腹腔镜肝切除治疗开腹手术切除后复发性肝细胞癌

Laparoscopic hepatectomy for recurrent hepatocellular carcinoma after previous open hepatectomy

目的 评估腹腔镜肝切除治疗开腹手术切除后复发性肝细胞癌的安全性和有效性.方法 回顾性分析2003年1月至201 1年1月14例接受腹腔镜再次肝切除的复发性肝细胞癌患者的临床资料.其中男性9例,女性5例;年龄32 ～ 70岁,平均年龄54岁.在施行腹腔镜再次肝切除前,14例患者均因原发性肝细胞癌接受过至少一次开腹肝切除术.结果 14例腹腔镜再次肝切除手术均顺利完成,其中大块肝切除6例（切除肿瘤最大径≥3 cm）,小块肝切除8例（切除肿瘤最大径＜3 cm）,无严重围手术期并发症.平均手术时间（124±82） min,平均术中出血量（112±43） ml,平均术后住院时间（7±4）d.随访14～42个月,平均随访时间23个月,截至末次随访,11例患者存活（无瘤生存8例,带瘤生存3例）.1例患者术后21个月死于肝功能不全,2例患者分别于术后17、31个月死于肿瘤复发.结论 腹腔镜肝切除治疗开腹肝细胞癌切除术后复发性肝细胞癌是可行、安全和有效的,但病例选择标准应从严把握.

Objective To evaluate the feasibility,safety and long-term outcomes of laparoscopic repeat hepatectomy for recurrent hepatocellular carcinoma （HCC） following previous resection.Methods Between January 2003 and January 2011,14 patients with recurrent HCC were carefully selected to undergo repeat laparoscopic hepatectomy,among which 9 patients were male,5 patients were female,and the average age was 54 years.Prior to re-resection,all patients had undergone at least one open hepatectomy for HCC.The perioperative and long-term outcomes of these patients were retrospectively analyzed.Results Repeat laparoscopic hepatectomy for these 14 patients were successfully performed without major perioperative complications.The mean operative time,introperative blood loss and hospital stay were （124 ± 82） minutes,（112 ±43） ml and （7 ±4） days,respectively.The mean follow-up period was 23 months （range 14 to 42 months）.At the time of follow-up,11 patients were still alive,among which 3 patients developed recurrent disease and 8 patients remained disease free.One patient died of liver dysfunction at 21 months,and another 2 patients died of tumor recurrence at 17,31 months,respectively.Conclusion Laparoscopic surgery for recurrent HCC remains a viable option for repeat hepatectomy in selected patients who have undergone open hepatectomy.