“五步法”腹腔镜前入路右半肝切除术治疗巨大肝癌的安全性及疗效  

Safety and efficacy of five-step laparoscopic right hemihepatectomy via anterior approach for giant hepatocellular carcinoma

作　　者：张成[1] 王春明 钟凯航 程远[1] 何国林[1] 付顺军 蔡磊[1] 刘海燕[1] 潘明新 Zhang Cheng;Wang Chunming;Zhong Kaihang;Cheng Yuan;He Guolin;Fu Shunjun;Cai Lei;Liu Haiyan;Pan Mingxin(DepartmentⅡof Hepatobiliary Surgery,Zhujiang Hospital of Southern Medical University,Guangzhou 510220,China)

机构地区：[1]南方医科大学珠江医院肝胆二科,广州510220

出　　处：《中华肝脏外科手术学电子杂志》2022年第1期32-38,共7页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：广州市科技计划项目(201508020053);广东省医学科学技术研究基金项目(2019112010321569)。

摘　　要：目的探讨"五步法"腹腔镜前入路右半肝切除术(AA-RH)治疗右半肝巨大肝细胞癌(肝癌)的安全性和疗效。方法回顾性分析2015年12月至2020年9月南方医科大学珠江医院收治的50例肝右叶巨大肝癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。按照手术方式不同将患者分为腔镜组(25例)和开腹组(25例)。其中腔镜组男20例,女5例;平均年龄(54±17)岁;肿瘤最大直径(11±6)cm;采用"五步法"腹腔镜AA-RH。开腹组男19例,女6例;年龄(55±12)岁;肿瘤最大直径(11±6)cm;采用传统开腹右半肝切除术。比较两组围手术期情况。两组术中出血量、术后肝功能等比较采用t检验,术中输血率、术后并发症发生率比较采用χ^(2)检验。结果两组患者均顺利完成手术,腔镜组无中转开腹。腔镜组术中出血量(285±85)ml,明显少于开腹组的(464±142)ml(t=-9.014,P<0.05)。腔镜组术中输血率为4%(1/25),明显低于开腹组的24%(6/25)(χ^(2)=4.153,P<0.05)。腔镜组术后1 d的ALT和AST分别为(195±81)、(203±83)U/L,明显低于开腹组的(288±114)、(295±106)U/L(t=-5.452,-6.229;P<0.05)。腔镜组术后住院时间(10±4)d,明显短于开腹组的(12±5)d(t=-2.398,P<0.05)。腔镜组术后并发症发生率为8%(2/25),明显低于开腹组的32%(8/25)(χ^(2)=4.500,P<0.05)。结论采用"五步法"腹腔镜AA-RH安全、可行,与传统开腹手术相比,能有效降低术中出血量及输血率,加快术后恢复,降低术后并发症发生率。Objective To evaluate the safety and efficacy of five-step laparoscopic right hemihepatectomy via the anterior approach (AA-RH) in the treatment of giant hepatocellular carcinoma (HCC).Methods Clinical data of 50 patients with giant HCC in the right lobe admitted to Zhujiang Hospital of Southern Medical University from December 2015 to September 2020 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.All patients were divided into the laparoscopic group (n=25) and open group (n=25) according to different surgical methods.In the laparoscopic group,20 patients were male and 5 female,aged (54±17) years on average.The maximum diameter of tumor was (11±6) cm.Five-step laparoscopic AA-RH was adopted.In the open group,19 patients were male and 6 female,aged (55±12) years on average.The maximum diameter of tumor was (11±6) cm.Traditional open right hemihepatectomy was performed.Perioperative conditions were statistically compared between two groups.Intraoperative blood loss and postoperative liver function were compared byt test.The intraoperative blood transfusion rate and the incidence of postoperative complications was compared by Chi-square test.Results Operations in all the patients of two groups were completed successfully.No patient was converted to open surgery in the laparoscopic group.Intraoperative blood loss in the laparoscopic group was (285±85) ml,significantly less than (464±142) ml in the open group (t=-9.014,P<0.05).In the laparoscopic group,the intraoperative blood transfusion rate was 4%(1/25),significantly lower than 24%(6/25) in the open group (χ2=4.153,P<0.05).In the laparoscopic group,the ALT and AST levels at postoperative 1 dwere (195±81) and (203±83) U/L,significantly lower compared with (288±114) and (295±106) U/L in the open group (t=-5.452,-6.229;P<0.05).The length of postoperative hospital stay in laparoscopic group was (10±4) d,significantly shorter than (12±5) d in the open group (t=-2.398,P<0

关 键 词：癌 肝细胞 肝切除术 腹腔镜 前入路 

分 类 号：R735.7[医药卫生—肿瘤]