腹腔镜肝切除术治疗复发性肝癌的单中心经验  

Single center experience of laparoscopic hepatectomy for recurrent liver cancer

作　　者：洪晟乾 张素芳 韩淼 严雨楼 刘世奇 金铨 祁付珍[1] HONG Shengqian;ZHANG Sufang;HAN Miao(Department of Hepatobiliary and Pancreatic Surgery,the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University,Huai'an 223300,China;Department of Oncology,Affiliated Hospital of Jiangsu University)

机构地区：[1]南京医科大学附属淮安第一医院肝胆胰外科,江苏淮安223300 [2]江苏大学附属医院肿瘤内科

出　　处：《腹腔镜外科杂志》2023年第7期500-504,共5页Journal of Laparoscopic Surgery

基　　金：南京医科大学附属淮安第一医院创新团队(YLCT202003)。

摘　　要：目的:探讨腹腔镜肝切除术治疗复发性肝癌的优势及可行性,总结手术经验。方法:回顾分析2017年3月至2022年7月为10例复发性肝癌患者行腹腔镜手术的临床资料。术前评估肿瘤及肝功能储备情况,出院后门诊或电话随访。使用Kaplan-Meier法进行生存分析。结果:手术时间平均(173.0±61.3)min,出血量(410.0±338.9)mL。术后1例患者发生腹腔出血,予以保守治疗,病情平稳;余患者均未出现肝衰竭、出血、胆漏等并发症。引流管平均留置(5.0±2.2)d,引流量平均(371.0±348.2)mL。患者于生命体征平稳、营养状况良好、胃肠道功能恢复后出院,平均住院(11.9±5.7)d。术后中位生存时间36个月,1年无瘤生存率为100%,3年无瘤生存率为50%。结论:腹腔镜手术治疗复发性肝癌具有独特优势,可精细化分离腹腔粘连,减少出血,清晰观察肿瘤边界,实现解剖性切除,且损伤小,利于术后恢复。在术前准确评估肿瘤及肝功能储备情况的前提下行腹腔镜手术是安全、有效的。Objective:To explore the advantages and feasibility of laparoscopic hepatectomy in the treatment of recurrent liver cancer,and summarize the surgical experience.Methods:The clinical data of 10 patients who suffered from recurrent liver cancer and underwent laparoscopic operation from Mar.2017 to Jul.2022 were retrospectively analyzed.The treatment team assessed preoperative tumor status and liver function reserve of patients,follow-up was performed through outpatient clinic or phone.Kaplan-Meier method was used for survival analysis.Results:The average operation time was(173.0±61.3)min and the blood loss was(410.0±338.9)mL.One patient with intraperitoneal hemorrhage after surgery was treated conservatively and the condition was stable.No liver failure,bleeding,bile leakage and other complications occurred in other patients.The average indwelling time of the drainage tube was(5.0±2.2)d,and the average drainage volume was(371.0±348.2)mL.All the patients were discharged with stable vital signs,good nutritional status and recovery of gastrointestinal function.The mean hospital stay was(11.9±5.7)d.The median postoperative survival time was 36 months,the one-year disease free survival rate was 100%,and the three-year disease free survival rate was 50%.Conclusions:Laparoscopic surgery has unique advantages in the treatment of recurrent liver cancer.It can finely separate abdominal adhesions,reduce bleeding,clearly observe the tumor boundary,achieve anatomical resection,and cause less damage to patients,which is conducive to postoperative recovery.As a result,laparoscopic surgery is safe and effective on the premise of accurate evaluation of the tumor and liver function r eserve before operation.

关 键 词：肝肿瘤 复发 肝切除术 腹腔镜检查 病例报告 

分 类 号：R657.3[医药卫生—外科学]