腹腔镜肝切除术与腹腔镜微波消融术治疗肝血管瘤的有效性和安全性研究  

Efficacy and safety of laparoscopic hepatectomy versus laparoscopic microwave ablation for hepatic hemangioma

作　　者：邵天胤 余俊[1] 周洪浩[1] 李园秋 申雪晗 董汉华[1] 张志伟[1] 陈孝平[1] SHAO Tianyin;YU Jun;ZHOU Honghao;LI Yuanqiu;SHEN Xuehan;DONG Hanhua;ZHANG Zhiwei;CHEN Xiaoping(Department of Hepatic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Radiology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院肝脏外科,湖北武汉430000 [2]华中科技大学同济医学院附属同济医院放射科,湖北武汉430000

出　　处：《肝胆胰外科杂志》2023年第11期660-667,共8页Journal of Hepatopancreatobiliary Surgery

摘　　要：目的比较腹腔镜肝切除术(LH)和腹腔镜微波消融术(LMA)治疗肝血管瘤(HH)的有效性和安全性。方法选取2018年5月至2022年1月华中科技大学同济医学院附属同济医院肝脏外科收治的262例HH患者进行回顾性分析。根据治疗方式将患者分为LH组(n=192)和LMA组(n=70),采用1∶2倾向性评分匹配配对出68对患者(LH组136例,LMA组68例),对比两组患者的围手术期结果、并发症情况和随访情况,运用Logistic回归分析探索影响LMA疗效的因素。结果LMA组的手术时间、术后肠道功能恢复时间、术后静脉镇痛时间和术后住院时间明显短于LH组[(160.32±69.51)min vs(273.09±96.46)min,(1.63±1.15)d vs(2.36±1.10)d,(2.91±1.55)d vs(4.36±1.87)d,(5.10±2.41)d vs(7.46±3.02)d,均P<0.05]。LMA组术后引流率及术中输血发生率明显低于LH组(51.5%vs 98.5%,0 vs 11.8%,均P<0.05)。两组的VAS评分呈逐渐降低趋势,且LMA组明显低于LH组(P<0.05)。LMA组术后贫血、胸腹水(Ⅰ级)、发热、轻微及显著低白蛋白血症发生率均明显低于LH组(P<0.05)。术后首次评估中,LH组完全缓解(CR)率明显高于LMA组(100%vs 72.1%,P<0.05)。在针对LMA疗效的多因素分析中,瘤体最大径、毗邻肝门、毗邻主要静脉是不完全反应(ICR)的独立危险因素(P<0.05)。结论相较于LH,LMA在达到良好治疗效果的同时可缩短手术时间和术后恢复时间,术后疼痛更轻,并降低部分并发症发生率。在临床上治疗HH患者时,应结合瘤体的大小和部位等特点,充分考虑创伤大小与疗效获益,为不同患者制定个体化的治疗方案。Objective To compare the efficacy and safety of laparoscopic hepatectomy(LH)and laparoscopic microwave ablation(LMA)for hepatic hemangioma(HH).Methods A retrospective analysis was conducted on 262 patients with HH who admitted to Tongji Hospital,Huazhong University of Science and Technology,from May 2018 to Jan.2022.Patients were divided into LH group(n=192)and LMA group(n=70).After the propensity score matching analysis,68 pairs of patients were created(136 in LH group,68 in LMA group).The perioperative outcomes,complications incidence,and follow-up information between the two groups were compared.Logistic regression analysis was used to explore the factors affecting the efficacy of LMA.Results In LMA group,the operation time,postoperative intestinal function recovery time,postoperative intravenous analgesia time,and postoperative hospitalization time were shorter than those in LH group[(160.32±69.51)min vs(273.09±96.46)min,(1.63±1.15)d vs(2.36±1.10)d,(2.91±1.55)d vs(4.36±1.87)d,(5.10±2.41)d vs(7.46±3.02)d,all P<0.05).LMA group had lower rates of postoperative drainage and intraoperative blood transfusion(51.5%vs 98.5%,0 vs 11.8%,all P<0.05).The VAS scores in both groups showed a gradually decreasing trend,and the scores in LMA group were lower than those in LH group(P<0.05).The incidences of postoperative anemia,chest and abdominal effusion(grade I),fever,and mild to severe hypoalbuminemia in LMA group were significantly lower than those in LH group(P<0.05).In the first postoperative assessment,the complete response(CR)rate in LH group was significantly higher than that in LMA group(100%vs 72.1%,P<0.05).In the multivariate analysis for efficacy of LMA,the maximum tumor diameter,adjacent to the hepatic hilum,and adjacent to the major veins were independent risk factors for incomplete response(ICR)(P<0.05).Conclusion Compares with LH,LMA can not only achieve expected tumor control,but also shorten the operation time and postoperative recovery time,and reduce postoperative pain and the complication inciden

关 键 词：肝血管瘤 腹腔镜手术 微波消融 肝切除术 LOGISTIC回归 并发症 

分 类 号：R735.7[医药卫生—肿瘤]