腹腔镜肝切除与开腹肝切除治疗原发性肝细胞癌临床研究

Clinical analysis of the efficacy of different surgical treatment of primary hepatocellular carcinoma

目的对比分析腹腔镜肝切除术(Laparoscopic hepatectomy,LH)与开腹肝切除术(Open liver resection,OH)在原发性肝细胞癌(Hepatocellular carcimoma,HCC)治疗中的临床疗效。方法回顾性分析我院于2010年1月~2012年6月收治的随访36个月以上的63例HCC患者,根据治疗方式的不同,将经LH治疗者设为LH组(30例),经OH治疗者设为OH组(33例),记录患者手术切口的长度、手术时间、术中出血量、肝功能(ALT、AST、Alb)、住院期间术后并发症、术后输血率、术后首次排气时间、腹腔引流时间、术后绝对卧床时间、住院时间。所有患者自开始治疗之日计起,开展随访,记录复发及死亡情况,随访率100%,截止日期2015年6月30日。结果 63例患者住院期间无死亡且术后病理切缘均阴性;LH组手术时间为(193.5±63.7)min,这与OH组的(197.6±75.6)min相当(P>0.05);LH组的手术切口长度、术中出血量、术后首次排气时间、术后输血率、腹腔引流时间、术后绝对卧床时间、住院时间均优于OH组,且差异显著(P值均<0.05);两组患者术前Alb、ALT、AST水平相当,无统计学差异(P>0.05);LH组术后第1、3、7天ALT、AST水平显著优于OH组(P<0.05),且其Alb、ALT、AST的恢复速度显著优于OH组(P<0.05);LH组发生胆瘘和肝周积液各1例,OH组发生胆瘘2例、腹腔感染1例,对症处理后均得到控制;随访36个月后发现,LH组中8例死亡、3例远处转移、11例肝内复发;OH组中9例死亡、4例远处转移、12例肝内复发;两组患者第1、2、3年复发率和生存率的无显著差异(P>0.05)。结论 LH与OH在HCC的治疗中疗效相当,但LH具有切口小、出血少、安全性高、恢复快、绝对卧床时间和住院时间短等优势,可考虑在HCC的治疗中推广。

Objective A comparative analysis of laparoscopic hepatectomy （ Laparoscopic hepateetomy, LH） and open hepa- tectomy （Open liver resection, OH） clinical efficacy in HCC （Hepatocellular careimoma, HCC） therapy. Methods A retrospective analysis of our hospital in 2010 1 Month-June 2012 follow-up of 36 months were treated more than 63 patients with HCC, depending on the treatment modality, will be set LH group （30 cases） by the LH treatment, After treatment to OH OH group （33 cases）, were re- corded incision length, operative time, blood loss, liver function （ALT, AST, Alb） , postoperative complications during the hospital stay, postoperative transfusion rates, after first exhaust time, peritoneal drainage, postoperative absolute bed time, hospitalization time. All patients from the date of the plan from the start of treatment, to carry out follow-up, recurrence and death records, follow-up rate of 100% , the deadline June 30, 2015. Results 63 patients during hospitalization and no deaths pathologic margins were nega- tive ; LH operative time was （ 193.5 ＋ 63.7 ） min, which is OH group （ 197.6 ＋ 75.6） rain fairly （ P 〉 0. 05 ） ; LH group incision length, blood loss, postoperative first exhaust time, postoperative transfusion rates, peritoneal drainage, postoperative absolute bed time, hospitalization time are better than OH group, and the difference was significant （P 〈 0. 05 ） ; Preoperative Alb, ALT, AST lev- el is very, no significant difference （P 〉 0. 05） ; LH group postoperative day 1,3,7 ALT, AST were significantly better than the OH group （P 〈0. 05）, and its Alb, ALT, AST recovery rate was significantly better than OH group （P 〈0. 05） ; LH group had biliary fis- tula and one case each perihepatic effusion, OH group biliary fistula occurred in 2 cases, 1 case of abdominal infection, symptomatic treatment After all under control; follow-up of 36 months after the discovery, LH group, 8 patients died, three cases of distant metasta- ses, 11 eases of intrahepatie recurrence; OH group died nine cases, four cases of distant metastasis, 12 cases of intrahepatic recur- rence ; 1, no significant difference （ P 〉 0.05 ） groups were 2, 3-year recurrence rate and survival. Conclusion： LH and OH in HCC treatment efficacy equivalent, but LH with a small incision, less bleeding, safe, quick recovery, absolute bed time and shorter hospital stay and other advantages, could be considered to promote the HCC treatment.