腹腔镜肝切除术在复发性肝癌治疗中的应用

The clinical application and evaluation of laparoscopic hepatectomy in the treatment of recurrent hepatocellular carcinoma

目的探讨腹腔镜肝切除术应用于复发性肝癌治疗的安全性及临床效果。方法回顾性分析2015年1月—2017年12月在海南省人民医院肝胆胰外科行腹腔镜肝切除术治疗的17例复发性肝癌患者的临床资料。其中男13例、女4例,年龄37~79(51.3±7.6)岁,复发时间3~39(15.3±6.8)个月,既往均明确诊断肝癌,复发病灶直径1.3~3.5(2.5±0.6)cm,位于原发灶Cantile线对侧12例、同侧3例、双侧2例。观察并详细记录每例患者的手术时间、术中出血、术后引流量、术后拔除引流管时间、术后肛门排气时间、住院时间等手术相关指标,以及术后并发症、肿瘤复发情况。结果17例患者手术均顺利完成,手术时间40~360(130±40)min,术中出血50~800(165±45)mL,术后引流量为35~160(70±20)mL/d,术后拔除引流管时间2~5d,术后肛门排气时间2~4(2.4±0.6)d,住院时间3~14(7.5±1.7)d,术后均未发生大出血、胆漏、气体栓塞等严重并发症。所有病例随访6~24个月,肝内复发4例,其中术后3个月复发l例、术后8个月复发2例、术后14个月复发1例,其余均未见局部复发及腹壁穿刺孔种植性转移等。全组无死亡病例。结论腹腔镜肝切除术创伤小、恢复快、短期随访效果良好,用于复发性肝癌的治疗是可行的;但应谨慎选择,严格把握适应证。

Objective To explore the clinical safety and feasibility of completely laparoscopic hepatectomy for recurrent hepatocellular carcinoma. Methods The clinical data of 17 patients with recurrent hepatocellular carcinoma underwent completely laparoscopic hepatectomy from January 2015 to December 2017 were retrospectively analyzed. There were 13 males and 4 females with an age of 37-79 (51.3±7.6) years. The recurrence time was 3-39 (15.3±6.8) months. Hepatocellular carcinoma was clearly diagnosed in the past. The diameter of recurrent lesions was 1.3-3.5 (2.5±0.6) cm, including 12 patients with recurrent lesions on the opposite side, 3 patients on the same and 2 patients on both sides. Observe and record the following indicators of patients in detail, including the operative time, intraoperative hemorrhage, postoperative drainage volume, postoperative removal of drainage tube, the time of gastrointestinal recovery, total hospitalization time, postoperative complications and tumor recurrence. Results The completely laparoscopic hepatectomy of all patients with recurrent hepatocellular carcinoma were successfully performed. The operating time was 40-360 (130±40) min, the blood loss volume during operation was 50-800 (165±45) mL, and the drainage volume 40-360 (70±20) mL/d. The drainage tubes were removed 2-5 d after operation. The time of gastrointestinal recovery was 2-3 d after surgery, and the overall hospitalization was 3-14 (7.5±1.7) d. No serious postoperative complications occurred such as bile leakage, massive bleeding and air embolism. All cases were followed up for 6 to 24 months. One case in 3 months, two in 8 months and one in 14 months had tumor relapse, the others had no local recurrence and abdominal wall hole planting metastasis. There was no operative mortality. Conclusions Laparoscopic hepatectomy is a safe and feasible operation for recurrent hepatocellular carcinoma. It has the characteristics of small trauma and rapid recovery. This method has good results during short-term follow-up. But the selection of this surgical indications should be more careful and strict.