类 号：R735.7[医药卫生—肿瘤]