腹腔镜大肝癌切除术安全性及有效性评估  

Safety and efficacy of laparoscopic resection of giant liver cancer

作　　者：黄华坤[1] 杨斌 张起帆[2] 邓敬舵 陈志 程远[1] Huakun Huang;Bin Yang;Qifan Zhang;Jingduo Deng;Zhi Chen;Yuan Cheng(DepartmentⅡof Hepatobiliary Surgery,Zhujiang Hospital of Southern Medical University,Guangzhou 510285,China;Department of Hepatobiliary,Nanfang Hospital of Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学珠江医院肝胆二科,广州510285 [2]南方医科大学南方医院肝胆外科,广州510515

出　　处：《中华肝脏外科手术学电子杂志》2022年第6期569-573,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

摘　　要：目的探讨腹腔镜大肝癌切除术的安全性及有效性。方法回顾性分析2018年1月至2020年12月在南方医科大学南方医院和南方医科大学珠江医院行手术切除的172例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。其中男152例,女20例;平均年龄(54±17)岁。根据不同手术方式将患者分为腹腔镜肝切除术组(腔镜组,78例)和开腹肝切除术组(开腹组,94例)。比较两组围手术期情况及术后生存情况。生存分析采用Kaplan-Meier法和Log-rank检验。结果腔镜组在术中出血量、术中输血率分别为200(300)ml、24%(19/78),明显低于开腹组的300(300)ml、46%(43/94)(Z=-3.123,χ2=8.457;P<0.05)。腔镜组术后引流管留置时间、术后住院时间分别为6(4)、8(3)d,明显短于开腹组的8(5)、11(4)d(Z=-4.652,-6.110;P<0.05)。腔镜组术后腹腔积液发生率、Clavien-DindoⅢ~Ⅳ级严重并发症发生率分别为1%(1/78)、4%(3/78),明显低于开腹组的11%(10/94)、15%(14/94)(χ2=6.234,5.841;P<0.05)。腔镜组R0切除率为89%(69/78),开腹组为85%(80/94),差异无统计学意义(χ2=0.414,P>0.05)。腔镜组1年无复发生存率为47%,开腹组为52%,差异无统计学意义(χ2=0.001,P>0.05)。结论在足够的技术储备及术前准备下,腹腔镜大肝癌切除术安全、有效。Objective To evaluate the safety and efficacy of laparoscopic resection of giant liver cancer.Methods Clinical data of 172 patients with giant liver cancer who underwent surgical resection in Nanfang Hospital of Southern Medical University and Zhujiang Hospital of Southern Medical University from January 2018 to December 2020 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,152 patients were male and 20 female,aged(54±17)years on average.According to different surgical methods,all patients were divided into the laparoscopic resection group(n=78)and open resection group(n=94).Perioperative conditions and postoperative survival were compared between two groups.Survival analysis was performed by Kaplan-Meier method and Log-rank test.Results In the laparoscopic resection group,intraoperative blood loss was 200(300)ml and intraoperative blood transfusion rate was 24%(19/78),significantly lower than 300(300)ml and 46%(43/94)in the open resection group(Z=-3.123,χ2=8.457;P<0.05).In the laparoscopic resection group,postoperative indwelling time was 6(4)d and the length of postoperative hospital stay was 8(3)d,significantly shorter than 8(5)d and 11(4)d in the open resection group(Z=-4.652,-6.110;P<0.05).In the laparoscopic resection group,the incidence of postoperative peritoneal effusion and Clavien-DindoⅢ-Ⅳsevere complications were 1%(1/78)and 4%(3/78),significantly lower compared with 11%(10/94)and 15%(14/94)in the open resection group(χ2=6.234,5.841;P<0.05).In the laparoscopic resection group,the R0 resection rate was 89%(69/78)and 85%(80/94)in the open resection group,and no significant difference was observed(χ2=0.414,P>0.05).In the laparoscopic resection group,the 1-year recurrence-free survival rate was 47%,and 52%in the open resection group,with no significant difference(χ2=0.001,P>0.05).Conclusions With sufficient technical experience and preoperative preparation,laparoscopic resection of giant liver cancer

关 键 词：肝肿瘤 腹腔镜 肝切除术 疗效 安全性 

分 类 号：R735.7[医药卫生—肿瘤]