开腹与腹腔镜肝切除治疗肝癌合并微血管侵犯病人的近期疗效比较  

Comparison of short-term efficacy of open liver resection versus laparoscopic liver resection for liver cancer patients complicated with microvascular invasion

作　　者：朱明强 裴俊鹏 熊祥云 杨大帅 沈杰 丁佑铭[1] Zhu Mingqiang;Pei Junpeng;Xiong Xiangyun;Yang Dashuai;Shen Jie;Ding Youming(Department of Hepatobiliary Surgery,Renmin Hospital of Wuhan University,Hubei Wuhan 430060,China)

机构地区：[1]武汉大学人民医院肝胆外科,湖北武汉430060

出　　处：《腹部外科》2023年第5期393-398,共6页Journal of Abdominal Surgery

基　　金：国家重点研发计划(2022YFC2407304)。

摘　　要：目的比较开腹肝切除(open liver resection,OLR)与腹腔镜肝切除(laparoscopic liver resection,LLR)治疗肝癌合并微血管侵犯(microvascular invasion,MVI)病人的近期疗效。方法回顾性收集2019年12月至2023年2月武汉大学人民医院肝胆外科行外科手术治疗的88例原发性肝癌合并MVI病人的临床资料。根据外科手术方式分为OLR组(51例)和LLR组(37例)。比较两组病人术前基础资料、手术相关指标、术后肝功能、术后应激反应指标和术后并发症及恢复情况,评价两组的治疗效果。结果OLR组和LLR组病人的年龄、性别、体重指数、乙型肝炎、肝硬化、腹部手术史、年龄校正的查尔森合并症指数、美国麻醉医师协会评分、肿瘤数目、肿瘤分化程度、Child-Pugh评分、中国肝癌分期、谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、乳酸脱氢酶、甲胎蛋白、吲哚菁绿15 min滞留率、凝血酶原时间、血红蛋白、血小板计数、血肌酐、总胆固醇、血清K+、血清Na+等基础资料差异均无统计学意义(均P>0.05);两组病人的手术部位、肝段切除范围、解剖性肝切除、切缘性质、手术时间、肝门阻断时间、是否输血等手术指标差异亦均无统计学意义(均P>0.05);两组病人术后的白细胞计数、中性粒细胞计数、淋巴细胞计数、中性粒细胞与淋巴细胞比值、控制营养状态评分等应激指标以及术后的ALT、AST、TBIL、终末期肝病模型评分等肝功能指标差异均无统计学意义(均P>0.05)。OLR组和LLR组的肿瘤最大径、白蛋白水平、术中出血量、术中平均动脉压、术后白蛋白-胆红素评分差异均有统计学意义(均P<0.05)。LLR组病人胃肠道恢复时间、引流管放置时间和术后总住院时间明显短于OLR组(均P<0.05)。在并发症发生率方面,LLR组(8.1%,3/37)优于OLR组(25.5%,13/51),差异有统计学意义(P<0.05)。两组病人术后30 d内均未见死亡。结论LLR治疗肝�Objective To compare the short-term efficacy of open liver resection(OLR)versus laparoscopic liver resection(LLR)for liver cancer patients with microvascular invasion(MVI).Methods The relevant clinical data were retrospectively reviewed for 88 surgical patients with primary liver cancer complicated with MVI from December 2019 to February 2023.They were assigned into two groups of OLR(n=51)and LLR(n=37).Preoperative profiles,surgery-related parameters,postoperative liver functions,postoperative stress response parameters,postoperative complications,recovery status and outcomes were compared between two groups.Results No significant differences existed in age,gender,body mass index(BMI),hepatitis B,liver cirrhosis,history of abdominal operation,age-adjusted Charlson comorbidity index(aCCI),American Society of Anesthesiologists(ASA)score,tumor number,degree of differentiation,Child-Pugh score,China liver cancer staging(CNLC),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),lactate dehydrogenase(LDH),alpha-fetoprotein(AFP),indocyanine green-R15(ICG-R15),prothrombin time(PT),hemoglobin(Hb),platelet(PLT)count,blood creatinine(Scr),total cholesterol,serum potassium,serum sodium and such surgical parameters as surgical site,hepatic segmental resection range,anatomic hepatectomy,operative marginal properties,operative duration,hepatic portal occlusion time,blood transfusion and such postoperative stress parameters as leukocyte count,neutrophil count,lymphocyte count,neutrophil-to-lymphocyte ratio(NLR),controlling nutritional status(CONUT)and such postoperative liver function parameters as ALT/AST,TBLI and model for end-stage liver disease(MELD)score(all P>0.05).Significant inter-group differences existed in tumor diameter,ALB,intraoperative blood loss,intraoperative mean arterial pressure and albumin-bilirubin(ALBI)score(all P<0.05).Gastrointestinal recovery time,drainage tube placement time and total postoperative hospitalization stay were significantly lower in LLR group than those in

关 键 词：开腹肝切除 腹腔镜肝切除 原发性肝癌 微血管侵犯 近期疗效 

分 类 号：R616.2[医药卫生—外科学]