腹腔镜解剖性右半肝切除术治疗原发性肝癌患者的可行性与安全性  

Feasibility and safety of laparoscopic anatomical right hemihepatectomy in the treatment of patients with primary liver cancer

作　　者：赵贞达 吕君波 邵文琪 ZHAO Zhenda;LYU Junbo;SHAO Wenqi(Department of Hepatobiliary Surgery,Shangrao Dongxin Fifth Hospital,Shangrao 334000,Jiangxi,China)

机构地区：[1]上饶东信第五医院肝胆外科,江西上饶334000

出　　处：《癌症进展》2024年第8期863-867,871,共6页Oncology Progress

基　　金：上饶市科技计划医疗卫生指导性项目(2023CZDX23)。

摘　　要：目的探讨腹腔镜解剖性右半肝切除术治疗原发性肝癌(PLC)患者的可行性与安全性。方法依据手术方法的不同将60例PLC患者分为对照组和研究组,每组30例,对照组患者采取腹腔镜非解剖性右半肝切除术,研究组患者采取腹腔镜解剖性右半肝切除术。比较两组患者的围手术期指标、应激指标[皮质醇(Cor)、去甲肾上腺素(NE)、C反应蛋白(CRP)、白细胞介素-6(IL-6)]、肝功能指标[总胆红素(TBIL)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、白蛋白(ALB)]、生活质量[肝癌患者生活质量测定量表(QOL-LC)]、并发症发生情况及复发转移、生存情况。结果研究组患者术中出血量、术中输血量、术后引流量均明显少于对照组,术后拔管时间、首次肛门排气时间、首次进食时间、首次下床活动时间、住院时间均明显短于对照组,手术时间明显长于对照组,差异均有统计学意义(P﹤0.01)。术后1天,两组患者Cor、NE、CRP、IL-6水平均高于本组术前1天,研究组患者Cor、NE、CRP、IL-6水平均低于对照组,差异均有统计学意义(P﹤0.05)。术后7天,两组患者TBIL、ALT、AST水平均高于本组术前1天,ALB水平均低于本组术前1天,研究组患者TBIL、ALT、AST水平均低于对照组,ALB水平高于对照组,差异均有统计学意义(P﹤0.05)。术后3个月,两组患者QOL-LC各维度评分及总分均高于本组术前1天,研究组患者QOL-LC各维度评分及总分均高于对照组,差异均有统计学意义(P﹤0.05)。研究组患者的并发症总发生率低于对照组(P﹤0.05)。随访1年,研究组患者的复发转移率低于对照组,生存率高于对照组,差异均有统计学意义(P﹤0.05)。结论与腹腔镜非解剖性右半肝切除术相比,腹腔镜解剖性右半肝切除术治疗PLC可促进患者术后恢复,减轻应激反应,提高生活质量和生存率,降低并发症发生率和复发转移率,且对肝功能损伤较小。Objective To explore the feasibility and safety of laparoscopic anatomical right hemihepatectomy in the treatment of patients with primary liver cancer(PLC).Method According to different surgical methods,60 patients with PLC were divided into control group(n=30,laparoscopic non-anatomical right hemihepatectomy)and study group(n=30,laparoscopic anatomical right hemihepatectomy).The perioperative indexes,stress indexes[cortisol(Cor),norepinephrine(NE),C-reactive protein(CRP),interleukin-6(IL-6)],liver function indexes[total bilirubin(TBIL),alanine aminotransferase(ALT),aspartate aminotransferase(AST),albumin(ALB)],quality of life[quality of life scale for liver cancer(QOL-LC)],complications,recurrence,metastasis and survival were compared between the two groups.Result The intraoperative blood loss,intraoperative blood transfusion volume and postoperative drainage volume in the study group were significantly less than those in the control group,the postoperative extubation time,first anal exhaust time,first feeding time,first getting out of bed time and hospital stay were significantly shorter than those in the control group,and the operative time was significantly longer than that in the control group,and the differences were statistically significant(P<0.01).One day after surgery,the Cor,NE,CRP and IL-6 levels in the two groups were higher than those at one day before surgery,and the Cor,NE,CRP and IL-6 levels in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).Seven days after surgery,the TBIL,ALT and AST levels in the two groups were higher than those at one day before surgery,the ALB levels were lower than those at one day before surgery,the TBIL,ALT and AST levels in the study group were lower than those in the control group,the ALB level was higher than that in the control group,and the differences were statistically significant(P<0.05).Three months after surgery,the dimensional scores and total scores of QOL-LC in both groups were higher th

关 键 词：原发性肝癌 腹腔镜解剖性右半肝切除术 可行性 安全性 

分 类 号：R735.7[医药卫生—肿瘤]