三种不同肝切除术式治疗原发性肝癌的临床比较

Clinical comparison of three different hepatectomy for primary liver cancer

目的探讨传统开腹手术、2D腹腔镜和3D腹腔镜三种不同肝切除术式治疗原发性肝癌的临床疗效与预后效果。方法回顾性分析了2013年2月至2015年1月收治的确诊为原发性肝癌并行肝切除术的患者共80例患者临床资料,其中传统开腹组30例,2D腹腔镜组25例,3D腹腔镜组25例。采用SPSS 24.0进行统计分析,性别、肿瘤部位等无序二分类资料采用χ2检验,Child-Pugh分级、AFP分级等有序二分类资料采用秩和检验。术中术后等计量资料以均数±标准差表示,采用t检验。术后生存资料分析采用Kaplan-meier法;以P<0.05表示差异有统计学意义。结果 2D腹腔镜组、3D腹腔镜组、肛门排气时间、术后住院时间明显小于开腹组;3D腹腔镜组ALT术后1 d显著低于开腹组和2D腹腔镜组,术后3 d、5 d均低于开腹组(P<0.05);3D腹腔镜组围手术期TBIL 3次测量均低于开腹组(P<0.05);三组患者并发症发生率及术后2年内生存情况比较差异无统计学意义(P>0.05)。结论 3D腹腔镜肝切除术有助于缩短患者肛门排气时间和术后住院时间,加快患者术后肝功能的恢复,具有良好的临床应用价值。

Objective To investigate the clinical efficacy and prognosis of conventional laparotomy , 2D laparoscopic and 3D laparoscopic, in the treatment of primary liver cancer. Methods From February 2013 to January 2015, clinical data of 80 patients with liver cancer who received hepatectomy were analyzed retrospectively.According to the operation mode, they were divided into traditional laparotomy group （30 cases）, 2D laparoscopic group （25 cases）, and 3D laparoscopic group （25 cases）.Statistical analysis was performed by using SPSS 24.0 software, Sex, tumor location and other unordered two categories of data were compared by chi square test , Child-Pugh classification, AFP classification and other ordered two categorical data, the rank sum test was used.Age, tumor size, time, amount of blood, et al were presented as （ -x ±s）, and t test was applied.The postoperative survival data was analyzed by Kaplan -meier.P value of〈0.05 was considered as significant difference . Results Compared with traditional laparotomy group , anal exhaust time, postoperative hospitalization time of 2D laparoscopic group and 3D laparoscopic group was significantly lower.Compared with traditional laparotomy group and 2D laparoscopic group, ALT of patients in 3D laparoscopic group at 1d after operation was not only significantly lower , but also at 3 days and 5 days after operation （P 〈0.05）.The TBIL of three measurements of 3D laparoscopic surgery group were lower than those in traditional laparotomy group （P 〈0.05）.There was no significant difference among three groups in terms of incidence of complications and survival time within two years after operation . Conclusion 3D laparoscopic hepatectomy could shorten anal exhaust time and postoperative hospital stay , and could accelerate the recovery of postoperative liver function , with good clinical value.