3D腹腔镜与2D腹腔镜下肝癌切除术的短期疗效比较

Short-term outcomes of three-dimensional vs two-dimensional laparoscopic hepatectomy for hepatocellular carcinoma

目的对比肝癌患者行3D腹腔镜或2D腹腔镜下肝切除术的短期疗效差异。方法回顾性收集北京大学首钢医院2018年4月16日至2020年12月31日期间行腹腔镜肝切除术的79例原发性肝细胞癌患者临床资料,其中,男性54例,女性25例;年龄26~81岁,平均(57.6±10.7)岁;行2D腹腔镜肝切除术30例,3D腹腔镜肝切除术49例。观察2组手术时长、术中失血量、术后住院天数、住院费用以及术后并发症发生情况。结果2组患者在性别、年龄、体质量指数、术前肝功能分级、肿瘤大小、肿瘤数目、肝切除范围方面差异无统计学意义(P均>0.05),具有可比性。3D腹腔镜组手术时间[(170.8±59.2)min]、术中出血量[(251.2±175.1)ml]少于2D腹腔镜组[(207.7±98.6)min,(387.3±284.7)ml],差异有统计学意义(P均<0.05)。术后并发症方面,3D腹腔镜组与2D腹腔镜组总并发症发生率相当,差异无统计学意义(24.5%vs 30.0%,P>0.05);在亚组分析中3D腹腔镜组术后胆漏发生率(2.0%)低于2D腹腔镜组(16.7%),差异有统计学意义(P<0.05)。2组患者术后住院天数、住院费用相当,差异无统计学意义(P均>0.05)。结论与2D腹腔镜肝切除术相比,3D腹腔镜可以减少术中出血量,缩短手术时间,减少术后胆漏的发生。

Objective To compare the short-term outcomes between three-dimensional(3D)and twodimensional laparoscopic hepatectomy for hepatocellular carcinoma.Methods The clinical data of 79 patients who underwent laparoscopic hepatectomy at Peking University Shougang Hospital from April 16,2018 to December 31,2020 were analyzed retrospectively.There were 54 males and 25 females,aged from 26 to 81,with an average of(57.6±10.7)years.Among them,30 patients received 2D laparoscopic hepatectomy and 49 received 3D laparoscopic hepatectomy.Indexes of operation time,intraoperative blood loss,postoperative hospital stay,hospitalization expenses,and postoperative complications were observed.Results There were no significant differences in gender,age,body mass index,preoperative liver function grade,tumor size,tumor number,or hepatectomy range between the two groups(P>0.05).The operation time[(170.8±59.2)min]and intraoperative blood loss[(251.2±175.1)ml]of the 3D laparoscopic hepatectomy group were significantly less than those of the 2D laparoscopic hepatectomy group[(207.7±98.6)min,(387.3±284.7)ml;P<0.05].In terms of postoperative complications,the rate of total complications was similar between the 3D laparoscopic hepatectomy group and 2D laparoscopic hepatectomy group(24.5%vs 30.0%,P>0.05).The incidence of postoperative bile leakage in the 3D laparoscopic hepatectomy group(2.0%)was significantly lower than that of the 2D laparoscopic hepatectomy group(16.7%;P<0.05).The postoperative hospitalization days and hospitalization expenses of the two groups were similar(P>0.05).Conclusion Compared with 2D laparoscopic hepatectomy,3D laparoscopic hepatectomy is associated with less blood loss,shorter operation time,and lower incidence of postoperative bile leakage.