腹腔镜肝切除术治疗困难部位肝细胞癌的疗效

Efficacy of laparoscopic liver resection for patients with hepatocellular carcinoma at complicated region

目的探讨腹腔镜肝切除术(LLR)治疗困难部位肝细胞癌(肝癌)的疗效。方法回顾性分析2015年2月至2017年2月在四川大学华西医院接受诊治的89例困难部位肝癌患者临床资料。根据手术方式不同将患者分为LLR组和开腹肝切除术组(OLR组)。其中LLR组36例,男27例,女9例;平均年龄(54±13)岁。OLR组53例,男44例,女9例;年龄(52±11)岁。患者均签署知情同意书,符合医学伦理学规定。两组围手术期情况和术后生活质量评分比较采用t检验或Kruskal-Wallis秩和检验,生存分析采用Kaplan-Meier法和Log-rank检验。结果 LLR组的手术时间为(268±89)min,明显长于OLR组的(210±74)min(t=3.365,P<0.05)。LLR组的术后住院时间为(6.2±1.2)d,明显短于OLR组的(7.2±2.3)d(t=-2.347,P<0.05)。LLR的手术费用为(1.91±0.93)万元,明显高于OLR组的(0.61±0.17)万元(t=10.425,P<0.05)。LLR组日常活动评分、肝癌附加症状评分和生活质量总评分分别为(25±4)、(64±7)和(151±20)分,明显高于OLR组的(23±3)、(60±7)和(144±9)分(t=2.278,2.375,2.720;P<0.05)。OLR组总体生存率、无瘤生存率分别为93.0%、78.0%,LLR组相应为97.0%、79.0%,差异无统计学意义(χ~2=0.276,0.029;P>0.05)。结论与OLR相比,LLR治疗困难部位的肝癌能明显缩短住院时间、提高术后生活质量,且安全、可行。

Objeetive To explore the efficacy of laparoscopic liver resection （LLR） in the treatment of patients with hepatocellular carcinoma （HCC） at complicated region. Methods Clinical data of 89 patients with HCC at complicated region treated in West China Hospital of Sichuan University between February 2015 and February 2017 were analyzed retrospectively. These patients were divided into LLR group and open liver resection group （OLR group） according to different operative procedures. There were 36 patients in LLR group, including 27 males and 9 females, with an average age of （54±13） years old. There were 53 patients in OLR group, including 44 males and 9 females, with an average age of （52±11） years old. The informed consents of all patients were obtained and the local ethical committee approval was received. Perioperative conditions and postoperative quality of life score in both groups were compared using t test or Kruskal-Wallis rank sum test, and survival analysis was conducted using Kaplan-Meier test and Log-rank test. Results The length of operation was （268~89） min in LLR group, significantly longer than （210±74） min in OLR group （t=3.365, P〈0.05）. The postoperative length of hospital stay was （6.2±1.2） d in LLR group, significantly shorter than （7.2±2.3） d in OLR group （t=-2.347, P〈0.05）. The operation expenses was （19.1±9.3） thousand RMB in LLR group, which was significantly higher than （6.1±1.7） thousand RMB in OLR group （t=10.425, P〈0.05）. The score of daily activity, accessory symptoms of HCC and score of quality of life were （25±4）, （64±7） and （151±20） points in LLR group, significantly higher than （23±3）, （60±7） and （144±9） points in OLR group, respectively （t=2.278, 2.375, 2.720; P〈0.05）. The overall survival, disease-free survival were respectively 93.0%, 78.0% in OLR group, and respectively 97.0%, 79.0% in LLR group, where no significant difference was observed 0（2=0.276, 0.029; P〉0.05）. Conclusions Compared with OLR, LLR can obviously shorten the length of hospital stay and improve the postoperative quality of life for patients with hepatocellular carcinoma （HCC） at complicated region. It is safe and feasible.