腹腔镜超声下左半肝切除术治疗原发性肝癌的近期预后及对肝功能的影响

Short-term prognosis of left hemihepatectomy under laparoscopic ultrasound in treatment of primary liver cancer and its influence on liver function

背景与目的:腹腔镜超声(LUS)下肝切除术的临床应用时间尚短,其在原发性肝癌(PLC)中的应用效果研究仍较少。因此,本研究探讨LUS下左半肝切除术治疗PLC的近期预后及对肝功能的影响。方法:回顾性分析2017年1月─2020年1月期间收治的64例原发性肝癌患者的临床资料,其中30例行LUS下左半肝切除术(LUS组),34例行常规腹腔镜下左半肝切除(常规组)。比较两组围手术期情况及并发症发生情况,以及术前及术后3 d、1个月检测血清白蛋白(ALB)、天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)、总胆红素(TBIL)、甲胎蛋白(AFP)、凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶原时间(PT),以及随访情况。结果:两组患者术前基本资料与肝功能指标均无统计学差异(均P>0.05)。LUS组的术中平均出血量明显低于常规组(322.64 m L vs. 395.94 m L,P<0.05),两组手术时间、病灶切缘距离、术后引流管置管时间、肛门排气时间、住院时间差异均无统计学意义(均P>0.05)。LUS组无肝中静脉损伤,常规组肝中静脉损伤5例(14.71%),差异有统计学意义(P<0.05)。LUS组与常规组并发症发生率差异无统计学意义(13.33%vs. 23.53%,P>0.05),两组术后3 d、1个月的APTT、FIB和PT以及ALB和AFP水平差异均无统计学意义(均P>0.05);术后3 d,LUS组的ALT、AST、TBIL均低于常规组(均P<0.05),但术后1个月时差异均无统计学意义(均P>0.05)。术后中位随访时间13.5 (918)个月,LUS组与常规组的复发率、病死率差异均无统计学意义(10.00%vs. 17.65%,P=0.483;3.33%vs. 5.88%,P=0.999)。结论:LUS下左半肝切除术治疗PLC安全有效,近期预后与常规腹腔镜手术相当;较常规组可减少术中出血并更好地保护早期肝功能。

Background and Aims: It is still a short period since the laparoscopic ultrasound(LUS) liver resection was employed in clinical practice, and the reports on the efficacy of its application in primary liver cancer(PLC) is also limited. Therefore, this study was conducted to investigate the short-term prognosis of LUS left hemihepatectomy for PLC and its influence on liver function.Methods: The clinical data of 64 patients with PLC treated from January 2017 to January 2020 were retrospectively analyzed. Of the patients, 30 cases underwent left hemihepatectomy(LUS group) and34 cases underwent conventional laparoscopic left hemihepatectomy(conventional group). The perioperative conditions and complications, and the serum albumin(ALB), aspartate aminotransferase(AST), alanine aminotransferase(ALT), total bilirubin(TBIL), α-fetoprotein(AFP), thromboplastin time(APTT), fibrinogen(FIB), prothrombin time(PT) before surgery and 3 d and 1 month after surgery as well as the follow-up data were compared between the two groups of patients.Results: There were no statistical differences in preoperative data and liver function parameters between the two groups of patients(all P>0.05). The average intraoperative blood loss of the LUS group was significantly lower than that of conventional group(322.64 m L vs. 395.94 m L, P<0.05). There were no statistical differences in terms of the operative time, distance from the cutting edge to the lesion, time for postoperative drainage tube retention, time to anal gas passage, and length of hospital stay between the two groups(all P>0.05). Middle hepatic vein injury occurred in none of the patients in LUS group, and occurred in 5 patients(14.71%) in conventional group, the difference was statistically significant(P<0.05). The incidence rates showed no statistical difference between LUS group and conventional group(13.33% vs. 23.53%, P>0.05). There were no statistical differences in APTT, FIB and PT as well as the ALB and AFP levels between the two groups on 3 d and 1 month after the surgery(all P>0.05);the ALT, AST and TBIL levels of LUS group were significantly lower than those of conventional group on3 d after surgery(all P<0.05), which showed no significant differences on 1 month after surgery(all P>0.05). The median follow-up time was 13.5(9-18) months. the recurrence and the mortality rates showed no statistical differences between LUS group and conventional group(10.00% vs.17.65%, P=0.483;3.33% vs. 5.88%, P=0.999).Conclusion: The LUS left hemihepatectomy is safe and effective for the treatment of PLC, its shortterm prognosis is similar to that of conventonal laparoscopic left hemihepatectomy. However, LUS is more effective for reducing intraoperative bleeding and protecting liver function in the early stage.