腹腔镜肝切除术治疗老年原发性小肝癌的临床分析

Clinical analysis of laparoscopic hepatectomy in treatment of elderly patients with primary small hepatocellular carcinoma

目的探讨腹腔镜肝切除术治疗老年原发性小肝癌的临床应用价值。方法回顾性分析37例行腹腔镜肝切除术的老年原发性小肝癌患者的临床资料,包括术前、术后实验室检查及手术相关指标、术后并发症发生率、随访复发率及死亡率等。结果 37例患者中35例在不阻断肝血流的情况下完成腹腔镜肝切除术,2例中转开腹手术。手术时间为25～142(48. 51±23. 37) min,术中出血量为20～180(41. 08±25. 28) m L。术后并发切口皮下积液2例、腹水1例,无胆瘘、术后感染、气体栓塞等并发症,围术期死亡率为0。术后住院时间为4～11(6. 51±1. 89) d。术后随访6～45(20. 43±9. 22)个月,2例出现肝内非原位复发,术后1年生存率为100. 00%(37/37),无瘤生存率为97. 30%(36/37)。结论腹腔镜肝切除术治疗有适应证的老年原发性小肝癌是安全可行的,患者恢复快,住院时间短,可作为老年小肝癌患者治疗的标准术式之一。

Objective To investigate clinical value of laparoscopic hepatectomy applied to the treatment in the elderly patients with primary small hepatocellular carcinoma.Methods Clinical data of 37 primary small hepatocellular carcinoma patients undergoing laparoscopic hepatectomy were retrospectively analyzed,including preoperative and postoperative laboratory data,operation-related indicators,incident rate of postoperative complications,recurrence rate and mortality rate during follow-up.Results Among the 37 cases,laparoscopic hepatectomy was performed without blocking the hepatic blood flow in 35 cases,while conversion to open laparotomy in 2 cases.The operation duration was 25-142(48.51±23.37)min,and the intraoperative blood loss was 20-180(41.08±25.28)mL.Postoperative complications of subcutaneous effusion of incision and ascites occurred in 2 cases and 1 case respectively,no other complications such as biliary fistula,postoperative infection and gas embolism occurred,and the perioperative mortality was 0.The postoperative hospital stay was 4-11(6.51±1.89)d.The duration of postoperative follow-up was 6-45(20.43±9.22)months,and intrahepatic recurrence ex situ occurred in 2 patients,the 1-year survival rate was 100.00%(37/37)and the tumor-free survival rate was 97.30%(36/37).Conclusion Laparoscopic hepatectomy is a safe and feasible method for the elderly primary small hepatocellular carcinoma patients with indications,and the patients recover quickly and the hospital stay is short.it can be considered as one of the standard surgical procedures for elderly patients with small hepatocellular carcinoma.