腹腔镜治疗肝血管周上皮样细胞瘤的疗效与安全性分析  

Laparoscopic surgery in treatment of perivascular epithelioid cell tumor in liver:safety and efficacy

作　　者：刘奔 肖玉婷 成昱昊 葛一亨 姚清扬 郭伟[2] 陈顺 尹新民[1] 成伟[1] 吕品[1] Liu Ben;Xiao Yuting;Cheng Yuhao;Ge Yiheng;Yao Qingyang;Guo Wei;Chen Shun;Yin Xinmin;Cheng Wei;Lyu Pin(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Hunan Normal University/Hunan Provincial People′s Hospital,Changsha 410005,China;Department of pathology,the First Affiliated Hospital of Hunan Normal University/Hunan Provincial People′s Hospital,Changsha 410005,China;Department of General Surgery,Zhongshan Hospital of Traditional Chinese Medicine/Zhongshan Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine,Zhongshan 528401,China)

机构地区：[1]湖南师范大学附属第一医院,湖南省人民医院肝胆外科,长沙410005 [2]湖南师范大学附属第一医院,湖南省人民医院病理科,长沙410005 [3]中山市中医院,广州中医药大学附属中山中医院外三科,中山528401

出　　处：《中华医学杂志》2022年第22期1648-1652,共5页National Medical Journal of China

基　　金：湖南省自然科学基金(2020JJ8085)。

摘　　要：目的评估腹腔镜手术治疗肝血管周上皮样细胞瘤(PEComa)的疗效与安全性。方法对湖南省人民医院肝胆外科2013年9月至2021年9月经手术治疗且病理结果确诊为肝PEComa的42例患者临床资料进行回顾性分析,按手术方式分为腔镜组与开腹组,比较两组手术时间、术中出血量、术后住院时间、术后病理资料及并发症发生率的差异。结果腔镜组27例,男5例,女22例,年龄(40.0±10.4)岁;开腹组15例,男5例,女10例,年龄(44.5±12.6)岁;腔镜组与开腹组手术时间分别为(239±156)min和(348±103.0)min,术后住院时间分别为(8.2±2.4)d和(13.7±4.9)d,腔镜组均明显优于开腹组,差异均有统计学意义(均P<0.05)。而两组术中出血量、肿瘤良恶性、肿瘤部位、肿瘤直径、Ki67指数、术后并发症(如胆漏、切口感染、胸腔积液等)差异均无统计学意义(均P>0.05)。随访时间2~103个月,其中失访1例,腔镜组死亡2例,开腹组死亡1例。腔镜组5年总体生存率(OS)与无瘤生存率(DFS)分别为80.8%与83.0%,开腹组则均为92.3%,两组差异均无统计学意义(均P>0.05)。结论腹腔镜治疗肝PEComa安全有效,具有手术时间短、术后住院时间短等优势,且并发症发生率、5年OS及DFS与开腹组比较差异无统计学意义。Objective To evaluate the efficacy and safety of laparoscopic surgery for perivascular epithelioid cell tumor(PEComa).Methods The clinical data of 42 patients with hepatic PEComa diagnosed by pathology in Hunan Provincial People′s Hospital from September 2012 to September 2021 were retrospectively analyzed.The patients were divided into the endoscopic group and the open group according to surgical methods.Statistical software was used to compare the differences in operation time,intraoperative blood loss,postoperative hospital stay,postoperative pathological data and incidence of complications between the two groups.Results There were 27 cases in the endoscopic group and 15 cases in the open group.In the endoscopic group,there were 5 males and 22 females,aged(40.0±10.4)years.In the open group,there were 5 males and 10 females,aged(44.5±12.6)years.The operative time of the endoscopic group and the open group was(239±156.2)min and(348±103.0)min,and the postoperative hospital stay was(8.2±2.4)d and(13.7±4.9)d,respectively,the endoscopic group was significantly better than the open group,and the difference was statistically significant(P<0.05).There was no significant difference in intraoperative blood loss,tumor benign and malignant,tumor site,tumor diameter,Ki67 index,postoperative complications such as biliary leakage,incision infection and pleural effusion(P>0.05).During the follow-up period of 2-103 months,one case was lost to follow-up,two cases died in the endoscopic group,one case died in the open group.The 5-year overall survival rate(OS)and disease-free survival rate(DFS)were 80.8%and 83.0%,respectively.Meanwhile,.The 5-year OS and DFS were both 92.3%,the difference was not statistically significant(P>0.05).Conclusions Laparoscopic treatment of hepatic PEComa has the advantages of short operation time and short postoperative hospital stay,and the incidence of complications,5-year OS and DFS are not significantly different from that of the open group.

关 键 词：腹腔镜手术 血管周上皮样细胞瘤 安全性分析 

分 类 号：R735.7[医药卫生—肿瘤]