腹腔镜与开腹肝切除术治疗肝细胞癌临床疗效的真实世界比较研究  

Clinical efficacy of laparoscopic versus open hepatectomy in the treatment of hepatocellular carcinoma:a real-world comparative study

作　　者：李军[1,2] 姚磊 胡芳远 叶轲 肖莫延[1,2] 张鸽文 LI Jun;YAO Lei;HU Fangyuan;YE Ke;XIAO Moyan;ZHANG Gewen(Department of General Surgery,Xiangya Hospital,Central South University,Changsha 410008,China;National Clinical Research Center for Geriatric Disorders(Xiangya Hospital),Changsha 410008,China)

机构地区：[1]中南大学湘雅医院普通外科,湖南长沙410008 [2]国家老年疾病临床医学研究中心(湘雅医院),湖南长沙410008

出　　处：《中国普通外科杂志》2024年第2期244-256,共13页China Journal of General Surgery

摘　　要：背景与目的:目前,腹腔镜肝切除术治疗肝细胞癌(HCC)的适应证已逐渐趋同于开腹肝切除术,腹腔镜肝切除术的可行性、安全性、有效性也逐步得到证实。但在手术方式的选择上外科医师往往存在选择偏倚,故腹腔镜和开腹肝切除术的选择也有待在不同的人群和医学中心仔细评估,且时至今日,仍有学者对腹腔镜肝切除术的不良肿瘤学结局心存疑虑。因此,本研究分析比较腹腔镜与开腹肝切除术治疗HCC的临床疗效。方法:回顾性分析2016年1月1日—2020年12月31日在中南大学湘雅医院517例因HCC施行肝切除术的患者临床资料。其中,196例行腹腔镜肝切除术(腹腔镜组),321例行开腹肝切除术(开腹手术组)。分析比较两组患者一般资料、围手术期情况及随访指标。结果:一般资料中,腹腔镜组与开腹手术组患者的肿瘤分期、肿瘤直径、术前白蛋白水平及肝切除部位方面的差异有统计学意义(均P<0.05),其余差异无统计学意义(均P>0.05)。围手术期指标中,腹腔镜组的中位术中出血量(200.00 mL vs.300.00 mL)、术后中位住院时间(6 d vs.8 d)、术后肝功能恢复、术后并发症发生率(6.63%vs.14.02%)均优于开腹手术组(均P<0.05)。随访指标中,腹腔镜组总生存期(OS)和无病生存期(DFS)优于开腹手术组(OS:χ^(2)=4.478,P=0.034;DFS:χ^(2)=8.915,P=0.003)。采用倾向性评分匹配(1∶1匹配,每组51例)均衡两组的一般资料后比较,腹腔镜组术后中位住院时间(6 d vs.9 d)与术后并发症发生率(3.92%vs.19.61%)仍优于开腹手术组,但两组的OS与DFS差异无统计学意义(均P>0.05)。结论:腹腔镜肝切除术治疗HCC是安全、有效的,并可加快患者术后恢复,缩短术后住院时间。腹腔镜肝切除术和开腹肝切除术治疗HCC的远期疗效相当。腹腔镜有其自身的适应证,在充分评估患者后,腹腔镜手术是HCC患者的首选手术方式。Background and Aims:Currently,the indications for laparoscopic hepatectomy in the treatment of hepatocellular carcinoma(HCC)have gradually converged with those for open hepatectomy,and the feasibility,safety,and effectiveness of laparoscopic hepatectomy have been progressively confirmed.However,surgeons often exhibit selection bias in choosing the surgical method.Therefore,the choice between laparoscopic and open hepatectomy also needs careful evaluation in different patient populations and medical centers.Despite this,doubts still persist among scholars regarding the oncological outcomes of laparoscopic hepatectomy.Therefore,this study was conducted to analyze and compare the clinical efficacy of laparoscopic versus open hepatectomy in the treatment of HCC.Methods:The clinical data of 517 patients who underwent hepatectomy for HCC in Xiangya Hospital,Central South University,from January 1,2016,to December 31,2020 were retrospectively analyzed.Of the patients,196 cases underwent laparoscopic hepatectomy(laparoscopic group),and 321 patients underwent open hepatectomy(open surgery group).The general data,perioperative conditions,and follow-up results were analyzed and compared between the two groups of patients.Results:In terms of general data,there were statistically significant differences between the laparoscopic group and the open surgery group in tumor stage,tumor diameter,preoperative albumin level,and site of liver resection(all P<0.05),while the remaining differences were not statistically significant(all P>0.05).In perioperative variables,the laparoscopic group showed better outcomes than the open surgery group in terms of median intraoperative blood loss(200.00 mL vs.300.00 mL),median length of postoperative hospital stay(6 d vs.8 d),postoperative liver function recovery,and incidence of postoperative complications(6.63%vs.14.02%),all of which were statistically significant(all P<0.05).Regarding follow-up results,the laparoscopic group had superior overall survival(OS)and disease-free survival(DFS)compar

关 键 词：癌 肝细胞 肝切除术 腹腔镜 预后 

分 类 号：R735.7[医药卫生—肿瘤]