腹腔镜肝切除术与开腹肝切除术治疗肝硬化肝细胞癌患者的效果比较

Clinical effect of laparoscopic versus open liver resection in treatment of patients with hepatocellular carcinoma complicated by liver cirrhosis

目的探讨肝硬化肝细胞癌患者行腹腔镜肝切除术与开腹肝切除术的临床疗效比较。方法收集2006年1月-2007年12月于临夏市人民医院确诊为肝硬化肝细胞癌的患者136例,分别行腹腔镜肝切除术(LLR组,64例)和开腹肝切除术(OLR组,72例),分析2组患者的近期疗效、病理因素及远期疗效。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验,生存函数的比较采用log-rank进行检验。结果与OLR组患者相比,LLR组在手术时间[(86.43±23.55)min vs(62.31±19.61)min]、术后住院时间[(7.22±3.45)d vs(12.27±5.31)d]方面差异有统计学意义(t值分别为8.539、2.764,P值分别为<0.001、0.024),而在患者术中出血量、肝门阻断时间、总病死率方面差异均无统计学意义(P值均>0.05)。2组患者的肿瘤数目、有无肝硬化、有无微血管侵犯、有无肝包膜侵犯、切缘范围、最大肿瘤直径等差异亦无统计学意义(P值均>0.05)。远期疗效方面LLR组患者1、3、5年无疾病生存率分别为83.30%、48.61%、38.29%,OLR组分别为78.64%、51.26%、43.01%;LLR组患者1、3、5年总生存率分别为97.42%、95.13%、89.23%,OLR组分别为96.41%、94.28%、90.06%,2组比较差异均无统计学意义(P值均>0.05)。结论腹腔镜肝切除术治疗肝硬化肝细胞癌患者术后恢复快,且与开腹肝切除术相比远期疗效相当,适合在临床推广及应用。

Objective To investigate the clinical effect of laparoscopic liver resection（ LLR） versus open liver resection（ OLR） in the treatment of patients with hepatocellular carcinoma（ HCC） complicated by liver cirrhosis. Methods A total of 136 patients who were diagnosed with HCC complicated by liver cirrhosis in Linxia Municipal People＇s Hospital from January 2006 to December 2007 were enrolled and underwent LLR（ LLR group,64 patients） or OLR（ OLR group,72 patients）. The short-term outcome,pathological factors,and long-term outcome were compared between the two groups. The t-test was used for comparison of continuous data between groups,the chi-square test was used for comparison of categorical data between groups,and the log-rank test was used for comparison of survival functions.Results There were significant differences between the LLR group and the OLR group in time of operation（（ 86. 43 ± 23. 55） min vs（ 62. 31 ± 19. 61） min,t = 8. 539,P〈0. 001） and length of postoperative hospital stay（（ 7. 22 ± 3. 45） d vs（ 12. 27 ± 5. 31） d,t =2. 764,P = 0. 024）,while there were no significant differences in intraoperative blood loss,time of hepatic portal occlusion,and overall fatality rate（ all P〉0. 05）. There were also no significant differences in number of tumors,presence or absence of liver cirrhosis,microvascular invasion,resection margin,and maximum tumor diameter between the two groups（ all P〉0. 05）. As for long-term outcome,the 1-,3-,and 5-year disease-free survival rates were 83. 30%,48. 61%,and 38. 29% in the LLR group and 78. 64%,51. 26%,and43. 01% in the OLR group; the 1-,3-,and 5-year overall survival rates were 97. 42%,95. 13%,and 89. 23% in the LLR group and96. 41%,94. 28%,and 90. 06% in the OLR group. There were no significant differences in these survival rates between the two groups（ all P〉0. 05）. Conclusion In patients with HCC complicated by liver cirrhosis,LLR helps to achieve rapid postoperative recovery and similar long-term outcome compared with OLR; therefore,it holds promise for clinical application.