腹腔镜肝切除与开腹肝切除治疗肝细胞癌的临床对比研究

Comparison of clinical efficacy between laparoscopic hepatectomy and open hepatectomy for hepatocellular carcinoma

目的比较腹腔镜肝切除与开腹肝切除治疗肝细胞癌(肝癌)的安全性与疗效。方法回顾性分析2013年1月至2018年1月在梅州市人民医院行肝切除的67例肝癌患者临床资料。患者签署知情同意书,符合医学伦理学规定。根据不同手术方式分为腹腔镜组和开腹组。其中腹腔镜组31例,男29例,女2例;平均年龄(58±3)岁;开腹组36例,男32例,女4例;年龄(57±3)岁。两组手术时间、胃肠道功能恢复时间等临床指标比较采用t检验,率的比较采用χ~2检验。结果腹腔镜组胃肠道功能恢复时间、引流管留置时间、术后住院时间分别为(3.0±0.2)、(2.9±0.3)、(9.4±1.2) d,明显短于开腹组的(4.7±0.3)、(4.1±0.5)、(15.4±1.4)d(t=-26.820,-11.670,-18.610;P<0.05)。两组均无围手术期死亡,腹腔镜组术后并发症发生率为3%(1/31),与开腹组的22%(8/36)比较差异无统计学意义(χ~2=3.670,P>0.05)。腹腔镜组1年总体生存率和无瘤生存率分别为90%(28/31)、80%(25/31),与开腹组的86%(31/36)、72%(26/36)比较差异无统计学意义(χ~2=0.023,1.150;P>0.05)。结论与开腹肝切除比较,腹腔镜肝切除治疗肝癌具有安全、微创、术后恢复较快的优势,可达到相似的疗效。

Objective To compare the safety and clinical efficacy between laparoscopic hepatectomy and open hepatectomy in the treatment of hepatocellular carcinoma(HCC).Methods Clinical data of 67 patients with HCC who underwent hepatectomy in Meizhou People's Hospital from January 2013 to January 2018 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.The patients were divided into the laparoscopic hepatectomy and open hepatectomy groups according to different surgery.In laparoscopic hepatectomy group(n=31),29 patients were male and 2 were female,aged(58±3)years on average.In open hepatectomy group(n=36),32 cases were male and 4 were female,aged(57±3)years on average.The operation time and resumption time of gastrointestinal function between 2 groups were compared by t test.The rate was compared by Chi-square test.Results In laparoscopic hepatectomy group,the resumption time of gastrointestinal function,retention time of drainage tube and postoperative length of hospital stay were(3.0±0.2),(2.9±0.3)and(9.4±1.2)d,significantly shorter than(4.7±0.3),(4.1±0.5)and(15.4±1.4)d in open hepatectomy group(t=-26.820,-11.670,-18.610;P<0.05).No perioperative death occurred in either group.The incidence of postoperative complications in laparoscopic hepatectomy group was 3%(1/31)and 22%(8/36)in open hepatectomy group,where no significant difference was observed(χ2=3.670,P >0.05).The 1-year overall survival rate and tumor-free survival rate in laparoscopic hepatectomy group were respectively 90%(28/31)and 80%(25/31),which did not significantly differ from 86%(31/36)and 72%(26/36)in open hepatectomy group(χ2=0.023,1.150;P >0.05).Conclusions Compared with the open hepatectomy,laparoscopic hepatectomy has the advantage of safe,minimal invasion and faster postoperative recovery,and achieve a similar clinical efficacy.