腹腔镜与开腹肝切除术治疗肝癌的疗效对比

A comparison between laparoscopic hepatectomy and open hepatectomy for the treatment of hepatocellular carcinoma

目的探讨腹腔镜肝切除术（1aparoscopichepatectomy，LH）与开腹肝切除术（openhepatectomy，OH）治疗肝癌的临床疗效。方法广州医学院第二附属医院2008年1月至2010年12月期间收治原发性肝细胞癌患者45例，将其分为2组，LH组21例，OH组24例。比较2组患者术中、术后的情况与生存率，评价其疗效。结果本组患者术中失血量和输血量LH组显著高于OH组（分别x^2=3．973，x^2=4．862，均P〈0．05），近期并发症发生率LH组（2例）显著低于OH组（9例）（x^2=4．746，P〈0．05）；总住院天数LH组为（17．3±5．0）d，OH组为（21．5±5．1）d，2组比较差异有统计学意义（t=-2．717，P〈0．05）。2组患者随访的总生存率比较差异无统计学意义（x^2=0．172，P〉0．05）。LH组的无瘤生存率为52．4％，显著高于OH组（25．0％，x^2=4．543，P〈0．05）。结论腹腔镜与开腹肝切除均为肝癌治疗的有效方法，腹腔镜术式近期并发症少，住院时间短，但两组总体生存率无差异。

Objective To investigate the efficiency and safety of laparoscopic hepatectomy （LH） and open hepatectomy （OH） in patients with hepatocellular carcinoma （HCC）. Methods A total of 45 HCC cases undergoing hepatectomy from January 2008 to December 2010 in our hospital were divided into LH group （ n = 21 ） and OH group （ n = 24）. Their clinical efficiency and safety were compared and analyzed. Results The amount of intraoperative blood loss and blood transfusion in LH group were significantly higher than that of OH （ respectively x^2 = 3. 973, x^2 = 4. 862, all P 〈 0.05 ）. LH is associated with less postoperative complications and duration of hospital stay, compared with OH （respectively X^2 = 4. 746, t = -2. 717, all P 〈 0. 05 ）. Cumulative survival rates in both groups were not statistically significant （ x^2 = 0. 172 ,P 〉 0. 05 ）. However tumor-free survival rate in LH was significantly higher, superior to that of OH （x^2 = 4. 543 ,P 〈 0. 05）. Conclusions LH and OH are all safe and effective hepatectomy for HCC. LH has the advantage of less complication and shorter hospital stay.