腹腔镜与开腹肝切除术治疗多发性肝细胞癌的安全性和疗效比较

Safety and efficacy of laparoscopic hepatectomy versus open hepatectomy for patients with multiple hepatocellular carcinomas

目的比较腹腔镜手术与开腹手术治疗多发性肝细胞癌的安全性和疗效。方法回顾性分析2014年3月至2018年12月于复旦大学附属华山医院普外科同一医疗组接受根治性切除的多发性肝细胞癌病人的临床资料,根据手术方式的不同分为腹腔镜组(39例)和开腹组(166例),在1∶1倾向性评分匹配后,比较匹配后两组的围手术期数据及随访疗效。结果腹腔镜组和开腹组各有31例匹配成功,匹配后两组的基线特征保持平衡。腹腔镜组较开腹组[结果数据以M(P25,P75)表示]手术时间(min)短[190(155,215)比210(200,245),P=0.010],术中出血量(mL)少[200(100,500)比400(200,500),P=0.047],术后住院时间(d)短[6.0(6.0,8.0)比8.0(6.0,11.0),P<0.001],术后引流时间(d)短[5.0(5.0,6.0)比7.0(6.0,9.0),P<0.001],且两组间术后并发症发生率差异无统计学意义(19.4%比35.5%,P=0.155)。两组总体生存率(P=0.643)和无病生存率(P=0.814)均差异无统计学意义。结论腹腔镜肝切除术治疗多发性肝细胞癌安全有效,且与开腹手术相比,具有出血量少、住院时间短、术后恢复快等优势。

Objective To compare the safety and long-term efficacy of laparoscopy versus open hepatectomy for patients with multiple hepatocellular carcinoma(HCC).Methods From March 2014 to December 2018,retrospective analysis was performed for patients with multiple HCC undergoing radical resection by the same medical group of general surgery.They were divided into two groups of laparoscopy(n=39)and open surgery(n=166)according to different surgical approaches.Perioperative and oncological outcomes were compared between two groups after 1∶1 propensity score matching(PSM).Results Each group had 31 patients after PSM with well-balanced basic profiles.As compared with open group,laparoscopic group showed shorter operative duration[190(155,215)vs.210(200,245)min,P=0.010]and less intraoperative bleeding[200(100,500)vs.400(200,500)mL,P=0.047].Regarding postoperative recovery,laparoscopic group compared to open group showed shorter postoperative hospital stay[6.0(6.0,8.0)vs.8.0(6.0,11.0)days,P<0.001]and postoperative extraction time[5.0(5.0,6.0)vs.7.0(6.0,9.0)days,(P<0.001)].Also no significant inter-group difference existed in the incidence of postoperative complications(19.4%vs.35.5%,P=0.155).As for long-term follow-ups,no significant inter-group difference existed in overall survival(P=0.643)or disease-free survival(P=0.814).Conclusion Laparoscopic hepatectomy is both safe and feasible for multiple HCC with minimal intraoperative blood loss and faster postoperative recovery.