腹腔镜肝切除术在肥胖肝癌患者中的应用价值

Value of laparoscopic hepatectomy in obese patients with hepatocellular carcinoma

目的:探讨肥胖对腹腔镜肝切除术的影响。方法:采用回顾性病例对照研究方法,收集2015年1月至2017年8月收治的75例体重指数≥25 kg/m^2的肝细胞癌患者的临床资料。其中38例行腹腔镜肝切除术(腹腔镜组),37例行开腹肝切除术(开腹组)。对比两组手术相关临床指标、术后并发症发生率;对术后并发症进行多因素分析,了解术后并发症的相关危险因素。结果:与开腹组相比,腹腔镜组手术时间更短[(191.9±68.4)min vs.(224.6±70.7)min,P=0.045],术中出血量更少[(260.1±154.5)ml vs.(338.1±160.8)ml,P=0.036],住院时间更短[(10.2±3.3)d vs.(14.0±4.5)d,P=0.000]。两组术后并发症发生率差异无统计学意义(20.1%vs.24.3%,P=0.735)。开腹组体重指数与手术时间(P=0.000)、术中出血量(P=0.027)呈正相关。腹腔镜组体重指数与手术时间(P=0.835)、术中出血量(P=0.791)无关。腹腔镜组经多因素分析提示,ICGR 15(OR=13.965,95%CI:1.098~177.533,P=0.042)、肝硬度值(OR=15.564,95%CI:1.076~225.203,P=0.044)是影响术后并发症的独立危险因素,而开腹组中肝硬度值(OR=30.843,95%CI:2.118~449.210,P=0.012)、BMI(OR=18.308,95%CI:1.222~274.216,P=0.035)是影响术后并发症的独立危险因素。结论:肥胖对开腹肝癌切除术具有较大影响,此类患者选择腹腔镜肝切除术更具优势。

Objective：To investigate the impact of obesity on laparoscopic hepatectomy. Methods：The retrospective case-control study was adopted. Clinical data were collected from 75 patients underwent hepatectomy for hepatocellular carcinoma（ HCC） from Jan. 2015 to Aug. 2017 with body mass index（ BMI） ≥25 kg/m^2. Among 75 patients,38 underwent laparoscopic liver resection（ LR）and 37 underwent open liver resection（ OR）,respectively. The clinical parameters and the incidence of postoperative complications were compared between the two groups. Multivariate analyses were performed on the risk factors for the postoperative complications. Results：Compared with the OR group,the LR group had shorter operation time [（ 191. 9 ± 68. 4） min vs.（ 224. 6 ± 70. 7） min,P =0. 045],less intraoperative bleeding [（260. 1 ± 154. 5） ml vs.（338. 1 ± 160. 8） ml,P = 0. 036] and shorter hospital stay [（10. 2 ±3. 3） d vs.（14. 0 ± 4. 5） d,P = 0. 000]. The incidence of postoperative complications was 20. 1% and 24. 3% respectively（ P =0. 735）. The BMI was positively correlated with operative time（ P = 0. 000） and intraoperative bleeding（ P = 0. 027） in OR group with statistical significance,but not in LR group. In LR group,multivariate analysis indicated that ICGR15（ OR = 13. 965,95% CI：1. 098-177. 533,P = 0. 042） and liver stiffness（ OR = 15. 564,95% CI：1. 076-225. 203,P = 0. 044） were the independent risk factors for the postoperative complications. In OR group,multivariate analysis indicated that liver stiffness（ OR = 30. 843,95% CI：2. 118-449. 210,P= 0. 012） and BMI（ OR = 18. 308,95% CI：1. 222-274. 216,P = 0. 035） were the independent risk factors for the postoperative complications. Conclusions：Obesity has a relatively larger effect on open hepatectomy for hepatic cancer,it is more advantageous for patients like this to choose laparoscopic hepatectomy.