腹腔镜下门静脉流域性肝切除在原发性肝癌治疗中的应用  

Application of laparoscopic regional hepatectomy in surgical treatment of hepatocellular carcinoma

作　　者：周海涛 周建春[1] 郑四鸣 ZHOU Haitao;ZHOU Jianchun;ZHENG Siming(Department of Gastrointestinal surgery,Yuyao People's Hospital,Ningbo 315400,China;不详)

机构地区：[1]余姚市人民医院肝胆胃肠血管外科,315400 [2]宁波市第一医院肝胆胰外二科

出　　处：《浙江医学》2023年第11期1172-1177,1185,共7页Zhejiang Medical Journal

基　　金：宁波市自然科学基金项目(2021J268);浙江省医药卫生科技计划项目(2022KY1114);浙江省医学会临床科研基金资助项目(2021ZYC-B24)。

摘　　要：目的探讨腹腔镜下门静脉流域性肝切除治疗原发性肝癌的可行性。方法回顾宁波市第一医院2021年1月1日至2022年5月31日行腹腔镜下流域性肝切除的120例肝癌患者(流域组)以及2018年1月1日至2020年12月31日行腹腔镜下非解剖性肝切除的192例肝癌患者的临床资料(非解剖组)。并通过倾向性得分匹配进行1∶1匹配,比较两组患者匹配后包括手术时间、术中出血量、术后血清白蛋白、AST、ALT、TBil水平,术后引流管留置时间、并发症发生率及住院时间。结果经倾向性得分匹配后,流域组与非解剖组各纳入40例患者,且匹配后两组患者临床资料比较差异均无统计学意义(均P>0.05)。流域组手术时间长于非解剖组,术中出血量少于非解剖组,差异均有统计学意义(均P<0.05);流域组术后血清白蛋白水平明显高于非解剖组,AST、ALT水平均低于非解剖组,术后引流管留置时间少于非解剖组,差异均有统计学意义(均P<0.05)。两组患者术后并发症发生率及住院时间比较差异均无统计学意义(均P>0.05)。结论门静脉流域性肝切除治疗原发性肝癌安全性与非解剖性肝切除相当,术后肝功能恢复优于非解剖性肝切除,值得临床推广。Objective To investigate the feasibility of laparoscopic regional hepatectomy in the treatment of hepatocellular carcinoma.Methods The clinical data of 120 patients with liver cancer who underwent laparoscopic regional hepatectomy in Ningbo First Hospital from January 2021 to May 2022(regional group),and the data of 192 liver cancer patients who underwent non-regional hepatectomy from January 2018 to December 2020(non-regional group)were analyzed retrospectively.The 1∶1 matching was performed by propensity score-matched(PSM)method.The shortterm efficacy,the operation time,intraoperative blood loss,postoperative serum albumin,AST,ALT and total bilirubin levels,postoperative drainage tube placement time,incidence of complications and length of hospital stay were compared between two groups.Results After matching by PSM method,40 patients in each group were included for further analysis.There was no significant difference in the baseline indicators between the two groups after matching(P>0.05).The operation time in the regional resection group was longer than that in the non-regional group,and the intraoperative blood loss in the regional resection group was less than that in the non-regional group(both P<0.05).The postoperative serum albumin level was significantly higher,the AST and ALT levels were lower in the regional resection group than those in the non-regional group(P<0.05).The postoperative drainage tube indwelling time of the regional resection group was less than that in the non-regional group(P<0.05).There was no significant difference in the incidence of postoperative complications and length of hospital stay between the two groups(P>0.05).Conclusion Portal vein regional hepatectomy is safe for the treatment of hepatocellular carcinoma,and the postoperative recovery of liver function is better than that of non-anatomical hepatectomy,which is worthy of clinical promotion.

关 键 词：肝切除 原发性肝癌 三维重建 

分 类 号：R735.7[医药卫生—肿瘤]