腹腔镜手术治疗高龄肝细胞癌患者的临床疗效分析

Analysis of clinical efficacy of laparoscopic surgery in elderly patients with hepatocellular carcinoma

目的:比较腹腔镜肝切除术(LLR)与开放肝切除术(OLR)治疗高龄肝细胞癌患者的近期疗效与远期生存率。方法:回顾分析2014年1月至2017年12月手术治疗的52例高龄患者的临床资料,依据手术方式分为两组,OLR组(n=26)行开腹手术,LLR组(n=26)行腹腔镜手术。比较两组手术时间、术中出血量、术后肝功能指标、术后恢复情况及远期生存率。结果:LLR组手术时间长于OLR组,术中出血量、术后引流管留置时间、住院时间、术后并发症发生率优于OLR组,差异有统计学意义。术后第5天,LLR组ALT、TBIL水平低于OLR组,ALB水平高于OLR组,差异有统计学意义。两组术后1年、3年总生存率、无瘤生存率差异无统计学意义。结论:腹腔镜手术治疗高龄肝细胞癌患者疗效可靠,术中出血少,术后并发症发生率低,术后恢复快的同时降低了对肝功能的影响。

Objective:To compare the effects of open liver resection(OLR)and laparoscopic liver resection(LLR)on the short-term efficacy and long-term survival of elderly hepatocellular carcinoma patients.Methods:The clinical data of 52 elderly patients who underwent surgical treatment from Jan.2014 to Dec.2017 were retrospectively analyzed.Patients were divided into two groups according to the surgical methods.26 patients undergoing laparotomy were classified as OLR group,and 26 patients undergoing laparoscopic surgery were classified as LLR group.The operation time,intraoperative blood loss,postoperative liver function indexes,postoperative recovery and long-term survival rate were compared between the two groups.Results:The operation time of the LLR group was longer than that of the OLR group,but the intraoperative blood loss,postoperative drainage tube indwelling time,postoperative hospital stay,and postoperative complication rate were significantly lower than those of the OLR group,the difference was statistically significant.The level of ALT,TBIL in the LLR group was significantly lower than that in the OLR group and the albumin level was higher than that in the OLR group at 5 d after surgery,the difference was statistically significant.There was no significant difference in the 1-year and 3-year overall survival rate and the tumor-free survival rate between the two groups.Conclusions:In elderly patients with hepatocellular carcinoma,the efficacy of laparoscopic surgery is reliable,with less intraoperative bleeding and lower incidence of postoperative complications,shortening the postoperative recovery time and reducing the impact of surgery on liver function.