腹腔镜肝切除术对原发性大肝癌的近期疗效

Short term effect of laparoscopic hepatectomy on primary large hepatocellular carcinoma

目的:探讨腹腔镜肝切除(LH)对原发性大肝癌的近期疗效及其对血清甲胎蛋白(AFP)、癌坯抗原(CEA)和糖类抗原199(CA199)的影响。方法:回顾性分析84例自愿接受肝切除术治疗的原发性大肝癌患者资料,根据手术方式分为LH组(n=43)和开腹组(n=41),分析两组手术近期疗效(手术时间、术中出血量、输血率、R0切缘、首次下床活动时间、引流管留置时间、住院时间和总并发症率)及术前、术后30 d血清AFP、CEA、CA199水平变化。结果:两组手术时间、术中出血量、输血率、R0切缘和切缘比较,差异无统计学意义(P>0.05);LH组术后首次下床活动时间、引流管留置时间、住院时间和总并发症率均短于或低于开腹组,差异有统计学意义(P<0.05);两组术后30 d血清AFP、CEA、CA199水平均较术前明显下降(P<0.05),组间比较差异无统计学意义(P>0.05)。结论:LH治疗原发性大肝癌的近期疗效显著,术后恢复快且并发症少。

Objective:To investigate the short-term efficacy of laparoscopic hepatectomy(LH)in the treatment of primary hepatocellular carcinoma(HCC),and its influence on tumor serum markers alpha fetoprotein(AFP),carcino embryonic antigen(CEA)and carbohydrate antigen 199(CA199).Methods:The data of 84 patients with primary liver cancer and who voluntarily accepted hepatectomy were retrospectively analyzed.They were divided into LH group(n=43)and open hepatectomy group(n=41)according to the operation methods.The short-term effects(operation time,intraoperative blood loss,blood transfusion rate,R0 margin,first ambulation time,drainage tube indwelling time,hospitalization time and total complication rate)and the changes of serum AFP,CEA and CA199 levels before and 30 days after operation were analyzed.Results:There was no significant difference in operation time,intraoperative blood loss,blood transfusion rate,R0 margin and incision margin between the two groups(P>0.05).The first ambulation time,drainage tube indwelling time,hospitalization time and total complication rate in LH group were shorter or lower than those in open group(P<0.05).The levels of serum AFP,CEA and CA199 at 30 days after operation were significantly lower than those before operation(P<0.05),but there was no significant difference between the two groups(P>0.05).Conclusion:The short-term curative effect of LH in the treatment of primary liver cancer is significant,the postoperative recovery is fast and the complications are few.