腹腔镜解剖性与非解剖性肝切除术治疗原发性肝癌的近、远期疗效分析  

Analysis of the Treatment Efficacy of Laparoscopic Anatomic and Non-anatomic Hepatectomy for Primary Liver Cancer

作　　者：洪海杰[1] 蔡欣然[1] 陈敏敏 潘韡[1] 林圣哲 陈燕凌[1] HONG Haijie;CAI Xinran;CHEN Minmin;PAN Wei;LIN Shengzhe;CHEN Yanling(Department of Hepatobiliary Surgery,Fujian Medical University Union Hospital,Fujian Institute of Hepatobiliary Surgery,Fujian Medical University Cancer Center,Key Laboratory of Ministry of Education for Gastrointestinal Cancer Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院肝胆外科,福建省肝胆外科研究所,福建医科大学肿瘤中心,消化道恶性肿瘤教育部重点实验室,福州350001

出　　处：《福建医科大学学报》2021年第2期116-120,共5页Journal of Fujian Medical University

基　　金：国家卫生和计划生育委员会公益性行业科研专项(201502014);福建省微创医学中心建设项目([2017]171);福建省自然科学基金(2018J05132);湖北陈孝平科技发展基金(CXPJJH11900001-2019342)。

摘　　要：目的分析腹腔镜下解剖性肝切除术(LAH)与非解剖性肝切除术(LNAH)治疗原发性肝细胞癌(HCC)的近、远期疗效。方法回顾性分析107例接受腹腔镜肝切除术且术后病理证实为HCC的患者的临床资料,其中LAH组66例,LNAH组41例。比较两组患者围手术期的相关情况及术后生存率等近、远期疗效。结果LAH组和LNAH组患者的术中出血量[(135.0±249.9)mL vs(117.7±311.3)mL]、住院时间[(18.0±5.0)d vs(16.3±5.4)d]比较,差别无统计学意义(P>0.05);LAH组的手术时间较LNAH组长[(173.0±65.6)min vs(145.3±65.7)]min,P<0.05];LAH组术后1,3,5 a累积无瘤生存率(分别为84.8%,63.2%及52.2%)高于LNAH组(80.5%,39.2%及24.9%,P<0.05);LAH组术后1,3,5 a累积总体生存率(分别为95.5%,78.6%及68.4%)高于LNAH组(92.7%,64.3%及44.2%,P<0.05)。单因素分析显示,脉管瘤栓、肿瘤>5 cm、LNAH及包膜侵犯是影响术后无瘤生存率的危险因素;肿瘤>5 cm、LNAH及包膜侵犯是影响术后总体生存率的危险因素。COX回归模型多因素分析结果显示,肿瘤大小和手术方式是影响无瘤生存率和总体生存率的独立危险因素。结论腹腔镜LAH治疗HCC具有更好的近、远期临床疗效。Objective To analyze the short-and long-term efficacy of laparoscopic anatomic hepatectomy(LAH)and non-anatomic hepatectomy(LNAH)in the treatment of primary hepatocellular carcinoma(HCC).Methods A retrospective analysis of the clinical data of 107 patients,who were diagnosed with primary hepatocellular carcinoma and accepted laparoscopic liver resection was performed.Among them,66 patients received laparoscopic anatomic hepatectomy(LAH)and 41 patients accepted laparoscopic non-anatomic hepatectomy(LNAH).The perioperative situation and postoperative survival rate were analyzed in the two groups.Results LAH compared with LNAH,intraoperative blood loss[(135.0±249.9)mL vs(117.7±311.3)mL]and length of hospital stay[(18.0±5.0)d vs(16.3±5.4)d]showed no statistically significant difference(P>0.05).The operation time in the LAH group was significantly longer than that of LNAH group[(173.0±65.6)min vs(145.3±65.7)min,P<0.05].The cumulative disease-free survival rates(DFS)at 1,3 and 5 years after operation in the LAH group were 84.8%,63.2%and 52.2%respectively,which were higher than those in the LNAH group(80.5%,39.2%and 24.9%,P<0.05).The cumulative overall survival rates(OS)at 1,3 and 5 years after operation in the LAH group were 95.5%,78.6%and 68.4%respectively,which were higher than those in the LNAH group(92.7%,64.3%and 44.2%,P<0.05).Univariate analysis showed that blood vessel invasion,tumor size more than 5 cm,LNAH and capsule invasion were the risk factors affecting postoperative DFS.Tumor size more than 5 cm,LNAH and capsule invasion are risk factors affecting postoperative OS.Multivariate analysis by COX regression model showed that tumor size and surgical procedure were independent risk factors for DFS and OS.Conclusion Laparoscopic anatomic hepatectomy for primary hepatocellular carcinoma has better short-term and long-term clinical efficacy.

关 键 词：原发性肝细胞癌 腹腔镜肝切除术 无瘤生存 总体生存 

分 类 号：R735.7[医药卫生—肿瘤]