基于倾向评分匹配的腹腔镜与开腹肝中叶切除术治疗中央型肝癌的疗效比较

Laparoscopic versus open mesohepatectomy for centrally located hepatocellular carcinoma: a propensity score matching study

目的:基于倾向评分匹配(propensity score matching,PSM)比较腹腔镜与开腹肝中叶切除术治疗中央型肝癌的临床疗效。方法:回顾性分析2011年1月至2017年12月行手术治疗的中央型肝癌患者130例,其中腹腔镜组60例,开腹组70例,分别接受腹腔镜或开腹解剖性肝中叶(Ⅳ、Ⅴ、Ⅷ段)切除术。对两组患者进行PSM后,比较两组患者近期及远期疗效。结果:经PSM后每组各41例患者。腹腔镜组患者术中出血量少于开腹组患者,术后住院时间短于开腹组患者,且差异均有统计学意义(P<0.05);两组患者手术时间、术中输血率及并发症发生率差异均无统计学意义(P>0.05);两组患者3、5年总生存率及无瘤生存率差异均无统计学意义(P>0.05)。结论:与开腹肝中叶切除术相比,腹腔镜肝中叶切除术治疗中央型肝癌术中出血更少,术后恢复更快,且远期疗效相当,是一种安全、可行的手术方式。

Objective: To compare open and laparoscopic mesohepatectomy for centrally located hepatocellular carcinoma by propensity score matching(PSM).Methods: The clinical data of 130 patients with centrally located hepatocellular carcinoma treated by surgery from January 2011 to December 2017 were collected. There were 60 patients and 70 patients in the laparoscopic group and the open group all treated by anatomical mesohepatectomy( Ⅳ, Ⅴ, Ⅷ segment) and the short-term and long-term outcomes were collected.Results: There was no significant difference in baseline data between the two groups after matching by propensity score(P>0.05). Laparoscopy was associated with lower blood loss and shorter postoperative hospital stay(P<0.05). The operation time, blood transfusion rate and complications rate were similar in open and laparoscopic groups(P>0.05). The 3 and 5-year overall survival rates and disease-free survival rates were similar in open and laparoscopic groups(P>0.05).Conclusion: Laparoscopic anatomic hepatectomy for centrally located hepatocellular carcinoma can be carried out safely with favorable short-term and long-term outcomes.