多措施联合的腹腔镜肝切除术治疗肝癌合并肝硬化并门静脉高压症的临床应用研究

Clinical application of multiple measures combined with laparoscopic liver resection for patients with hepatocellular carcinoma complicated with cirrhosis and portal hypertension

目的探讨多措施联合的腹腔镜肝切除术(LLR)治疗肝癌合并肝硬化并门静脉高压症的临床效果。方法回顾性分析2015年1月至2017年7月经LLR治疗43例肝癌合并肝硬化并门静脉高压症患者资料,其中联合组(n=23)给予多措施联合的LLR,常规组(n=20)给予常规LLR。患者随访情况统计到2019年7月。选用SPSS 22.00统计软件进行数据分析。围术期指标用(±s)表示,采用独立t检验;并发症发生情况采用χ^2或Fisher检验。P<0.05差异有统计学意义。结果联合组手术时间、术中出血量、输血量、胃肠减压时间和住院时间显著低于常规组(P<0.05),43例患者中,术后1周内共发生9例并发症,无肝功能衰竭情况发生,联合组术后并发症发生率20.9%(3/23)低于常规组30%(6/20),但两组比较差异无统计学意义(P>0.05)。联合组截止至观察终点复发转移率为46.5%(11/23)小于常规组61.2%(12/20),两组患者截止至观察终点无病生存率比较差异无统计学意义(χ^2=0.637,P=0.425)。结论多措施联合的LLR治疗肝癌合并肝硬化并门静脉高压症安全可行,术中出血少、手术时间短、并发症少、术后复发率较低。

Objective To explore the clinical effect of multiple measures combined with laparoscopic liver resection for patients with hepatocellular carcinoma complicated with cirrhosis and portal hypertension.Methods The clinical data of 43 patients with liver cancer complicated with cirrhosis and portal hypertension,who received laparoscopic hepatectomy from January 2015 to July 2017,were retrospectively analyzed.Patients in the combined group(n=23)was given multiple measures combined laparoscopic hepatectomy,while patients in the conventional group(n=20)was given conventional laparoscopic hepatectomy.The postoperative follow-up of the patients ended up on July 2019.Statistical analysis were performed by using SPSS 22.0 software.Measurement data,such as Perioperative indicators were expressed as,and were examined by using independent t test.postoperative complications were analyzed by usingχ^2 test A P value<0.05 was considered as statistically significant difference.Results The operation time,intraoperative blood loss,transfusion volume,gastrointestinal decompression time and hospital stay in the combined group were significantly lower than those in the conventional group respectively(P<0.05);Among 43 patients,9 complications occurred within one week after surgery,and no liver failure occurred.The postoperative complication rate was 20.9%(3/23)in the multi-treatment group,which was lower than 30%(6/20)in the conventional group,with no significant difference(P>0.05).The recurrence and metastasis rate of the multi-method combination group was 46.5%(11/23), which was lower than 61.2%(12/20)in the conventional group.There was no significant difference in the disease-free survival rate between two groups until the observation end point(χ^2=0.637,P=0.425).Conclusion Multi-measurement combined with laparoscopic liver resection for the treatment of liver cancer with cirrhosis and portal hypertension is safe and feasible,with less intraoperative bleeding,shorter operation time,less complications,and lower postoperative recurrence rate.