腹腔镜肝切除术与开放式肝切除术治疗肝细胞癌的近期疗效对比  

Laparoscopic hepatectomy and open hepatectomy in treatment of hepatocellular carcinoma

作　　者：王永泽 李孝敏 WANG Yongze;LI Xiaomin(Department of General Surgery,Shanxi Bethune Hospital,Shanxi Academy of Medical Sciences,Tongji Shanxi Hospital,Third Hospital of Shanxi Medical University,Taiyuan,Shanxi 030032,China)

机构地区：[1]山西白求恩医院、山西医学科学院、同济山西医院、山西医科大学第三医院普通外科,山西太原030032

出　　处：《中国临床研究》2024年第6期876-879,共4页Chinese Journal of Clinical Research

基　　金：山西省卫生健康委科研课题(2021149);山西省基础研究计划(202103021224361);山西省“136”兴医工程。

摘　　要：目的探究肝细胞癌患者采用腹腔镜下肝切除术或传统开放式肝切除术两种不同术式治疗时,其围术期情况及对肝功能的影响。方法回顾性分析2020年1月到2022年12月就诊于山西白求恩医院胆胰外科的肝细胞癌患者85例,根据其手术方式分为开腹组(开放式肝切除术,n=53)和腹腔镜组(腹腔镜肝切除术,n=32)。两组患者均于出院后随访1个月。对比两组患者的一般资料、术中情况及术后并发症情况及肝功能指标。结果腹腔镜组与开腹组相比,住院时间[(14.19±3.02)d vs(16.36±3.30)d,t=3.03,P<0.01]以及手术后肛门首次排气时间[(2.30±0.77)d vs(2.75±0.49)d,t=3.29,P<0.01]更短,手术中出血量更少[(395.63±70.25)mL vs(440.38±62.42)mL,t=3.05,P<0.01],差异具有统计学意义。腹腔镜组术后3 d血清总胆红素、丙氨酸氨基转移酶、门冬氨酸氨基转移酶水平低于开腹组,差异有统计学意义(P<0.05)。术后1个月内,两组手术后并发症的总发生率差异无统计学意义(15.63%vs 16.98%,χ^(2)=0.92,P=0.34)。结论对于肝细胞癌患者,应用腹腔镜肝切除术是安全可行的,而且可以减轻对肝功能的影响,缩短住院时间,促进患者早期康复。Objective To explore the perioperative situation of patients with hepatocellular carcinoma(HCC)treated with laparoscopic hepatectomy or open hepatectomy and their effects on liver function.Methods A retrospective analysis was conducted on 85 patients with HCC who visited the Department of Biliary and Pancreatic Surgery,Shanxi Bethune Hospital from January 2020 to December 2022.According to the surgical methods,the patients were divided into open group(open hepatectomy,n=53)and laparoscopic group(laparoscopic hepatectomy,n=32).Both groups of patients were followed up for one month after discharge.The general information,intraoperative conditions,postoperative complications,and liver function indicators were compared between two groups of patients.Results Compared with the open group,the laparoscopic group had shorter hospitalization time[(14.19±3.02)d vs(16.36±3.30)d,t=3.03,P<0.01],as well as shorter time for the first postoperative anal evacuation[(2.30±0.77)d vs(2.75±0.49)d,t=3.29,P<0.01]and less intraoperative bleeding[(395.63±70.25)mL vs(440.38±62.42)mL,t=3.05,P<0.01].Serum total bilirubin,alanine aminotransferase,aspartate aminotransferase levels were lower in the laparoscopic group than those in the open group at 3 days postoperatively,and the difference was statistically significant(P<0.05).In the 1-month postoperative period,the difference in the overall rate of postoperative complications between the two groups was not statistically significant(15.63%vs 16.98%,χ^(2)=0.92,P=0.34).Conclusion For patients with HCC,the application of laparoscopic hepatectomy is safe and feasible,which can reduce the impact on liver function,shorten hospitalization time,and promote early recovery.

关 键 词：肝细胞癌 肝切除术 腹腔镜下 开放式 肝功能 甲胎蛋白 

分 类 号：R735.7[医药卫生—肿瘤] R61[医药卫生—临床医学]