腹腔镜与开腹肝切除术治疗肝细胞肝癌的对照研究

The clinical comparative study of laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma

目的评价腹腔镜肝切除术(LH)的短期和长期疗效,并探讨其根治性和临床应用前景。方法 2005年2月至2008年3月实施LH并且术后病理证实为肝细胞肝癌且随访满3年的患者23名,与相同时期、由同组医师实施开腹手术的患者在病例资料、围术期数据、术后恢复情况、长期复发率、病死率、生存率等方面作对照研究。结果腹腔镜组(LH组)与开腹组(OH组)相比,在切口长度、引流例数及且时间,术后肝功能指标恢复情况、住院时间等方面具有非常显著的优势(P<0.01)。除此之外,LH组患者的饮食恢复更快,术中出血量和输血率更少,术后体温、白细胞、中性粒细胞等指标更早恢复至正常水平。另外,LH组与OH组比较,术后3年肿瘤复发率、病死率和生存率差异无统计学意义。结论 LH与OH比较具有手术创伤小、术后恢复快、住院时间短等优点。而且对于肝细胞肝癌的根治性,腹腔镜手术与开腹手术相比差异无统计学意义,值得在有条件开展此项手术的医院内推广。

Objective To evaluate the short-term and long-term efficacy of laparoscopic and open hepatectomy（LH and OH）for patients with hepatocellular carcinoma（HCC）.And investigate the radical effect and clinical application of the LH.Methods From Feb.2005 to Mar.2008,23 patients underwent the LH and diagnosed as HCC postoperatively in our center.Compare their clinical data, perioperative data,recovery status,tumor recurrence rate,mortality rate and survival rate with the OH group which is operated by the same surgeons with the same amount of patients.Results The LH group had the obvious advantages in shorter incision,less drainage cases with less days,more rapid recovery in liver function and less hospital stay.Moreover,members of the LH group had the earlier food restoration, less operational bleeding,less cases in blood transfusion.And their Tmax,WBC and N%turned down to the normal lever earlier than the OH group.Furthermore,there is no significant difference in the recurrence rate,mortality rate and survival rate among the two groups.Conclusions The laparoscopic hepatectomy for HCC is provided with less trauma,more rapid recovery and less hospital stay.And its radical effect for HCC has no significant difference with the OH group.So,it is recommended to beapplicated in the medical centers which is competent.