肝细胞癌腹腔镜大范围肝切除术后并发症分析

Postoperative Complications of Laparoscopic Major Hepatectomy in the Treatment of Heptocellular Carcino-ma:A Propensity Score Matched Analysis

目的研究腹腔镜大范围肝切除术治疗肝细胞癌的术后并发症。方法回顾性分析2012年6月至2018年7月中山大学孙逸仙纪念医院行大范围肝切除术的306例肝细胞肝癌患者的相关资料,按入腹路径差异,分入腹腔镜大范围肝切除术组(laparoscopic major hepatectomy,LMH;n=79)与开腹大范围肝切除术组(open major hepatectomy,OMH;n=227),行配比度1∶1的倾向性评分匹配,各组可纳入患者68例,进一步分析两组术后并发症的差异。结果倾向性评分匹配后,LMH组和OMH组在围手术期死亡率、术后总并发症率、术后肝功能衰竭发生率、术后胆漏发生率、术后腹腔出血发生率、术后腹部切口感染率、术后胸腔积液发生率、腹水发生率、并发症Clavien-Dindo分级等方面无统计学差异(P>0.05)。结论由腹腔镜肝切除技术成熟的肝胆外科医师实施腹腔镜大范围肝切除术并未导致肝细胞癌患者手术后并发症发生率的增加。

Objective To evaluate the postoperative complications of laparoscopic major hepatectomy(LMH)in the treatment of resectable hepatocellular carcinoma(HCC).Methods It was retrospectively reviewed of the medical records in 306 patients who underwent pure laparoscopic major hepatectomy(LMH)(n=79)or open major hepatectomy(OMH)(n=227)between June 2012 and July 2018 in Sun Yat-sen Memorial Hospital.Propensity score matching(1∶1)was performed between the two groups and 68 patients were included in each group.The postoperative complication rates were compared between the two groups.Results There were no significant differences between the LMH group and OMH group regarding the mortality rates,the overall postoperative complication rates,and the incidence of posthepatectomy liver failure,postoperative biliary leak,postoperative bleeding,wound infection,pleural effusion,ascites and the Clavien-Dindo classification of complication(P>0.05).Conclusions It seems to be a safe approach for HCC of laparoscopic major hepatectomy performed by experienced hepatobiliary surgeons.Laparoscopic procedures would not raise the postoperative complication rate for major hepatectomy.