腹腔镜与开腹再次肝切除治疗复发性肠癌肝转移患者的术后短期预后比较

Short term postoperative prognosis of patients with colorectal cancer liver metastasis after laparoscopic versus open repeat liver resection

目的:探讨腹腔镜与开腹再次肝切除治疗复发性肠癌肝转移患者的术后短期预后情况。方法:选择2011年1月至2019年12月接受肝脏再切除的289例复发性肠癌肝转移患者,其中40例接受腹腔镜手术,249例接受开腹手术。将腹腔镜及开腹组按1∶2进行倾向匹配评分,比较2组的围手术期情况。结果:倾向匹配后,腹腔镜组及开腹组分别有40、80例患者纳入研究。2组均无围手术期死亡发生,输血率、肝门阻断时间、30 d内非计划再入院率差异均无统计学意义。与开腹组相比,腹腔镜组术中出血量更少(50 mL vs 200 mL,P=0.001),各级术后并发症发生率更低(25.0%vs 47.5%,P=0.030),术后住院时间更短(6 d vs 7 d,P=0.009)。结论:复发性肠癌肝转移接受腹腔镜再次肝切除较接受开腹手术患者的围手术期预后更好。

Objective:To compare the safety and efficacy of repeat laparoscopic liver resection(LLR)and open liver resection(OLR)for patients with colorectal cancer liver metastasis(CRLM).Methods:A total of 289 patients with CRLM undergoing curative resection from January 2011 to December 2019 were enrolled and divided into LLR group(n=40)and OLR group(n=249).Propensity score matching(PSM)was performed as 1∶2 in the LLR and OLR groups.The perioperative outcomes were compared between the two groups.Results:There was no perioperative death in the two groups.There was no statistically significant difference in blood transfusion rate,porta hepatis block time,and unplanned readmission rate within 30 days after surgery.After PSM,40 patients in the LLR group and 80 patients in the OLR group were included.Compared with the patients in the OLR group,the intraoperative bleeding was less(50 mL vs 200 mL,P=0.001),the postoperative complication rate was lower(25.0%vs 47.5%,P=0.030),and the postoperative hospital stay was shorter(6 d vs 7 d;P=0.009)in the LLR group.Conclusions:CRLM patients who receive repeat LLR have better perioperative outcomes than those who receive repeat OLR.